The day can begin either extremely early or start in the middle of the night. Rotating shifts are part of some nurse’s daily routine. Some of us never really know what the weather outside is or if it is am or pm.
Once we wake and realize what day it is, what time it is, and what shift we are scheduled to work, many of us get the kid’s breakfast or dinner, get them on or off the bus, dressed for the day or put in their pj’s.
We kiss our families good morning or good night, and we get ourselves prepared for our shift at work. We may be wishing them a Merry Christmas or Happy Thanksgiving……without us.
We arrive at work each morning, afternoon, or night never really knowing what to expect. Each shift is extremely different from the one before. What unit will I be assigned to? What will my patient load be? Will I lose someone or will I save someone?
We start our shifts on the assigned unit after finding our assigned patients, supply closets, utility rooms. We introduce ourselves to any number of people of varied disciplines and figure out who does what. It’s a constantly changing cast of characters every shift, and we depend on every one of them.
We make our patient rounds, introducing ourselves to people we may have never met before but whose lives are in our hands. We will share extremely intimate details and experiences during the next few hours, earn their confidence and be approachable and professional simultaneously. As we are getting to know the patient, we are constantly assessing them, looking for clues, verbal as well as non, to accurately determine their state of being. We instantaneously become the “point person” for an extremely vulnerable group of strangers. We will learn things in minutes that may take a lifetime in other professions.
We check our doctor’s orders and immediately begin to coordinate care. Can the patient ambulate, eat a regular diet, what scans are scheduled and is the blood work back? Their skin is assessed, input and output are measured and documented. Do they have pain, if so, how severe? What medications are ordered and on what schedule and what possible side effects do I need to look for? Are the vital signs stable? Why does Mr. Jones look different than he did an hour ago? Is he septic – check the labs, temperature, blood pressure, heart rate, skin color? Is he having a CVA – can he smile, squeeze my hand, speak, A&Ox3? Or maybe he’s afraid of being discharged because he has no family to assist him. We quickly gather as much information as possible and decide on the correct course of action. It may entail calling the physician or getting a social worker. It may involve the lab, respiratory, physical therapy. The list is endless. But we play detective analyzing the facts before us basing our interpretation on our education, certifications and years of experience. We not only do this for Mr. Jones, but for very possibly 6-8 other patients all simultaneously. If we make an error or fail to pick up a subtle nuance, the patient could end up making the sacrifice.
As we are intervening for Mr. Jones, we hear the vent go off in the room next door. We don PPE and run to assist the patient inside. She is nonverbal, intubated with a trach. The number of tubes and IV lines coming out of her body resemble a road map. The RN is responsible for each and every one of them. What is causing the vent to alarm, what is this patient feeling and what should I do about it.
After gathering together pieces of information that just may complete the puzzle, we make decisions based on our education, experience, and a whole lot of guts. If we’re wrong …….
We decide what needs to be done and immediately call for help. We hold the fort and perform chest compressions or apply pressure where needed to stop the bleeding until the cavalry arrives. We seamlessly coordinate with the other disciplines as if in a well- rehearsed ballet. Handing instruments, switching positions, reading monitors putting all else aside in the ultimate quest of saving a life.
Sometimes the heavens smile and we are successful. We leave the room and inform the family that their loved one is safe and they can go see her now. Other times, we leave the room without a victory and have to look into the eyes of expectant, hopeful families and admit our failure to save their father, mother, brother or child. We are taught to remain “strong” and “professional” but that just doesn’t fly. The level of intimacy we have shared with these patients and their families doesn’t allow us to drop the bad news and walk away. We grieve and feel the loss, each and every time. We provide one last caring act and ensure their loved ones continue to be treated with respect even in death.
We move on to the next patient. The loss, though tucked away for the moment, is still there. We take it home with us. We process it later when we are alone-we can’t cry now. The next patient is waiting for us with hope and trust in his eyes. We collect ourselves, put a welcoming, reassuring smile on our faces and greet him and begin the process of getting to know a stranger all over again. We pray for better outcomes and start anew.
When we finally crawl into our beds at night (or morning), when our shifts are complete, we ruminate over and over what we could have done differently to change an outcome. We wake up from a deep sleep and call the unit because we remembered something important to tell the next shift or to check the status of our patient. We are guardians. Our involvement doesn’t end when our shift does. We remain ever vigilant, searching for clues, putting the pieces together until our patients are whole again.
Considering we start each shift never knowing what is in store, who we will meet, or what is expected of us, we sure do end the day with continued courage of conviction and a dedication to solving that uncertainty.