Wednesday, October 17, 2012

Maybe I should have been a plumber.....

I'm all for chipping in, going above and beyond for the team, and working hard, but this was a little too much.  I arrived to work before 7 and eyed the patient board. We already had a full load of patients. Not a very good start to the day. My hospital recently decided, in all of its wisdom, that a normal load of nurses is not needed between the hours of 0700 and 1100. So, they have cut us back to a charge, triage and 2 other nurses to handle the entire department. Brilliant!

As I was getting my report from the night nurse, it didn't seem too bad. I had a new patient in one room - stable and pretty simple with regard to chief complaint. My trauma room had a post moderate sedation who should be discharged within an hour, maybe hour and a half. As I was getting the report, I heard the fire dispatcher on the radio send an ambulance to an unresponsive person. I start checking on my patients and doing the normal morning equipment checks.

10 minutes later, an ambulance comes in and fills my other room. After triaging this person, my charge comes to me and states that she will be using the other unassigned room for a code (the unresponsive person call).
Now, since we don't have enough nurses to cover the ER and run a code and watch my post sedation - we're in a pickle and have to get the trauma coordinator to leave her office and help.

Code comes in and its pretty much a done deal. As I was working that code, the triage nurse fills up all of my other rooms with not so stable patients. Next I discover that my charge has now assigned me the code. Although the patient is pretty much stable (dead), I still have to deal with paperwork, family, notifications, etc. Now I have 5 patients with all immediate needs. I wish I could have been there for the family members, but I couldn't. I had to delegate that to the pastor and administrators arrived to help. The post sedation patient was flippin' mad about not being able to go home yet, but the more she yelled - she had an airway and was coherent enough to understand her situation - she's stable. The other patient, threw some pillows at her and told her to elevate her limb and chucked the cast cutter in his room. Eyeballed the other patient and she looked like her bleeding was controlled a bit - not going to die in the next hour. Then I went to my new patient and started working on her - she could go down hill quicker than the other ones.

I'm whining, I know, but it's all a bit much when you can't actually do the job as well as you would like to do. In nursing school, they fill your head with all kinds of crap about therapeutic communication and nursing theories when in reality, you will never get to implement them because of all you have to do. You're set up to fail.

No one died, thank God (well, except the code, but that person was already dead). It's just there are many more days now that it just.....well, sucks.


  1. Sorry to hear this. Ironic, but a friend (a BSN) and I were just discussing yesterday that nursing was the second unhappiest job in America. The even greater irony, is that she would like to get into ER nursing (she is in medical office setting now). She thinks that would keep her challenged and also give her the opportunity to do travel nursing once her husband retires. It seems a perfect way to see the USA. Live in a travel trailer and move to a different city every 6 months.

    I'm thinking you might not be the person to point her towards to sing the praises of her plan.

    I hope your next shift is an improvement. (((hugs)))

  2. Actually, it would keep her challenged and she would be able to travel. She's got a good plan. I really think that it's widespread, not just in the EDs. There are a few areas where the stress is lower, but I haven't worked in them.
    The stress lies in wanting and trying to do your best in your job and can't because of the overwhelming obstacles in your way. It won't change, so you have to adjust your perception of reality. A nurse once told me - Did anyone die during your shift? If not, then you did your job. - Sadly, at times, it comes down to that one premise.

  3. Comment about stress is right on. That is why it is the second unhappiest job. Not because of the work, but because the nurse can't do the work as she learned it because of too many pts, and too many CYA protocols and paper work.

    If a nurse (well, the good nurses anyway) was allowed to do their job and to give the level of pt. care they wanted to, it could be in the "happiest jobs list." Hmmmm... well, I guess maybe it wouldn't be if you were in an ER with a lot of ungrateful "frequent flyers" on medical cards. But that's another issue.... better not bring that up; unless it's over a beer or two. :)

  4. Knowing all of this, I will never enter into the healthcare arena...especially head would explode from all of the stress of not being able to help everyone properly, it'd be messy, and then I'd just be another patient that you wouldn't be able to get to properly...not worth the trouble...thanks for the heads up!