My Monday night shift was one of the most emotionally wrecking shifts I've had, ever. Not all bad, but definitely draining. I've been thinking that I wanted to utilize the employee assistance program counseling at our hospital for a while now just with all the stress and anxiety from COVID, but after that shift...yeah, I'm gonna need it.
***
A coworker of mine called me in to help sit her patient up in bed, and she had warned me earlier that this patient wasn't doing well at all. The patient was a million years old, and had refused all care because she "just wants to go home." At first, my coworker thought that she wanted to go back to her residence, but the patient then said "don't do anything, I'm going to take my last breath here and I know where I'm going." My coworker was a little freaked out, so she called me in to help. Just before walking into the room, she told me that she was afraid when we sat that patient up that she would pass.
I helped my coworker sit this ancient patient up, she took a few deep breaths, and then over the next ten minutes we held her hands as she died. It was peaceful. It was devastating. It hurt me, to know that she would have died all alone if we weren't sitting there. I was thankful that I was the person my coworker asked to come in with her, but it was hard. We both cried, a lot. You could see the patient just...let go. She was there, and then she wasn't.
After that, we took a few minutes to gather ourselves and then immediately went into the next room to take care of a patient slowly, excruciatingly, trying to fight end stage liver failure and a wound infection. Their family wants everything done so they can get better and come home. They aren't going to make it though this.
***
I spent part of the shift in triage as well, getting yelled at by everyone in the city who doesn't want to wear a mask, or gets pissed when they can't have four friends come back to their room with them, or went out to a big house party two weeks ago and now feels short of breath with an SpO2 of 84% but flat out denies that they had any exposure to COVID.
I also had to help keep an eye on the waiting room for the family members of a traumatically deceased patient, which is a moment I absolutely dread.
***
The last half of my shift was up in our trauma bays, where we took care of a very critical patient for hours. The trauma surgeon, normally excellent and one of my favorites, got sloppy and left a sharp on the tray. When I was moving the tray off the patient, I felt a poke in my finger and realized that he had left a needle unaccounted for even after saying he had gotten them all. I scrubbed and scrubbed and scrubbed my hands with soap and water and betadine, but we all saw the blood it drew. Everyone in the room witnessed it, including the surgeon who instantly and profusely apologized.
I had to go through the whole process of paperwork, lab draws, house supervisor, everything. It sucks. I go in to employee health on Friday to hear his lab results and find out if I have to start taking any medications, but this waiting period is the absolute worst. Does he have HIV? Hepatitis? Do I? It fucking sucks. This is the first time I've ever had an exposure to anything. I feel a little bit numb, but mostly I'm angry.
I know the surgeon didn't maliciously leave that sharp on the tray, but this is the second time in a month that I have personally berated him for leaving sharps on the a tray - he left an open scalpel in a tray a few weeks back that nearly nicked me when I moved the trash aside. He apologized then, but after Monday I'm wondering if I'll be able to trust him anymore when working a trauma. We rely on each other to stay safe - there's so many opportunities to get hurt in a busy trauma. I do my part to keep my coworkers healthy, but who is looking out for me?
***
The other day I found out that a physician I used to work with at Home Hospital lost both her sister and her father to COVID. They were also physicians, which is just heartbreaking.
***
I'm just exhausted. COVID has really stretched us thin, and after this night and everything else going on in this world, I'm realizing I need to take advantage of the free counseling at work. No shame in doing that. I'll keep you guys updated on how it goes. Thanks for listening.
Wednesday, May 27, 2020
Wednesday, May 20, 2020
Idiocy, part 2
Halfway through my charge orientation, you guys. It's going...well? Horribly? Who can even tell, these days.
It's a very weird sensation to be at the bottom of the knowledge pile again. With every new role I've taken on over the past 11 years, it's been the same feelings of crushing inadequacy and slight panic that I'm doing a terrible job but have fooled everyone into not realizing it. I guess those same years have given me enough foresight to realize that those feelings will pass, though. I've managed to adapt and learn and grow enough that I became proficient at the things I've tried, from triage to travel nursing to trauma care to precepting. I've even been through this charge thing before.
I got suckered into doing charge as a way-too-new nurse years ago. I was very fortunate to work at a great facility that supported me and taught me everything I needed to know, but I was definitely not feeling ready to charge at that point. Somehow, though, I got through it and managed not to accidentally burn the ER down.
