Moving on…

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My first year anniversary as a nurse passed two days ago. I spent my first year at a hospital on their intermediate care unit. A step down unit. This August, I begin my education as an NP.

Too soon? Not enough experience as an RN? Maybe. But I started this journey because an MD who has been treating me for Lyme disease asked me to finish my education as an NP and join her primary care practice. Because I didn’t have an RN license at the time, I needed to get that first. So far, she’s been waiting 3 years. And she’ll have two more yeas to wait.

I may not have as much experience as I’d like, or is ideal, but I have a solid foundation. I saw a lot. I did a lot. And it truly is time to leave. Things are getting.. hairy… at the facility.

Nurses are leaving in droves. Sometimes it’s because of better pay at other facilities, sometimes it’s because there has been a change in management that just didnt sit well. The hospital, at this point, is hemorrhaging nurses. The hospital has been in a code red situation more than once (critically low staffing) and nurses are being forced to take more patients than is safe.

There will be a sentinel event. It’s coming. I dont want to be around for when it does. I worked hard to earn my license, I intend to keep it. Because eventually, the people that will pay the ultimate price for this will be the patients, and the nurses.

I refuse to clean up your mess

Management, you saw this coming. You watched as nurses left in droves from every floor, every department. And now we’re critically low in staffing numbers. I heard you hired 2 ppl to replace the 4 RNs and 2 techs that left our floor. But the new hires haven’t even passed boards yet. You failed to hire more, already trained nurses. Nurses who would just need some orientation to the unit before they could hit the ground running and start helping.

And now you want to make it our problem. The nurses who are already suffering burnout. The nurses who already carry a heavier load than they should. These are the next nurses who will be tempted to leave.

Where are you, management? Why aren’t you on the floor helping with patient care? Or are you all above that now? Pushing papers around trying to keep administrators happy so you can keep your job, but not really supporting the people in the trenches.

So no. I will not come in.

I, and so many others I know, also suffer with chronic illnesses of our own. Chronic pain, chronic fatigue and despite it we dedicate our lives to serving others in their crises. I and my cohorts need time to recover. We need time to heal between shifts so we can do it all over again when we have to. We have families that also need us. Cooking and cleaning and laundry and the like still need to get done.

So no. I will not come in. My time off is precious, and I need it. My peers need it. So to management and administrators I say: Come down from your ivory towers and get your hands dirty. And take a good look into why folks are leaving, how to replace them efficiently, and how to keep them.

Open Apology to my Day Shift Counterparts

Night shift is short staffed. This is just how it’s going to be for awhile, and I need to come to grips with that. If we have a tech, we’re lucky, because usually charge nurse ends up doing tech duties in addition to her own, and once in awhile is forced to take a patient.

This means that often I need to provide total care for my patients. This also means that I don’t get to dig around in the charts and get the details day shift invariably asks about them when I hand them over. Vascular signed off? Sorry. I didn’t have time to read through charts, and it wasn’t given to me in report, so I apologize for not changing that dressing, because I thought the Vascular doc would be in around 7am to tear it off and look at the wound. But I did change the PICC line dressing. I hope that helps.

I do what I can. I also prioritize not just my patients’ care but the care of my teammates’ patients. That means I am in rooms answering call bells of my fellow nurses, toileting those patients, and even hanging IV meds when my team member is stuck in an isolation gown trying to give meds down a PG tube to a patient who has MRSA in an amputated BKA stump.

I need to find a succinct way to tell oncoming day shift staff that I’m not being lazy because I dont have details they want. Instead I have spent my night doing my work, the work of our often non existent techs, and sometimes the work of my fellow nurses who have a crappier assignment than mine, and are behind schedule because of it. And I want to make it clear that dont resent or regret helping my team members one single bit. I know that I am also on the receiving end of that crappy assignment from time to time, and they are the ones that will settle in my new admit when I’m behind in my work.

I’m told management hired two nurses. But we are still lacking techs for the night shift. The few that remain can’t cover the entire week of shifts on their own. And the nurses they hired are actually still in school, hopefully graduating this May, possibly taking boards this June, and if all goes well, will come off orientation in October. That’s a long time to be short staffed.

So, I apologize to my day shift team members, that I don’t often know the nitty gritty of the patients I am handing off to you. But I got all the patients through the night, and no one died.

Reality

Because just in case the usual aches and pains of my days aren’t enough…

I fell yesterday. I was going out to the grill to check on the chicken, and my leg gave out and I fell to the deck floor in a heap. I stayed there for a time. Assessing the situation, because my foot was twisted in one direction and my hip twisted in another, and I was alone. It took me a few moments to first recover from the pain, and then figure out how I was going to upright myself without further twisting my already inflamed joints.

A day later, and my knee is still protesting my clumsiness, making it hard just to lift myself from a sitting position.

And I wonder how my shift is going to go tonight.

An already physically demanding job is getting more physically demanding, because on night shift, we have lost not just a few nurses, but a few techs as well. It’s the story of bedside nursing across the country. RNs being asked to do more and more with less and less.

July will be a year since I graduated nursing school and started my career as a bedside nurse at a community hospital. I like what I do. The environment is rich with learning experiences, and the team (or what’s left of it at the moment) is great. But more night shifters are on their way out, and despite the promise of another group of nurse and tech graduates starting in the summer, it wont be until late fall until they are ready to work on their own and make a difference in the holes in the schedule.

I’m just not sure if I can wait that long. My days off are spent recovering from balancing the demands of my job with the chronic pain I suffer from, as well as keeping up with laundry, cooking, and food shopping. Relationships are suffering, too. My marriage is under enormous strain right now, and my daughter is hitting some important milestones as a high school junior: SATs, prom, sports events…

I’ve applied to graduate school, to finish my education as a Family Nurse Practitioner, in hopes I can bow out of my job with a more appealing excuse besides, “it hurts too much,” or “I can’t keep up.” But the reality is setting in that if I dont make it in this year, I may have to find a nursing job doing something else.

Because it hurts too much. And I just can’t keep up.

Self Care

I’m feeling guilty for not having done much of anything with my past 2 days. I’ve been extraordinarily fatigued, so I’ve spent the major part of my time either on the couch or in bed. I know the sudden surge in fatigue levels is partially due to my hormones, and I know it will come to an end (or at least be more manageable), but there is so much I have to get done that just isn’t getting done: ACLS studying, filing the family taxes, batch cooking, helping mom organize her expense ledger… and that’s just the beginning.

If this was someone else’s blog, I’d leave a comment about self care, and that sometimes that means that in doing nothing, you’re doing something: you’re giving your body the time and rest it needs in the moment it needs it. I’d go on to say something about how our society celebrates the idea of running ourselves into the ground, and how that serves no one in the end: not the individual, and not society.

I need to learn to listen to my own advice.