Inadvertent Skirmishes

Time: 9 days ago
Setting: All by myself, no second nurse, no ER Tech, no breaks. My bladder is about to explode, my stomach has stopped rumbling a long time ago. The ER is getting pounded with ambulances, every room is full with ten people in the waiting room. The queue keeps getting longer. I'm helping out as much as I can, taking people back to fast tract to "get them going" until a bed opens up front. Never mind the acuity, never mind the lack of monitors. Never mind there are six of them and one of me. There's a gentleman who will need moderate sedation to pop a dislocated ankle back into place. Labs & IV started, x-rays done, pain meds given. No problemo. The usual drug seeking behaviors, lots of time-consuming IV abx. My charting gets more and more behind. The ER medical director asks me if I'll stay late; kind of a moot question since I'm already late getting off. No problem, I agree to stay until the 4's are gone. The last one finally leaves, at around 145 AM, and I look at my mountain of charts that still need to be documented. Wait, my NP provider says. There's a "soft 3" in the waiting room, we should see him too. She says something about IV fluids, and I know I've hit my limit. I set the clipboard down with a little more force than necessary, and tell her I'm already behind...I'm due back tomorrow, on a shift I've picked up on top of my regular schedule, my little guy will be getting up in 5 hours, regardless of how much sleep I've gotten, and I am done. I just don't have it in me. The ER Gods smile down on me as I learn that the S3 has eloped, or has left before being seen due to the wait times.

Time: 8 days ago
I'm back for the shift I've picked up, and I'm getting pummeled again. I have a sepsis work-up, two infants (one 12 days old) that need IV hydration, and an admit. At least Siv is my ER Tech; he's good and a hard worker. I'm so grateful to have someone to help out a little. I talk to the NP about my outburst later on that shift, and apologize. She says she understands, and I tell her I'll work harder on controlling my emotions. I didn't realize I upset her so much, but I feel better after talking to her. 0100 rolls around, and my crazy string of shifts comes to an end. I walk out, looking forward to six glorious days off.

Time: Yesterday
I email my manager to relay my concerns about the acuity and being so understaffed. She apologizes, states she didn't realize the ER Techs were being pulled from me to do random things up front. She's hired another nurse to start the beginning of July. And by the way, what was up with me throwing a chart last week? I'm shell shocked. What? I didn't throw a chart. I had no idea Deb was so upset about this. Why would she go to Kendra? She never said anything about this when I talked to her. I apologize to my supervisor, try to explain what happened, but I get the sinking feeling it isn't doing any good.

Time: Today
My first day working with Deb. I am still a little upset and hurt, but I've decided to suck it up and just be professional. Subconsciously I think I'm deliberately being extra cheerful because I don't want her to think I have a bad attitude. The shift goes well, and we're on the last patient of the day. Slammed her hand in a car door...looks pretty painful. No obvious fracture on the x-ray, so Deb gives us an order to ACE wrap and her discharge papers. I go in to let her go, and place the ACE wrap on her hand. I'm wrapping it a lot more loosely than I normally would; she's cringing and appears to be in pain. She looks up at me and says, "I think I'm going to pass out". Her skin is super pale, especially against the contrast of her raven black hair. I tell her to put her head between her knees, ask the ER Tech to get her a cold washcloth, and check her vitals. Her blood pressure is 80 something over 37. Shit. That's not good. I'm asking her questions, and taking her blood pressure again. I try to find Deb, but she's gone. I have a sinking feeling in my stomach...technically the provider isn't supposed to leave until the patient is gone. I ask the charge nurse, Mike, if he's seen Deb. He says she's done for the night. I explain to him what's going on, and he comes back with me. I check a blood sugar, another blood pressure reading, and so on. Mike talks to the ER medical director about bringing her up front. Crap. This is Deb's boss. I can't help thinking, I really hope Deb doesn't think I'm just trying to get her in trouble. The patient feels better and is insisting on going home. As I finish up my charting, say my good-byes and walk out the ambulance bay doors, my stomach is churning and Nate's saying is running through my head...ducks and kangaroos and orangutans with healthy doses of rhyming profanities to go with each.