Fast forward 8 years and I'm learning that my old relief charge job was almost...easier? While I wasn't as strong clinically, I think that ER had a much better flow and there was far less paperwork than my current one. It's only been a week of orientation here but it seems like I spend most of my time documenting all the things that happen - a sticker in the book of traumas, paging the stat system for every elevated lactic acid, remember to put a sticker in the stroke book AND page the stat system AND call the neurologist. STEMIs get paged to the stat line but you don't call the cardiologist on-call, you have to call the interventional doc. Everything goes into an email at the end of the shift, including all the information you just put into the log books. Keep track of your bed board, too! You're the one who has to make sure there are admit orders before requesting the bed. It's also global pandemic time so make sure the bed requested is for the right COVID floor. Sometimes there are airborne negative pressure rooms on other floors, but it's anyones guess as to which rooms those are. Better figure it out before you request the bed! All COVID-suspected patients go into a log as well, and you've got to keep a running tally of how many are admitted vs discharged. Sometimes people have to get tested twice! Especially psych patients, which means they get stuck in our ER for hours, maybe days. We've got exactly six rooms with glass windows/doors, and four of those are our negative pressure rooms. If you have a psych patient who gets swabbed, they're now on airborne isolation and have to go to one of those rooms. Where do you put the truly sick COVID patients when all rooms are taken up by psychs?
It's a massive juggling act, made so much more complicated by COVID. So far I feel like I've been doing nothing but paperwork, and really haven't been able to round the department to check on people, support them, re-distribute resources and make sure people have what they need to do well. Hopefully after learning the processes I will be able to get better at being an actual good charge nurse, not just a warm body sitting in the chair and getting yelled at by everyone while I'm busy putting stickers in books. Hopefully.
It's a very weird sensation to be at the bottom of the knowledge pile again. With every new role I've taken on over the past 11 years, it's been the same feelings of crushing inadequacy and slight panic that I'm doing a terrible job but have fooled everyone into not realizing it. I guess those same years have given me enough foresight to realize that those feelings will pass, though. I've managed to adapt and learn and grow enough that I became proficient at the things I've tried, from triage to travel nursing to trauma care to precepting. I've even been through this charge thing before.
I got suckered into doing charge as a way-too-new nurse years ago. I was very fortunate to work at a great facility that supported me and taught me everything I needed to know, but I was definitely not feeling ready to charge at that point. Somehow, though, I got through it and managed not to accidentally burn the ER down.
Fast forward 8 years and I'm learning that my old relief charge job was almost...easier? While I wasn't as strong clinically, I think that ER had a much better flow and there was far less paperwork than my current one. It's only been a week of orientation here but it seems like I spend most of my time documenting all the things that happen - a sticker in the book of traumas, paging the stat system for every elevated lactic acid, remember to put a sticker in the stroke book AND page the stat system AND call the neurologist. STEMIs get paged to the stat line but you don't call the cardiologist on-call, you have to call the interventional doc. Everything goes into an email at the end of the shift, including all the information you just put into the log books. Keep track of your bed board, too! You're the one who has to make sure there are admit orders before requesting the bed. It's also global pandemic time so make sure the bed requested is for the right COVID floor. Sometimes there are airborne negative pressure rooms on other floors, but it's anyones guess as to which rooms those are. Better figure it out before you request the bed! All COVID-suspected patients go into a log as well, and you've got to keep a running tally of how many are admitted vs discharged. Sometimes people have to get tested twice! Especially psych patients, which means they get stuck in our ER for hours, maybe days. We've got exactly six rooms with glass windows/doors, and four of those are our negative pressure rooms. If you have a psych patient who gets swabbed, they're now on airborne isolation and have to go to one of those rooms. Where do you put the truly sick COVID patients when all rooms are taken up by psychs?
It's a massive juggling act, made so much more complicated by COVID. So far I feel like I've been doing nothing but paperwork, and really haven't been able to round the department to check on people, support them, re-distribute resources and make sure people have what they need to do well. Hopefully after learning the processes I will be able to get better at being an actual good charge nurse, not just a warm body sitting in the chair and getting yelled at by everyone while I'm busy putting stickers in books. Hopefully.
Saturday, May 16, 2020
Charge
BOY HOWDY was my first charge orientation...interesting.
It seems that I am in fact a shit magnet, so much so that the shift supervisor wandered by and after finding out that it was my first day kindly asked me to leave and not do this again.
