the phrase I TOLD YOU SO comes to mind

nursing dilemma: fall into bed exhausted, or fall into bed exhausted after drinking large glass of wine?

i told the powers that be that we needed another tech, but nobody listens to me. apparently they want you to feel like you're participating in staffing choices by making you the charge nurse, but they don't actually want you to make any decisions or (heaven forbid!!) voice an opinion. so we had 1 tech tonight, 1 tech for 19 patients which i'm told is "appropriate staffing". 1 person is supposed to get vitals and fingersticks on 19 people? to take them all to the bathroom, and bring them waters, and count the intakes and outputs? to answer the call lights and clean up messes and change sheets and help turn? as fabulous as our tech is and as hard as she works, this is just not possible. but the (holy, almighty) staffing matrix says we don't get a second tech until we have 20 patients.

which is why after we got our first (of several, thank you very much) admits, i went to the powers that be and said "so we got an admission, where's my tech?"

in hindsight, that may have been inappropriate.

long story short, there was no tech. but there was another admission, then 2 more on the night shift. it was about this time that we realized that our second tech for nights never showed up to work.

then my admission rolled in at 2130 and i couldn't get anything done with her until the police finished grilling her about how she got stabbed.

so here i am, finally home after punching out almost an hour and a half late. i'd like to think of it as "revenge overtime".

should have given me that tech, hmm?

i don't think i need the wine tonight. i've got my righteous anger to keep me warm.

there are dollar signs where our hearts should be.

my heart breaks a little today, as i just found out that my favorite trauma nurse clinician's position is being eliminated in february. frankly, i'm getting more than a little bit tired of working for an organization that obviously enjoys showing nurses just how little they are valued.

it's ok with "the man" that i am verbally threatened by my patient's family. in fact, it is actually MY fault.

it's ok that i have to walk a half mile in the dark/freezing cold past the mental institution to my car at night.

it's ok that we constantly work short, with equipment that doesn't function.

it's ok to take the best resource that we have as nurses (aka our trauma nurse) away from us. It's not like she's the only one on the service that knows what's going on...oh wait, SHE IS.

i think we should change the motto of the organization to {enter greedy hospital name here}: you are replaceable.

why on earth would the hospital eliminate the person who mediates between doctors and nurses and makes us see each other as people? why would they take away the individual who can build a relationship with even most soulless of patients? why would they get rid of the nurse who has the skills to see when there is something wrong with a patient and the power to actually DO something about it. i'll tell you why

$$$

that is the only reason. and that makes me sick.

so we saved a life before 1500

nothing good starts with the sentence "I don't like the way my mom is breathing". of course i would have to be the one to answer THAT call light...so i sent the nurse down to the room to see what was going on. she came out a few minutes later reporting that the patient was breathing at 8 a minute. not good, not good at all. she grabbed a vial of narcan to reverse the narcotics the patient had gotten earlier and i went to page the doctor. i looked everywhere for the patient's chart to find what resident was taking care of her and couldn't find it, so i just sent out a general page through the operator and went in to help. the nursing student got vitals, which showed that the patient's O2 sats were 78%. my coworker started pushing the narcan and i ran to grab a face mask and put the patient on 10 liters of oxygen. less than a minute later, the patient's sats came up to 100% and she woke up, thanks to the miracle of narcan. we titrated her O2 down to 3 liters and the nursing student stayed with her to take more vitals. it wasn't until this point than the doctor called back. apparently i paged the attending.

oops.


i could tell that things weren't going too well...the nurse was having to explain herself way too much and there appeared to be some lecturing going on. the attending told her that he didn't feel comfortable telling her that it was ok to give the narcan, and he needed to look up the policy. to which i say:

SERIOUSLY?

giving narcan is within our scope of practice. and when i see a patient who is struggling to breathe, turning white, and looking like she's headed to heaven i will give my narcan and have no remorse. feel free to look up the policy, because i'm pretty sure that it won't say that we should let little old ladies die while we wait for you to return my page.

five minutes later the attending called back. he looked it up and had decided that we were indeed allowed to give the narcan. gee thanks. oh, and YOU'RE WELCOME for helping your patient live to see another day.