Every nurse has had a shift like this

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“I came to a report about a patient I couldn’t recall. ‘Mr. Henderson,’ I said, reading the note slowly. ‘Low blood pressure. Cerebral hemorrhage, unconscious, neck fracture….’ Who was this? How could I not know about a patient, especially one this sick?” Every nurse has had a shift like this….

The following is an excerpt from the chapter “Harder, Faster” in The Making of a Nurse by Tilda Shalof.

I spent the entire night running from crisis to crisis. In between, I was answering the telephone, speaking with families, ordering drugs from the pharmacy, filling out forms, paging doctors, ordering trays from the kitchen, restocking cupboards, cleaning rooms.

It was well after four o’clock in the morning and I had yet to begin to make a dent in my charting, but I decided to check on the homeless man one more time. I turned the light away so as not to wake the other patient in the room who was snoring lightly. At first I thought Mr. Olsen was asleep, too, but upon closer examination, I saw that he was dead. Now, there would be a slew of paperwork, a call to the morgue and, once his bed was vacated, the possibility to get a new admission in his place. “Well, at least it’s one less to worry about,” the resident said, coming up to stand beside me at the patient’s bedside, and I hate to admit it, but I had just had the exact same thought.

It’s almost over, I told myself as the day shift began to arrive. This is my last shift, my last night as a nurse. I was throwing in the towel. (I would have thrown in my cap, too, if I wore one in the first place.) I sat down to collect my scattered thoughts as I prepared to hand over to the oncoming charge nurse. I went through them one by one. “Mr. X…wound still inflamed, spiked a temp last night…Mrs. Y, slept well, good pain control…Mr. Z, less nausea but urine output still low.”

Then I came to a report about a patient I couldn’t recall. “Mr. Henderson,” I said, reading the note slowly. “Low blood pressure. Cerebral hemorrhage, unconscious, neck fracture….” Who was this? How could I not know about a patient, especially one this sick? I saw Colleen snickering and whispering to her day shift friends, who looked over at me and laughed. She had set me up! Some jokes are meant to provoke laughter and others to provoke embarrassment, and this was of the latter type. But hadn’t I been warned? Nurses eat their young. Unfortunately, I had never learned how you avoided becoming someone’s live bait.

Just as I was leaving, the nurse manager came over to ask me to stay for a few hours of overtime. “We’re dangerously short-staffed. How ’bout it, Tilda?”

“Sorry. No can do,” I told her curtly without even offering a reason. Let me outta here. Let me put an end to this nightmare.

But still, it was not to be. As I tried to leave again, a nurse shouted from the medication room.

“Call the Mounties! The narcotics count is off.” She’d said it like a joke, but it was a serious situation and no one could leave until we reconciled the count. The morphine tallied, as did the codeine and the Dilaudid, but two vials of Demerol were missing. As the nurse in charge, I was held responsible and had to fill out an incident report.

Unaccounted-for narcotics was something never taken lightly and I knew this report would become a permanent part of my record. Again, I saw Colleen smirking as she left. I didn’t know if she’d had anything to do with it—whether she was a possible user or simply a troublemaker—and I didn’t even care at that point.

“Rough night?” said the nurse manager, coming back over to me.

I shot her a murderous glance, but my rudeness didn’t dissuade her from reaching out to me.

“Come to my office. Let’s have a chat.”

I shook my head because I knew if I spoke, I would cry, and if I cried, I would lose it altogether. “I’ll come,” I told her, “but I have nothing to say.” Yet the moment she sat down opposite me and gave me her undivided attention, I spilled my guts and told her everything. Not just about that horrific night and the homeless man who had died alone and the bleeding groin and Colleen, but about Buddy, too, and about the suppurating wound, and the patient who called me “Maggie” and about how impossible, frustrating and soul-destroying it was to be a nurse.

She listened to me, nodding her head from time to time. I expected her to tell me to toughen up and get better at my skills and at organizing myself, but she said none of that. What she did say surprised me. “You have to learn how to get in and how to get out.” You have to care, she explained, but not too much, or it will interfere with your ability to be effective.

“Fix what you can and leave the rest. Some things you can’t make better.” I must have looked dubious. “I know it sounds harsh,” she said, “but it’s the kindest thing. The most helpful.”

“I may be having a nervous breakdown,” I warned her, holding my head in my hands.

“You’re exhausted,” she said kindly.

Yes, there are times when sleep is the only solution.

Excerpted from The Making of a Nurse.  Copyright © 2004 Tilda Shalof.  Published by McClelland & Stewart Ltd. Reproduced by arrangement with the Publisher. All rights reserved.

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Tilda Shalof

Tilda Shalof RN, BScN, CNCC (C) has been a staff nurse in the Medical-Surgical Intensive Care Unit at Toronto General Hospital of the University Health Network, for the past twenty-four years. She is also the author of the bestseller, A Nurse’s Story and an outspoken patient advocate, passionate nurse leader, public speaker, and media commentator. She lives in Toronto with her husband, Ivan Lewis and their two sons, Harry and Max. Learn more about Tilda and her books at nursetilda.com.

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2 Responses to Every nurse has had a shift like this

  1. Oh shifts like this happen to me many times! But I love the nurse manager’s words! I’ll keep remembering that!

  2. Smithteamracing RN

    Sometimes keeping them safe & breathing (or passing peacefully) is all you can do. It is hard to strike a balance between caring to much & being cold & callous. When I first started nursing 20+ plus years ago a manager told me to leave the job at work…..don’t rehash to shift over & over,,,learn from your mistakes & move on. You can do everything for every patient every time.
    AND learn to laugh at yourself. I always feel like night shift is, laughing at me when I’m there late. They aren’t but when I’m tired I feel like they are. I work on a unit that can go crazy @ 5PM like someone flipped a light switch and sometimes you just cant get out on time.