I felt a little overwhelmed with the amount of mundane details I have to learn, and I think the hardest part is going to be navigating the ever-changing COVID processes. Overall though I think this will be okay - everyone that has found out I'm going to be charging has been very supportive, which is a very nice feeling. It definitely makes me feel like I've been a positive part of the department, which is what I hope for. I'll never go so far as to drink the Kool-Aid and be like "this hospital is the be all, end all and you should be thankful you get the privilege to work here," but I do want to be a person who isn't a drag to work with and who actively strives to make the workplace better.
My most important goal is to become someone who doesn't charge to get out of work, but in fact does it to make everyone else's work better. I want to be the person who takes whatever frustrations I have with being a staff nurse and works to resolve them, as opposed to viewing charge as a way out from dealing with those daily issues.
I also won't be doing charge full time. It will only be 1-2 shifts every two weeks, as they want to split the available shifts equally amongst the charge nurses. Their intention is to keep the charges from being solely a charge nurse. They want to have the charges also have regular staff shifts, which I think is a good idea. That way everyone has to deal with the regular COVID rooms, or take a group of four patients, or generally get shit on with a crappy assignment, just like the staff nurses do. If you regularly work a shift in the trenches, you can't get all high and mighty doing charge - you then split assignments and send help and cover your nurses as if you were the one taking that group, because on your next shift you probably will be.
Anyway, I'm optimistic that I won't be dog shit at this, and I'm excited to try something new. I hope I can be a good and positive charge nurse, and will strive for that by acting as if I am assigning myself those patients. Hopefully this goes well, and I'll keep y'all updated!
Tuesday, May 12, 2020
Idiocy
You guys, I'm an idiot.
COVID has wrecked our comfy little ER way of life, in addition to being the Great World Fuckery of my lifetime. My job is stressful at baseline, and dealing with this pandemic has brought on so many changes. Hospitals are losing money hand over fist, so budgets are being cut wherever possible. The first thing to go at our ER was any overtime shift. As in, you can't work it. We operate at a below-par staffing level anyway, and cutting out all the overtime shifts has meant twice the work with half the staff. Oh, you're gowned up in a COVID room and need something? Better hope your coworkers aren't also taking care of a COVID patient because there is no one extra available to help. Two priority 1 traumas coming in? No extra nurses coming to the rescue, because ain't no one there. You're intubating your respiratory distress patient in the isolation corner? Sucks to be you, because our isolation rooms are staffed by ONE person.
There's a wave of new graduate nurses, which while new grads are great I'm not a fan of having twelve of them at once. I mean that literally. There are four orienting now, four more that just finished two weeks ago, and four more starting in another two months. Plus another eight that have less than a year on the job. Training in the time of COVID has been an especially big beating. Try teaching hospital policy to a new grad when the policy will change by the time you've finished explaining it.
It's been one of the hardest, most stressful times of my life.
So what did I do? I said, "how can I make my life more stressful right now?" and replied to the department-wide email asking for charge nurse applications.
Y'all. I applied for one of the two open charge nurse positions available. They picked me (and another coworker who I think will be absolutely fantastic as charge and I want to be like her when I grow up).
I'm an idiot.
COVID has wrecked our comfy little ER way of life, in addition to being the Great World Fuckery of my lifetime. My job is stressful at baseline, and dealing with this pandemic has brought on so many changes. Hospitals are losing money hand over fist, so budgets are being cut wherever possible. The first thing to go at our ER was any overtime shift. As in, you can't work it. We operate at a below-par staffing level anyway, and cutting out all the overtime shifts has meant twice the work with half the staff. Oh, you're gowned up in a COVID room and need something? Better hope your coworkers aren't also taking care of a COVID patient because there is no one extra available to help. Two priority 1 traumas coming in? No extra nurses coming to the rescue, because ain't no one there. You're intubating your respiratory distress patient in the isolation corner? Sucks to be you, because our isolation rooms are staffed by ONE person.
There's a wave of new graduate nurses, which while new grads are great I'm not a fan of having twelve of them at once. I mean that literally. There are four orienting now, four more that just finished two weeks ago, and four more starting in another two months. Plus another eight that have less than a year on the job. Training in the time of COVID has been an especially big beating. Try teaching hospital policy to a new grad when the policy will change by the time you've finished explaining it.
It's been one of the hardest, most stressful times of my life.
So what did I do? I said, "how can I make my life more stressful right now?" and replied to the department-wide email asking for charge nurse applications.
Y'all. I applied for one of the two open charge nurse positions available. They picked me (and another coworker who I think will be absolutely fantastic as charge and I want to be like her when I grow up).
I'm an idiot.
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