Finally get home after two consecutive absolutely hellacious shifts in a small community ED at holiday time. If you've worked in an ED during flu season at holiday time, you know that equates to a nasty four-letter word: HOLD. As in admission hold. As in, admissions holding in the ED for 3(!) days awaiting an inpatient bed.
Night one began with the arrival of a patient who required intubation on arrival, while I'm holding the Etomidate the manager calls, opening with the normal pleasantry of "Hi, how are you?" I reply, "Hi, I'm in the middle of an intubation right now". In nurse-speak, "Unless your hair is on fire right now, please don't talk to me." Apparently the nurse-speak wasn't clear, and in reply to my statement I get "There's people in the waiting room for almost 9 hours, you need to get them back." Did I mention we're down a nurse, so I'm taking care of a couple of patients in an assignment, as well as charge headaches? Cursing under my breath while the primary nurse is laughing at my facial expressions I nod several times, hoping maybe that will telepathically get her off the phone. Finally hang up and mentally count to 5 so I don't throw the charge phone across the room. I understand someone has been out there for almost 9 hours, but in those 9 hours they haven't died yet; however this person in front of me almost did. Whatever. Go get the obviously non-dying, not-in-distress 9 hour wait. Seriously?? Who in the fucking world waits 9 hours in an ER. If I wasn't dead after 2 hours I'd leave.
The night continues at the steady pace of bullshitidness, sporadically peppered by truly sick people who cannot wait. They buy hallway stretcher in my juggling act, and then slowly make their way over to a core bed. I think around 5am we clear out the waiting room and the back is full. 2 hours left and all I've had is a cup of tea and 3 breathmints. Everyone else is pretty much in the same boat. Director calls around 6 and tells us she's stopping by to talk to us about the night, that we did great, and to listen to our concerns. We bring her genuine issues of staffing and lack of support from other departments (lab, Nursing Supervisor, other floors), and as we're finishing up I clearly warn her that for Night 2 we are fixing to be in very bad shape, as we are down a nurse at 7p, and will be down a total of 3 nurses at 3am. I reiterate to her that I only have two 7p-7a nurses working, she writes it down in her book of mysteries and promises to work on it. I go home feeling slightly accomplished.
Segue, Night Two:
Pulling down the side-street, I see my manager standing on the corner in scrubs. As I nearly hit a telephone pole in amazement, I convince myself that my bitching and moaning this morning actually worked. Only to have that fragile dream shattered minutes later when I walk in and see that staffing is no better than it was 12 hours ago. Except that they've conned (read guilted and forced) the 7-3 nurses not to leave at 3am. Both of them are happy to help me but upset with the manager for asking/making/forcing them to stay. So much for work-life balance that the new director is pushing. Somewhere they also dig up 2 IMC nurses to help us until 11pm. Mind you, all rooms are full at 7pm and we have a 6 hour wait. Manager flat out tells me "I'm not taking an assignment". The IMC nurses take out admission holds for 4 hours while we attempt to muddle through the nonsense. First order of business, take the drunk out of the waiting room who's been out there for 5 hours with a sustained HR of 130-140. I call security and ask them to meet me by the hallway stretchers reserved for Mr. EtOH and Mr. Psych Eval (who has sat out there for over 2 hours). Security starts giving me a ration of shit about how they've been out in the waiting room for so long and they haven't been a problem, so why do the have to watch them now. I turf that fight to my manager with the simple words "They're refusing to watch him, I don't have time for this shit". Magically, she accomplishes one task and security is watching them both in the hallway. Surprised that he hasn't hit the DTs yet, I walk away to mix the banana bag for Mr. EtOH. HR continues to be sinus tach, 130, despite fluids. CO2 comes back at 13. Fantastic. Get orders for 2000mL NSS bolus, bed-ahead submitted for ICU admit. Gotta love ICU admissions in the hallway. Hey, at least I can see him.
Time is creeping up to 1am, and the influx has not stopped. In a 16-bed ED, we are at 14 admissions, plus my hallway admit, plus my hallway surgical transfer, plus I can easily pick 5-6 people in the waiting room that will be admitted. All this and a bag of chips: I called in an extra nurse and she worked patients through fast-track beds for a few hours. Call the manager and director to update them of the evolving situation. We've also run out of IV pumps, chairs in the waiting room (twice), and have only 2 portable monitors left. Manager and director, as if they're reading from a script, in unison but 20 minutes apart on the phone: "Just do the best you can". Again, breathe and count to 5 to stop myself from smashing the charge phone to pieces.
5:30am rolls around and we know we have just a little over an hour left. We are all completely exhausted. 3am nurses haven't had a break, let alone a hint of when they can leave. We're working our way through morning labs when the lab supervisor calls screaming "Get my techs back to the lab, they are not there to draw your labs!". *Gasp* I thought that's EXACTLY what they were here for. Notify the house supervisor of what transpired because I'm tired of calling my manager and director.
5:45 - BiPAP. Enough said. Bump most stable admission to the hallway and make room for BiPAP. I already have a AAA transfer in the hallway, along with 2 others we're working up. The nurse who's supposed to be in her last week of orientation has been taking care of a full assignment by herself since 11pm. I call the supervisor, laughing manically and deliriously, to notify her that I have a Priority 1 Respiratory patient coming in. She laughs back at me, asking (completely honestly) what a Priority 1 means. I growly through the phone "It means they're really fucking sick!" She laughs again, asking me where I'm going to put them. I, literally, try to crawl underneath the nurses' desk while I growl back "I don't know, I'm working on it".
6am - 9 hour wait, 18 admissions in a 16 bed ED, plus several more in the waiting room. Just gotta keep it together for one more hour. Helicopter couldn't fly the transfer, so he's going by ground right after shift change.
Dayshift starts trickling in and I can see true panic in their eyes. We are all completely exhausted and totally spent. Turn over report. Apparently later on they will have 24 holds in a 16 bed main ED and 6 bed fast-track Curiouser and curiouser.
Get home around 8am, completely wiped out. Send the director and manager an email of how unacceptable last night was. That goes over like a wet fart in church. Take a power nap, only to wake up and field a phone call from the grand poobah, asking me if I'm suicidal. Not sure if she actually read my email or not, or only focused on the Facebook post some bleeding heart decided to show her:
“He liked everything to be right and had very high standards. But he became disillusioned over the last couple of years. It became harder to reach the targets.
“He still liked his job but felt he couldn’t do his best. He wasn’t getting the support he needed or the resources.”
Stuart’s sister Mandy Hicken added: “There wasn’t enough staff. He was working long hours without proper lunch breaks.
“I remember him telling me that he worked a 12 hour shift and had only enough time to drink one cup of coffee - there was no time for food."
OR
Either way, this ends in a long, forced conversation, at the end of which I'm leaning much more towards violent tendencies than suicidal. Way to make the situation all about me, when I'm trying to point out critical system problems to you. Way to go. And then she utters the ultimate wrong answer, telling me I can post whatever I want but I need to be very careful not to associate with the hospital in any way. Ahh, there's the rub. You never gave a damn about my mental health or anybody else's. You just don't want bad publicity for the hospital. Well then. You won't hear from me ever again. I'll keep my mouth shut, let the problems mount, and let the department implode, just like Hood Hospital.
This further cements my desire to get my NP ASAP and get the hell away from bedside nursing care, and move on to more advanced practice.
The only reason I stick around here is to see what happens next:
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