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Friday, February 1, 2008

Working nights solo can be challenging at times

I came into work last night anticipating on working on my fantasy baseball rankings, and it ended up being reminiscent of how it used to be here at Shoreline every night: busy.

My co-worker normally stays until 9 p.m., but all I had were a bunch of 10 p.m. treatments I figured I'd knock off in no time. But, lo and behold, as soon as he left all hell broke lose. Every patient who could possible go bad did.

And, as what usually happens when you have ten treatments due and two patients in failure, the emergency room paged: "We need another now treatment on room 1," the pager read, "and then Q30 minutes after that."

"This is completely ridiculous," I grumbled under my breath, and then looked up at the middle-aged lady I was currently giving a treatment to and watched as her body jiggled up and down as she laboriously struggled to move air.

I didn't know what else to do, so I dropped the pager. This reaction prevented me from whipping it across the room. I looked at my patient, and watched as she closed her eyes and rested her head on the pillow. She was pooping out. I decided right then and there I was not going to leave her.

I grabbed the phone on the endtable and dialed ER. When the unit secretary answered, being political was the last thing on my mind.

I grumbled, "Dr. Krane really wants Q30 minute treatments on this lady?"

"That's what she ordered," Diane said very politely.

"You have got to be kidding me," I said. "I already gave two treatments to that lady,and neither of them were indicated. And now she wants this."

"Well," she said, "You'll have to take it up with the doctor."

"If you guys think she needs the treatments, then you guys are just going to have to do it, because I'm swamped up here."

And that was the truth. Not only was this lady failing, so to was her neigbor. And that's not to mention all my treatments were due, and so was my vent check, and someone on East kept paging me because the Vision BiPaP keeps beeping.

A half hour later ER paged again: "Duoneb needed in ER."

They know I can't get down there right now. Why are they paging me agian?

I grabbed the phone. The unit secretary answered, and I asked to speak with an RN.

Moments later a female nurse said, "Hello."

"Listen," I said, "could you guys do me a real big favor and do that treatment for me. I'm really swamped up here."

"We would," she said, "but the doctor ordered Duoneb."

"How about if you just give Albuterol."

"Because the doctor ordered Duoneb." She was not going to give up.

"I'll be down there soon with some Duoneb for you." I was not in the mood for a debate, so I hung up.

If that's not the dumbest thing an RT ever heard. If a treatment is ordered because a patient is short-of-breath, why make them wait 20 minutes for an RT to give Duoneb when a vial of Albuterol is right there in the med cart just because the doctor ordered Duoneb.

However, I handled it. With excellent RN and RT care both my critical paitents averted a vent thanks to a wonderful drug called Lasix. I knocked off all the treatments, including ER. And, while doing all this, I was being paged various times for odd procedures like setting up suction, which you'd think RNs would know how to do.

And, just as I sat down in the RT Cave to eat my dinner, ER paged again: "EKG and ABG in ER."

So I trudged down there and find a 9 YO girl laboriously breathing. It's not often that we have to take care of a little kid here, and it's always a little bit of a shock to see such a little person lying there in my need, instead of an adult.

For the record, I never did an ABG on a kid before. In all my years doing this, I was never asked to. I took my time, kept my cool, succeeded, and walked the gas to lab. I expected it might be a little off, but here's what the results were: pH 6.90, CO2 17, HCO3 2.7, PO2 162 on 2lpm.


The RNs and I were tossing out possible diagnosis' from sepsis to cancer, but as soon as the doctor saw the gas she said, "We need to get a sugar."

That's when you think, "It was so obvious. Why didn't I think of that?"

The little girl's sugar was sky high.

There was nothing else for me to do with this patient, so I headed back to the cave thinking I'd put my aching feet up, when my beeper went off again.

That's how it was all night until about 4:00 when I finally made it to the cave to chart. And my boss just happened to be there. And, instead of asking me how I was doing, she provided me with some criticism about how we RTs have been making too many mistakes filing EKGs lately.

"Yes maam," I said. I really wanted to tell her to just leave me alone, but I didn't want to get into defense mode. I don't know about you guys, but 4:00 in the morning when I'm on my first day back to work, completely exhausted and swamped, is not the time I want to receive criticism from anybody.

"Wow," she said, smiling. "You are the only one who didn't blame someone else."

I looked at her stunned. I had expected many reactions from her, but this reaction caught me completely off guard. "Really," I said.

Instead of charting, which I didn't want to do anyway, I participated in a nice discussion with The Boss. And, as any of you night shift workers can attest to, when you are exhausted this late in a night shift, you tend not to hold anything back.

"You know," I said, "I never thought I'd say this, but I think that I've finally reached the point that I would like to go to days when a position comes open. I think I am just burned out from ER is what I'm saying."

She gave me a look I didn't know how to read. "I used to like ER when I worked nights."

"You know, boss, I really love taking care of vents and critical patients. That's why I love the CCU. And I love taking care of the critical patients in ER, it's just... I'm tired of the B.S. down there.

She gave me another look I could read. I don't want to say she rolled her eyes, but it was close to that. And then the subject conveniently changed. She was thinking this: "We make money on all those useless doctor orders."

It's neat how the mindset changes when you no longer have to actually do the stupid doctor orders.

And, just as my morning treatments were due, the the beeper went off.

Actually, this is how it used to be all the time here. While we are a small hospital, we have a large area we cover. I wonder if this is the start of a new trend, or an aberation.

Either way, working nights solo can be a challenge. But stupid doctor orders do not take precidence over critical patients.

1 comment:

Glenna said...

I don't know how you guys do it solo. We have several smaller hospitals around my area, a lot of them belonging to my hospital system actually, where there will be only one RT or maybe two but when it's busy it sucks. Even when we're working with fifteen RT's when it's busy it sucks BUT at least there's usually SOMEBODY who can squeeze in those extra PRN treatments here and there. I really feel for you guys. When I read that about the ER it made me thankful that our hospital changed and now, instead of someone from Neuro Trauma being assigned the ER as well, we now assign a therapist to the ER itself. You'd probably enjoy it so much more if you weren't running all over the hospital.