Sinking
Posted by realityrounds on May 2, 2009
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
Edward Gordon, RN said
Reality, that sounds insane. Not you personally, of course, but that doesn’t sound like a tenable situation. You’re charge nurse in a NICU and have three patients? And you work 16 hours? That’s just crazy. I realize a shift like that can, in the long run, give you maximum points in heaven, but jeez louise.
realityrounds said
The transport nurse ended up coming back and taking her patient, so I ended up with just one. But I was bouncing around between patients. Looks like I am still trying to wrap my head around it.
Eileen said
I work in healthcare, but am very far from the trenches. Stories like these make me thankful of provincial office work!
realityrounds said
Every job has it’s moments. This story was during a huge nursing shortage, times are better now. If you ever watch the show “The Office” it looks like there are times they are “sinking” too. But I would put up with it if Steve Carrell was my boss
Edward Gordon, RN said
One can be happy for not having the stress of caring for patients, but then they have to struggle with the fact that what they are doing is not all too important. And the less important our work, the less meaningful is our life becomes. One can sell shoes, one can be a nurse. Both make money, but only one is worth spending a life on.
I could be wrong, but I dont’ think so.
Takingheart said
I will never complain about the staff shortage et unsafe working conditions in my podunk county hospital again… lol.
um… wow.
You are a rock star.
I enjoy your blog!
realityrounds said
I’m the farthest thing from a rock star imaginable. Thanks for reading!
Grand Rounds 5:33 | Nursing Handover said
[...] Reality Rounds has a vivid “day in the life” tale for us straight from the NICU incubators. 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. [...]
midwest woman said
How you kept it together is beyond me. You’re my hero. Will think of you on my next crazy day.
realityrounds said
I actually did not keep it together. I sunk. If the day shift had not shown up when they did, I would have packed up my marbles and went home
midwest woman said
Pediatrics was the one rotation that scared the bejezus out of me. Between the frail sick little babies and just the general sadness I felt seeing young lives so disrupted by illness, I knew it wasn’t for me.
Hats off to the NICU nurses…you’re a special breed.
Barbara Olson said
Can I tweet a link to this as part of nurses’ week conversations, to show what front line nurses face? Great example of norms, especially the chain of command aspect.
realityrounds said
Of course you can! I would be honored. I am thrilled that I am “tweet worthy”!
ChickyMama said
A friend of mine sent me the link to your blog, and I love your perspective on Nursing! I’m currently in nursing school and I will graduate in 5 1/2 weeks (not a moment too soon!). Love reading Reality Rounds!
realityrounds said
Chick Mama (great name), thanks for reading! Good luck on your nursing career. I would love it if you would keep us posted on how everything is going. I often forget how it feels to be a new grad.
Erica said
Have you thought about getting in touch with the new show “Nurse Jackie” on Showtime to write an episode for them?
realityrounds said
Erica,
Thanks for your comment. I have actually never seen the “Nurse Jackie” show. Not sure if my stories would fit.
100 Blog Posts You Should Read Before Going to Nursing School | My Strong Medicine said
[...] *UPDATE* It seems I missed another fellow blogger who made the list. Please be sure to also read Reality Rounds contribution under the sub-section of Nursing Challenges titled : Sinking. [...]