Nursing Career Choices - My Journey from the OR to Downey VA

It's so easy to get locked into one particular nursing specialty and latch unto for life. The problem is further exacerbated by seeking more education in that particular area which further encapsulates a career within one particular bubble. Stepping outside your current nursing  comfort zone and engaging in something completely different can bring a new perspective to a divergent specialty arena. Maybe if psych nurses ventured into the OR they could ratchet down some of the everpresent angst and emotional hub bub. Maybe if OR nurses tried psych, they could implement some useful interventions. Who knows? I figured it was worth a try.

I had a life long interest in OR nursing or  in the vernacular of you whippersnapperns "perioperative" nursing. I still like the old fashioned scrub nurse terminology, but then again, I'm an OldfoolRN. Psych nursing always seemed so very different. The long term custodial care of chronic schizophrenics seemed to be the exact opposite of slapping instruments into a surgeon's hand for an immediate solution to a health problem.


I thought that this  expertise, if you could call it that, could be applied to another nursing specialty like psych. Youngsters do indeed generate some foolish ideas when they are out to cure the world and I was no exception. I like dramatic quick fixes and doing something to really cure the underlying problem. Proven interventions that get sick people back on their feet and back into the business of life. Psych was to be my new alternate universe and I would somehow help those institutionalized souls with novel and pioneering interventions. I was probably as delusional as some of the patients!

Downey VA Hospital, just north of Chicago was to be my new stomping ground. I was hired and told to carefully review the employee orientation manual. They actually wanted me to start working on the very same day as my interview. Desperation does not make for clear, level headed thinking so I declined and agreed to report the next morning.

The nursing supervisor escorted to my new assignment, Building 66 ( AB  ward) in a VA facility that was indeed  providing long term custodial care to chronic schizophrenics with a smattering of manic depressives thrown in for variety. She opened the massive door which resembled a bank vault with heavy robust hinges   to "A" ward and as we stepped in, a pool ball thrown with the velocity of a Nolan Ryan fast ball whistled just over my head. In the far corner a patient was doubled over in pain after beintng "bayoneted" in the abdomen with the end of a pool cue. The blue pool chalk was mixing with a small amount of bright red blood. I remember thinking to myself..how patriotic his plain white t-shirt looked with a red and blue stain.

"Is this the therapeutic milieu  mentioned in the orientation manual?" I foolishly asked my orienting supervisor. "Not exactly," was her reply as she quickly wrestled the pool cue from the agitated patient who was brandishing it like a he was preparing for another vicious  strike to the body. The supervisor complained bitterly that she had ordered the pool equipment locked up and set about for an attendant to shoulder the blame.

After resolving that issue, she suggested that I remain on the ward to observe. There were 40 patients in the cavernous, exiguously furnished dayroom, most of them pacing to and fro muttering unintelligible ramblings. Everyone smoked and a thick blue cloud enveloped the entire scene. A huge ceiling mounted unit that whined and whistled like a 747 on a take-off roll was sucking up some of the cough inducing smoke. I asked one of the attendants about the strange device and was told that it was a "smoke eater." At least they are trying, I thought to myself.

There was no danger of anyone leaving this facility. The windows had heavy wrought iron bars that rivaled the entrance door in terms of shear mass. The place reminded me of a maximum security prison or a Fort Knox for people.

I concluded that I needed to do something physical to establish mutual trust and get the ball rolling with these guys. Attendants and other ward personnel were chatting with some of the patients, but from what I observed, this did nothing constructive. These guys had been talked to for years and it did not seem to do much for them

I noticed that they were all wearing scuffed, dirty, leather dress shoes that they had obtained from the hospital canteen. The ubiquitous athletic shoe of today's world had yet to be invented. In a supply closet there was a shoe shine set-up complete with a fancy gizmo to prop feet up at the optimal level for a seated operator to shine the footwear.

I had an epiphany. This is how I could engage some of the patients and develop some sort of therapeutic relationship with their tortured souls. I think it was called making therapeutic inroads or some other term firmly rooted in the rubric of psychobabble nonsense. Anyhow., I decided to give it a go and  when I returned the next day  I reported to the ward with some newly purchased tins of shoe polish and a couple of worn out scrub suits that I had collected from my previous nursing life. I knew from experience they were perfect for buffing shoes to a deep shine

"Shoe shine..Get your shoes buffed up to a nice shine," I shouted out toward the pandemonium emanating from the dayroom. Whenever a patient approached the door, I greeted him with a friendly smile and cheerfully offered my shoe shine services. Even some of the more withdrawn patients began accepting my services and this was a great way to learn their names. One of the attendants cautioned me to limit my shoe shine services to when the supervisor was off ward, but I did not worry about that too much. After all, I was doing a heck of a lot more than they were to help the patients.

It touched me deeply when after about a week of my shoe shines, a motley collection of disheveled patients approached me and asked to polish my shoes. I was really getting somewhere with these guys.

For my next Downey VA post, another OldfoolRN innovation: Teaching violent patients to request restraints to avert injury. Supervisors thought I was a nut, but the proof was in the pudding- It worked