How Will The Cards Fall?

I never claimed to be overly informed about a lot of professions. I don’t know what a grip on a movie set does nor can I explain what happens on an off shore oil rig. One thing I do know, with great detail and accuracy, is the life of a nurse on shift. While we might function in different capacities, the bottom line is that we are the front line of medicine. If it needs fixed? We have to fix it. If a patient is uncomfortable, we have to rectify it.

Recently, a very ill informed Senator went on about how correct staffing really isn’t an issue because nurses are always playing cards in the break room. I don’t know what hospital she has been at to observe that behavior. Maybe she was watching a little too much General Hospital – spoiler alert, we don’t swoon over the doctors.

Been fortunate enough to work in several branches of nursing… let me give you an idea of how things do:

As a new Med Surg nurse: walk on the floor to chaos. Try to hunt down the assignment list to see which lucky ones are mine. While chasing around the nurse that is leaving for report, call bells are going off non stop. Attempt to answer, so as not leave the patient waiting. Come back, nurse has moved onto another nurse and I ask if she has any more to tell me? “Be careful of 107, he is a little handsy!” Great. Because we still paper charted at this time, collect all of the daily sheets. Ever heard of the Holy Grail? It’s like trying to find that. By this time it’s probably close to 9. Check the first Med pass and start assessments. Lab is calling with an abnormal value, have to stop, track down MD number and pray to God that he won’t rip my face off for calling. Because there is typically one aide on the floor, we have to end up doing full care on a 40 bed unit. Back to the Med pass but stopped a few moments later because a patient’s wife is on the phone yelling as to why her husband hasn’t gotten peanut butter crackers. Did I mention I was charge, also? Always on the lookout for triaging patients to the right level of care because we don’t want inappropriate admissions. It’s probably 1 am and my Med pass is no where near done. Uh oh, a patient’s heart rate just went into rapid afib. Cardiology wants what? To give him lopressor IV? Has to go to a higher level of care. Coordinate that. It’s about 3 am and my super parched throat tells me I haven’t had a sip all night. But, crap, labs are due. Draw all my labs, send them down. Have to make assignments for the am. I look at my pathetic charting? A few words scribbled here or there. New shift comes in and it’s almost a verbatim copy of the prior night’s report, including call bell sprints. I take my papers into the break room (is this what she meant by cards?) and chart for an additional 1.5 hours. By this point, my feet are throbbing, my eyes are bleary and I need to find a bathroom ASAP because I have to pee so badly I fee like I am leaving a trail behind me. I get to my car, the lunch I packed earlier that day sits lonely on the front seat. Oh well, maybe I will get to eat it during tonight’s shift.

Stepdown/ICU: I wore out more sneakers in these two floors than any others. Just when you think it’s going to be calm, in a matter of 16 seconds everything blows up. A patient is crashing, someone is trying to escape the hospital in his gown and with iv pole and the withdrawal patient (in restraints, yes, I am that old) has suddenly found the strength of Samson and is almost levitating his bed. When an ICU patient crashes, there is no code team… you are the code team. You leave your equally as sick patients and head over to help all the while trying to hear that monitor not beep. I had so many frequent UTIs on Stepdown that cranberry became part of my daily routine. I distinctly remember one time when the secretary was cleaning out the refrigerator in the break room, I had 5 lunches packed but not one opened. Maybe if it was Cards we were playing instead of something so basic and necessary as eating, I might have found the time.

Pacu is like a train station. Patients are with you for a short while and then you hopefully get them off to their destinations. Sounds great. The catch is that there are multiple OR going at the same time and you can have 4 patients come out at once. What about your patient that is waking up and in excruciating pain? Got to get them the meds. What about the family member who looks up to the board to see any updates? Make sure that’s done. No beds for these patients upstairs? Got to hold them in Pacu. Make sure you print out the right discharge information. Oh wait, the doc forgot your script for pain meds? Got to find him. He drops a script off at the desk and forgets to sign it? The hunt begins again. Patients in Pacu sometimes get the most life changing diagnosis and you want so badly to be there for them but you hear the OR doors opening with your next bed.

Hospice is a different animal. I am coming into your home. I have to be respectful of your time. I may start off the day with plan to see 4 patients and between phone calls for condition changes and new admission, I may get the chance to only see one. Need a special supply that no one around you has? Yep, drive at least 45 min to the office to find it. There have been times where I have made nursing home visits at 6pm because I have no other choice. As patients decline, they need daily visits. If their symptoms are not under control, guess who has to see them? Yeppers! That’s me. Forget about things I cannot control like weather or traffic. Many times my kid has texted me, “Mom, is everything ok? You are so late!” Yep? Kiddo, just playing solitaire. Of course, he is excited because he knows on those days, chances are he will be eating my non eaten lunch.

Staffing is the Pandora’s Box of Nursing. Many facilities don’t want to staff properly because it will bite into their profits. Is it worth a few more thousand dollars to attempt to create an atmosphere of safety? Imagine a NICU nurse having 4 babies. They are critical and should be 1:1. I used to have up to 9 patients at night on Med/Surg and sometimes I was so busy I would peek my head in the room to make sure sheets were moving. Stepdown was supposed to be 1:3, but we typically did 5 or 6.

Where is the taking care of your employees? Senator, go to an assisted living or skilled nursing facility and see how pitifully understaffed they are.


You see, we aren’t playing cards, we are running to save lives, we are popping Advil because our backs ache, we are trying to make sure someone’s father eats safely, we are trying to make sure no one falls out of bed which is why we do the sprints down the hall, we are trying to squeeze in a few moments to throw in an assessment so we don’t have to stay over our shifts, we are fighting with lab over ” hemolyzed blood” and searching every single bin for the antibiotic that pharmacy says they sent up. We are calling doctors, who aren’t sometimes very nice, in order to advocate for our patients. We are comforting patients and families in the most difficult of journeys. We do so with empty bellies and full bladders. We do so with aches, pains and soiled scrubs. We do so knowing that there are people like you who because of your obtuse nature sling about accusations, without stopping to pay respect to those who hold life and death in our hands. We do so despite people like you. We do it for the eyes of a mother whose child has been made better or for the family who clings to us as their loved one dies. We do so because we are nurses and that’s what we were born to do.

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