Surprisingly, management has actually shown some serious fortitude lately. Like, I didn't know it was in them. They're pulling 16 hour shifts, working as charge or triage or something other than staffing where they know the true ass raping occurs, but still. I don't even expect you to deal with that madness when you're up here for 70 hours a week or whatever.
Except- last night was another day like many we've had this week. Big boss was charge nurse. Now, a little about big boss- he's always been nice and approachable- but kind of clueless and spacey. Like, to the point that it scares me a little bit when he charges because one time he nearly transferred the wrong patient to another hospital until I caught and was all, "dude, that's not it." It's like he's been away from the clinical setting long enough that he's just kind of wandering around lost when a situation arises outside of "Room clean and open. Patient go in clean room. Patient like room. Patient unhappy? Me talk to patient, make patient happy. "
So, obviously why it was inadvisable to arrange the staffing so that the area where the really, really sick patients go is super short on nurses so you can open more rooms in the overflow unit and make more patients happy was a concept that escaped him.
So hey, here's all the resuscitation rooms in one spot. There's three of them, and four nurses, and each nurse is expected to take a full assignment including the resus room. Okay. So what happens when one of those rooms actually has to be used for like, I don't know, a resuscitation? Oh, and I forgot to mention that we have no transport, no medic, and no tech. Oh, and the resuscitation? Successful, which is awesome, except now you have a crumping, no-blood-pressure-having patient with an art line maxed out on vasopressors while you're on the phone begging pharmacy to please, please, send us that epinephrine drip stat no really we mean STAT DOUBLE STAT. So, that's at least two nurses in there. At least. Everyone has a full patient load. Everyone. So you have two nurses taking care the rest of the ER while trying to also help out with crashing train wreck ICU patient. Oh, and B-T-Dubs, ICU train wreck sure does have a pneumo because po-dunk fire medics know that broken ribs=awesome CPR (no, really, they were bragging about this while giving report on the patient). Haay, somebody go get the chest tube tray, y'all.
So, what is big boss up to right about now? You know, like filling out charge nurse reports and shit, and asking me if I've called report on my patients yet. Are they dead or dying? Then no, I haven't done anything for them in 3 hours. Oh! And sending ambulances to the few empty rooms we do have, including one with no blood pressure and no veins who was shitting. everywhere. EVERYWHERE. Constantly. But we're loading up all the rooms in the rest of the ER with vag complaints and baby fevers. Lalala!
A few hours in train wreck guy finally stops trying to go be with Jesus quite as aggressively as he was before, and I manage to get a patient or two discharged or upstairs. About that time, I get an ambulance- I'm getting them checked in as post-CPR guy starts crumping AGAIN as I overhear that I'm also getting the next ambulance. I try to catch up on my other admitted patient who has been criminally neglected at this point as my coworkers run in to help with the drain circling. About then my ambulance rolls in.
This guy is totally about to die. I mean, stop breathing and code for real. He's satting 60 percent on BIPAP with wet lung sounds that you can hear from the other side of the ER, and no IV access. Big boss is transporting my patient, surely so he can fill my room back up, my coworkers are busting ass in the resus room, the other resus rooms are full, and I am the only person at the nurse's station. I put this dude in the closest room I have while I grab all my IV shit and stick my head out the door to beg our secretary to find the doctor and our registration rep to bring me the crash cart from one of the other rooms. One of my coworkers emerges as the doctor comes running, we get a line, get our RSI drugs, get the guy intubated.
Naturally he's huge with the strength of the incredible Hulk and will not stay down on sedation for shit without dropping his pressure in the toilet. I'm trying to play the please don't extubate yourself game with him and am somehow still expected to magically get my shit together on my admit. I explain the improbability of this to big boss as I hold my patients hand down with my knee and try to switch him to a Versed drip and hang fluids to pressure bags. He responds by finding a phlebotomist from one of the floors to do my stat labs, who promptly comes into the room as I am holding the patient down while RT adjusts the ET tube to tell me that she doesn't know how to draw labs from an IV and she'll have to watch me do it. Yeah, I don't see that happening any time in the future, so just forget it. Obviously it's practical to replace our medics with this. Fantastic. 2 minutes later, labs calls to tell me all of my blood is hemolyzed and I'll have to recollect it.
I just say a prayer that no one dies or gets terribly pissed off while I'm dealing with this. At about that time one of my real nurse coworkers takes over charge and big boss goes to the triage desk. She comes into the room to ask what I need, I tell her all my shit is hemolyzed and I need labs, and she immediately goes to work getting me an IV. At that point, I seriously just burst into tears because I was frustrated and starving and thirsty and already feeling like utter shit and I was just so relieved to finally have someone who was able to help me who had a fucking clue. I think I actually hugged her after she drew my blood cultures.
And really. It was all better after that. Big boss left, ICU patients got beds, and at 5 am I even got to eat lunch! Anyway. I guess that point of this post is that while I appreciate managements' hard work, it doesn't make up for apparently having no fucking sense. Also, that the liquor store doesn't open early enough in the morning.