The Day Shift Quandary
It's been awhile since I've written, and for good reason. Working days has been a new experience for me.
I guess I figured that the difficult learning curve of my new unit was mostly related to the fact that I didn't know where things were found and how procedures were done in the unit. This is the first day/week (depending on the hospital) scourge of any new assignment. So, I expected to be at a loss the first couple of days, floundering around, trying to keep my head above water and perform some patient care at the same time. Then I realized something: it was less that I couldn't find anything, from saline syringes to triple lumen kits, and more that I haven't worked a day shift in a very long time. That made all the difference.
To put it bluntly, day shifts are difficult and ugly at best, and more commonly hellish. For someone like me, who prides myself in being as efficient (some might call it lazy) as possible, someone who tries very hard to get my work objectives accomplished with minimal to moderate exertion by cutting out the extraneous chores (e.g. climbing the notorious "clinical ladder"), working days is akin to slave labor. It's brutal.
Not only is there all the same work one would expect on night shifts, there is loads more of it. First, you get the pleasure of dealing with the packs of anonymous doctors parading around for the multiple rounds they make (every discipline, such as renal, cardiac, etc, does their own rounds on their patients, and any patient might belong to a large number of specialties). This means that every time you finally almost get caught up, another group of doctors comes up and asks a bunch of questions that you have no answers for, if you even were aware that your patient had a cardiac or renal issue, and that means you get to look a little stupid all over again. They all also write their own orders that may or may not be agreed upon with the unit team, which also rounds several times.
Next are families. I can understand the stress and frustration that runs in the veins of the families of the ill. That being said, families are the most irritating aspect of healthcare. Working night shifts, I had limited exposure to families, thanks to the 9 pm visiting hour limit. Now, they hound me, the mothers, the wives, all of them, like hens, clucking questions about their poor family member, telling me what one doctor on the weekend had told them (FYI doctors on the weekend will tell you anything, because come Monday, they won't be there to back it up), asking me, why oh why their husband who smoked 50 years has such difficulty being weaned off of the ventilator.
One such mother kept stopping me yesterday all throughout the afternoon with them same questions: why weren't we weaning? Why weren't we extubating? Why was he still under sedation? Finally, I needed to have her talk to a doctor, so I brought her to the fellow, who I didn't know but as a fellow, I expected some degree of intelligence. That turned out to be a dramatic mistake. She agreed with the mom to just turn off the sedation, in this case Propofol, which is a powerful, short acting drug but was running at a very high rate. I tried to explain to the doctor that this particular patient had failed a weaning test earlier in the day, perhaps she would want to talk to a respiratory therapist? Nah, she said, all patients need to be taken off sedation daily anyhow, and it looked like a good time for this patient (this is not true, but that's a whole different entry). By then, I was approaching the point of being hopelessly behind, so I decided fine, I'll show her what happens when you turn off the sedation on a patient not ready to be extubated. To make short a traumatically long story, it was a horrible experience for me, the patient, and hopefully the family, who all sheepishly hit the road right after the patient went completely crazy. The sedation came right back on, in addition to multiple doses of other meds to bring him under control and get his heart rate down from 165.
I really wanted to scorn that doctor, but as a traveler, I just had to smile and try not to look evil, as in better luck next time, fortunately the patient is still alive. Even when they are obviously incompetent, it is hard to say anything to them, because you don't want to step on any toes. Being a traveler means absolutely needing to fly under the radar. You also have to know which doctors you can never, ever ask a question or direct family inquiries to.
At any rate, these day shifts have been thrashing me like a dry field of corn (hey, it's everywhere up here). Even staying up all night working doesn't make me as tired as I am when I come home from working a day shift. Sometimes, I feel like I just finished 12 hours of Thai style caning, a beating that lasts all day. Days like yesterday, I work frenetically, I eat my lunch in ten minutes at 5 in the afternoon, I go from one chore to another constantly, and still I feel like I'm an hour or so behind. Mid-afternoon yesterday, I actually had a single hour where no meds were due for either of my patients; I must have celebrated too long, because the next thing I knew, I was an hour behind on meds for both of my patients. Days shifts are brutal, and now that I know my way around the unit pretty well, I can't even use that as an excuse anymore.
On the other hand, working day shifts does tend to be a very educational experience. It is interesting to listen to rounds, to hear what all of the patient's issues are (most of which are left out of the nurses reports), to hear a little education about treatment of all the conditions found in the ICU. It actually is very interesting, at least on the occasion that I can break from from the work to spend ten minutes listening to the rounds. I do like that aspect of days. Plus, it's nice to come home, go to bed, then wake up in the morning of a day off and not be completely exhausted. That is a nice change.
As it turns out, I have seen my tentative schedule through most of October, although the final version won't be out until next week. I'm working almost all days, except for a single four-shift stretch where I work nights. So, I guess I'll have to get used to the hustle and bustle.
Anyhow, there is something going on here in the Swiss Cheese that has not just been my observation. Again, perhaps it is a day shift phenomenon, perhaps not. There is a certain edge about this place. I'm not going to make a general statement about the hospital or even unit as a whole, but I have gotten the sense that some of the staff here have a certain sense of arrogance about their work and the way they do that work, which in turn is dangerous for travelers. These are the types who would think nothing of writing you up for anything, which at the very least creates bad juju with the management and could even lead to termination in a surprisingly short time. Thus, the art of flying under the radar is that much more important, especially in a place like this. Most of the travelers I have talked to have noticed the same thing; it's like we can sense it in the air: Danger!
Well, that might be a little dramatic, but it pays to watch yourself very carefully. Honestly, that tidbit is passed between all travelers here at this hospital.
Until next time, be safe.
