New job responsibilities

So you remember that time way back in June when I wrote about how I was asked to be trained as relief charge nurse? I ultimately told management no, because I didn't feel I was ready and I didn't want to deal with all the stuff that comes along with management type positions.

Fast forward to December, when situations again conspired to instigate the need for a relief charge nurse. The manager comes to me again to request I do relief, and in a moment of weakness I agree to it. I had a week of orientation - which really just equals three shifts - with a full-time charge nurse and then they gave me two weeks of "supervised charge," meaning I was alone in charge but one of the full-times took a patient group in the same station as me.

I'm currently in week three of supervised charge. What happened to just two weeks, you ask? I knew that I don't know much yet, but I discovered just how inadequate 2.5 years of nursing experience really is when I'm the one being asked all the questions. Boss Man subsequently gave me another two weeks.

It's been quite eye opening, to say the least. One of the unit secretaries, who has been working at the hospital almost 30 years and knows everything about everyone there, said to me last night while it was hellishly busy, "you're finding out just who doesn't know their stuff and who doesn't care to know it when you're in charge, aren't you?" And it's true. We're working with a huge amount of new grads who don't know much yet* and also with some nurses who are straight up lazy**.

I kind of imagined how much the charges had to deal with, but I never did understand the full scope of it - people calling in looking for advice, doctors calling in pissed about the number of patients getting referred to them after another doc shuts down his practice, needing to know the protocol for a rare procedure which only gets implemented four or five times a year, nurses calling to ask drug questions, deciding which ambulances go to which rooms, juggling the influx of ambulances while still bringing people back from the four hour backup in the waiting room, deciding which chest pains are legit and which chest pain complaints are bullshit and directly related to that four hour backup, personally handling patient complaints, sucking up to some complaining patients and telling other complaining patients to piss off in nice words, denying cab voucher requests, granting cab voucher requests, needling the staff to keep moving quickly to make patient throughput speed up, stepping in when staff isn't moving quickly enough, babysitting new staff during procedures they aren't familiar with, getting an obscure piece of equipment when the doc needs it, making sure xray is called to come do a portable on that newly intubated patient, knowing the story of a patient so you can tell the surgeon what's going on even when you've never laid eyes on that patient, being able to answer questions from bed coordinator when you've got no idea what the answer really is, needing to be at your desk constantly to review the tracking board and assign ambulances, needing to be walking around constantly to make sure staff is doing everything, being the contact point between the ER doc and the primary nurse in a room, being the last resort when a nurse can't get a pediatric IV, addressing a nurse doing a generally shitty job of patient care at the request of a doc, performing daily quality control tests on various devices, general upkeep of the department, tracking down a lost cardiac monitor, delegating tasks, cleaning beds when environmental is nowhere to be found, answering the phone when the secretary is somewhere else...and a thousand other things I haven't yet realized are my responsibility.

I'm overwhelmed, to say the least. I haven't once left work on time. I've cried more than once. I feel inadequate on a regular basis. Yet somehow the department hasn't imploded. A couple of docs have congratulated me on doing a swell job. No one seems too upset that I've agreed to do this. No one has laughed at me...much. I guess I'm doing alright, then. I've got one week left of scheduled charge, and then after this it's just on an as needed basis. We'll see how things go.

Sorry to talk your ears off, and sorry for the light posting recently.

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* I feel a little guilty calling some of the new grads out when I myself was a new grad starting straight into the ER. I, however, had the benefit of being one of two new nurses amongst a sea of experienced nurses and I never felt alone. Now, there are so many newbies and so few experienced nurses (as evidenced by them asking me to do charge) that we've had nights where the new outnumber the old by a horrifically high ratio - whole stations are staffed by nurses with less than four months of experience. A scary scenario indeed.

**A side effect of being charge is docs coming to me and telling me things I never would have heard otherwise. We had a real sick patient the other night who was unfortunately being cared for by the laziest of nurses. The usually level-headed doc was infuriated with the substandard care and pulled me into the dictation room where he went off. I've never heard this side of him - "she's a fucking lazy, shitty nurse and I can't believe she's taking care of this patient. Do you see it? She's a fucking awful nurse, and this patient might die because of her. You need to make sure she doesn't kill him." Um, thanks for your high opinion of me? Am I really ready to see this side of you, and actually act on it?