It started out as any normal 16 hour night shift (only nurses think working 16 hours straight from 3pm to 7am is normal). Walked in and found out I was in charge for the whole shift. No biggie. Should make the night go by faster.
Got report from the morning charge nurse, who also happened to be the day shift manager, who did not have a patient assignment herself. Must be busy if management is staffing.
AM charge nurse: “We have a full house with two open beds (48 patients, capacity of 50). Baby A just came back from the OR with a fresh tracheostomy. Baby B is scheduled for a PDA ligation (ie; patent ductus arteriosus closure, ie; heart surgery) on the unit at 4pm. The L&D board is full. You need to take report on Nurse X’s patient because she is out on a transport. You also have Baby C, who is stable, weaning on the ventilator.”
So I am left in charge, with a full house, with heart surgery being performed on the unit, with a fresh post-op, and with two vented patients to take care of myself. To top it all off, the most experienced nurse on the staff besides me (who had a whopping 5 years under her belt at this time) was out on transport.
Warning bells were going off in my head. What should I do? This situation does not seem safe. I suppose I should institute the “Chain of Command” but the chain link above me is dumping all this on me. If management thinks this situation is OK, then it must be. I do not want to seem like a whiny nurse. So, I muddle through.
4pm: Heart surgery in progress. Pediatric cardiac surgeon yelling like a howler monkey at new grad who was assigned his patient. Run over, talk monkey- man down, good boy.
5pm: Console crying new grad who was verbally assaulted by monkey- man. Convince her half-heartedly, that things will get better with more experience and confidence.
6-8pm: Assess and feed my two ventilated neonates. Where the hell is the transport nurse?
9pm: Transport nurse arrives with a rule out congenital heart defect patient. Infant is ventilated with oxygen saturations in the 60′s. Assist Awesome Neonatologist with placing central lines, starting prostaglandin, dopamine and dobutamine drips. Page monkey- man to swing back into nursery. We now have one open bed.
10pm: Deer-Caught-in-the-Headlights Nurse yells for my help. Her fresh trach patient is cyanotic and bradycardic. Physically restrain Deer-Caught-in-the-Headlights Nurse from pulling out fresh trach tube. Suction a mucous plug the size of a liver out of baby. Baby stable. Give Deer-Caught-in-the-Headlights Nurse a brief inservice on fresh trach care. Didn’t she get this on orientation?
11-1am: Continue to care for my two patients. They look messy. Dirty linen, stained t-shirt, disheveled. Yet, they are fed, medicated and safe.
1am-3am: 24 weeker has a pulmonary hemorrhage. Code infant for one hour. Push blood, epi, saline. Infant survives. Will have a head ultrasound in morning to assess for brain damage.
4am-7am: The shit hits the fan. L&D calls to prep for 27 week twins, walk-ins from the emergency room. Physically shuffle infants around to make room for two more babies. Arranging deck chairs on the Titanic. Run to the OR to help catch the twins. Admit twins to NICU. Assist with intubation, lines, blood work, medications. Get called urgently to bedside of infant who is being reintubated by Jaded Neonatal Nurse Practioner (NNP). Deer-Caught-in-the-Headlights Nurse is frozen, unable to assist Jaded NNP during middle of procedure. Assist with intubation. Awesome Neonatologist is calling me back to the twins bedside to assist with Surfactant administration.
The dark waves are getting higher and higher. I am sinking…………
7am: Calvary arrives. Nurse manager assesses the unit that looks like a war zone, without acknowledgment. Goes over to my patient who is crying and squirming in her isolette, and says with irritation: “Come over here and put a pacifier in this baby’s mouth, I’m not scrubbed in.
………..Fade to black
RR
