Okay, who turned the coffee pot off?

I learned turning off the coffee pot at night is a big "No No"

I feel like it’s been awhile since I have written on this blog, when in fact, I think my last post was written yesterday. Even so, I have the opportunity to reflect on night shifts, and life in general (perhaps you’ve noticed, I do a lot of reflecting). If by any chance you are a fellow night shift worker you might be able to understand what I talk about when your days seem to mesh into one big “glob” of days when you work night shifts, at least that is what it feels like to me. You become incredibly disoriented to the time of day-day of the week and month of the year you are in because your internal clock is so screwed up.

It’s been a couple of weeks since I started working nights in the ICU, and working at night is a whole different world than working during the day. I do not mean to offend any of my day-shift colleagues (who have been amazing), but nothing beats the fellow staff members I work with at night. Nurses and staff who work on a unit at night become a family–they reach out to one another before you can ask for help. And, depending on the staff you work with, night shifts can be fun. You make it entertaining in order to survive. There is a lack of support during the night shift–by that I mean fewer people on the floor to help you accomplish tasks–especially fewer patient care technicians (who are the nurses best friend). There are fewer nurses scheduled to work night shifts, even though there is the same number of patients on the floor (I know, it makes no sense). The pharmacy closes at 11pm and does not open until 6am, so you are mixing your own medications for patients if there are none made up.

Your critical thinking skills come into play more on night shifts, since there are no doctors around (yes, they can be contacted for emergencies, don’t get me wrong). The doctors rely on your critical care skills to be their eyes and ears when the are not there. “His blood pressure has been trending down; his MAPs are lower than 60, he’s throwing PVCs everywhere, his urine output is poor–would you like to give a bolus, or start him on some pressors?” If you are working in the ICU as a nurse, you need to be on the ball all-the-time for all your patients. There’s really no room for errors or mistakes, but we are still human and, mistakes and errors do occur. And yes, the number of law suits against nurses is on the rise in the United States, sad, but true.

For the first time in my nursing career, I now have malpractice insurance. On that note, that’s why documentation is drilled into your head from the beginning of nursing school. If you did not document that you did something–an intervention or give a medication–then you didn’t do it (even if, in reality, you did). During hospital orientation, the Hospitals legal representative came in to speak with the nurses just about documentation (kind of like a “freak-you-out” session of what happen in the United States with all the malpractice suits). Yes, in school we learned about documentation. But I never knew I’d end up needing to get my own malpractice insurance one day.

Back to night shifts. Nurse deals with more paperwork at night, more chart checking, wash and bath the patients, on top of the “normal” nursing activities that must be done for patients–medications, weaning from ventilators, dressing changes, etc. If you are a nurse, you know what I mean.

And let me tell you, even though one might assume that the night shift is a “slower” shift than day shifts, since there are fewer people around, fewer medical students to get in your way and asking questions that you knew the answers to when you were in nursing school. But, they can be busy. Very. Busy. For example, the other night, we had two patients discharged to different floors, four admissions from the emergency department, a code in house that had to be brought up to the ICU, and a rapid response that was brought up to the unit–all happening within the span of four hours. Right as I was helping the code get settled in one room I gazed up from the leads I was placing and just so happened to see my admission from the ER being rolled into another room. As you read it, it might not seem as insane as it was. Ofcourse, my admission was in DKA who needed hourly blood glucose testing and sliding of insulin, and all the admissions orders were messed up, so the time I was outside this patients room, I was on the phone with the doctor. Thank goodness my other patient was “stable.” Just crazy. Yet, craziness on night shift is good because it keeps you going. Otherwise, it can get painful trying to stay awake when you are exhausted.

After working three nights in a row, and averaging a solid four hours of sleep a day, I feel like I am living in a daze right now. You know that marathon I was going to do–tomorrow? I was “training” for it. Well, after a good solid week of trying to decide whether to do it or not (I’m incredibly indecisive, and if you were around me at that time, it is the only thing I talked about “Should I, or shouldn’t I?”), a sane friend told me it would probably be a bad idea to run and I’d wreck my already exhausted body. I’m fighting feelings of guilt and sense of disappointment since I am not doing it. But now, I realize it would have been really stupid to do, and there is no way I could have the energy to do it after my crazy nights.Thank God for the people in my life who do have normal views of sports and can talk sense into my stubborn self. (I do wish my friend incredible amounts of luck for running his first ever marathon–Go out there, run quickly, and don’t break a leg!!) I warned him that they are addicting (that’s another one of my many “gifts”– inspiring people to run long distances), and I can’t believe how hardcore of a runner he’s turned into since I’ve known him.Rock on, T.R!

Fall

With this incredibly gorgeous fall weather we are having, it’s painful for me not to be outside. So after a three hour nap, I got up and washed my car (I think it loves me now–it was just a tad dusty), and am about to head out for a bike ride. To satisfy the need of putting my body through pain, since I am not running the marathon tomorrow morning, as well as to help fight the feelings of failure, the insane person within me signed up for a duathlon that is only 30 minutes away from where I live. Replace a marathon with another race. Why not? It’s my day off.

It’ll be a piece of gluten-free cake–if I can get my legs to move that is.

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September 2010
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