It's not what you hear on NPR

While there are days that pass that leave me feeling strung out and overwhelmed, the past few weeks have not. Our 'census' as they say, has been low- meaning that our floor is not full. We have a maximum capacity to care for 18 patients - but last night we had only six.

From a nursing perspective - this translates into two things: 1. an easy night, in which we are able to truly care for our patients and not just make sure drugs arrive on time or 2. a phone call, an hour or so before we wake to go into work to ask if we want to stay home- take 'benefit time'.

This is a piece of working that I have never experienced before, and is rubbing me the wrong way. While I don't want to use up all of my vacation time on unexpected days off, I feel useless going in when there are 3 nurses for 6 patients. It leaves me feeling not-needed, which is a slimy feeling.

I worked this Saturday - which followed the week's trend. I started the day caring for 4 patients (my maximum is five on a day and six on a night) but sent one cute old man, all wrapped in blankets, to a rehabilitation floor, and sent one young Arabic man on his way, home with a prescription for percocet and a sheet of instructions. By 3pm I was left with only two patients. One man, hospitalized for the um-teenth time for a chronic infection of his sweat glands (yes, sweat glans appear in the most inconvenient places) seemed to catch on to how the day was going as I once again appeared in his room to check in: "Are you having a slow day? Because no one has ever seen me so much in one day?" I sayed calm. "No, this is just the way I practice nursing. I'm attentive." Ok, so part truth, part lie.

Meanwhile, WBUR, our local NPR station has run a 3 part series on "The Nursing Shortage: Inside out" - In it, they describe the multifaceted problems facing the nursing profession, not the least of which is overwhelmed nurses with 8 patients, feeling that there practice is unsafe. They shared the statistic that a patient who is cared for by a nurse that has 8 patients is 30% more likely to die than a patient who is cared for by a nurse with 4. It is a piece worth listening to:

http://www.insideout.org/documentaries/nursingshortage/index.asp

I suppose rather that get upset that the floor is slow at the moment, I should be grateful that I can give my patients what they deserve throughout the day - I am able to not be a drug pusher and wound binder, but a real nurse. The Florence Nightengale way.

One man, many stories

The hospital has been quiet this week – a breath from the past month’s madness. Perhaps the surgeons went on vacation and left us with fewer people whom they cut and diced who need a bit of tender care to heal a nice scar. Perhaps the warm weather has made for less falls on the ice, less hip fractures, less battered bodies. For all of this, I am thankful.

Each day brings with it a handful of unique stories amidst hours and hours of routine. Over dinner, often with wine, sometimes with a gourmet spread, but today with pizza, I relay these stories to Caleb who often comments simply “So, blog it.” Each shift contains a funny or heart breaking character, the witness of a beautiful familial moment, too much physical and emotional pain, a lot of morphine, and most likely a frustrating moment with a fellow nurse.

Today contained all of these factors. I will write only about one, but have vowed to do a better job consistently reflecting in writing:

Yesterday I sent home a 30 something year old Brazilian man. A construction worker by trade, he had just undergone a total hip replacement due to pain and arthritis. I had worked with him each shift since his operation over a week ago, and we had developed a nice rapport. Desirous of being macho, but succumbing to the unexpected and constant pain that comes with a joint replacement surgery, I had medicated him, helped him out of bed for the first time, and encouraged him to walk as much as possible. Each time I asked him if he had pain, he would respond – “This is Craaz.” Indeed, there are many things about being in the hospital that are crazy. Yesterday, on Martin Luther King Day, with his family by his side carrying his belongings, he crutched his way out the door towards home.

Today he phoned the hospital asking for me. He said that even with instructions to mention his recent surgery, he was unable to get a physical therapy appointment any sooner than next week. I called the rehab space and conferenced him in by three way call, insisting that he have a sooner appointment. Magically, one appeared and he was certainly thankful. After the third party hung up he said to me: “thank you. You have only done the best for me. Let me tell you though, if you do not speak English in this Country you can’t get anywhere.” While I know technically that’s not true, it was a potent reminder of prejudice that manifests its self in hidden ways today. The day after MLK day, he brought into light one of the many ways this country still has mountains to cross before true tolerance, as dreamed by Dr. King, abounds.

Time Passed

It has been a while since I have written. Christmas has come and gone. The dawn of 2007 has passed. And amidst day and night shifts, a wonderful Christmas day spent home with my family, and time spent dog sitting with Caleb, I finally sit down to write.

Here are some photos from some highlights of the blog-less month:The new Frank Gehry building on the lower West Side, Caleb with Tuck, our furry friend for the month around the Fresh Pond Resevoir, and Avi with Sophie, this year's chosen lady friend.