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.