Seems like I haven't worked/blogged in a VERY long time! But don't fear...the craziness has still be going on, I guess I've just been avoiding it...until last night. I turned down 2 extra shifts in my "8 days off (which was really 7 this time around...)" for 2 different but very valid reasons. I realized when I went car shopping yesterday that maybe a few extra shifts in the near future would be a GOOD thing and I need to stop coming up with excuses like "I'm tired" or "I'm busy", etc...reality bites!
Anyway, as I'm halfway to work yesterday (after an hour and a half nap after the car deal...) I get a call from the day charge nurse..."Sorry it's 1815, but we're putting you on call!" Seriously? Here I am thinking that I need extra shifts and I can't even work my regular ones anymore? I was JUST on-call, and I'm half-way to work already! But what can you do...so I drove to the gym (just a different building on the hospital campus) instead of work and ran a few miles, lifted some weights...on about mile 4.5 my phone rang "Well...a twin mom just walked in who's 6-7 so I think we'll need you. Well, only 1 nurse has said we need help so far...Well, I'm not sure if we'll need you LaborNure wise, but I know I don't have NICU help..." Before the conversation could go deeper I said I'd take a shower and come in. Meanwhile thinking "#1 I'm not going to be of any use if they need NICU help, I do mom's not babies (especially 35 week twin babies!) and #2 if I get there and they don't need me, I'm going to be ticked!"
When I walked in I got ticked, but for a different reason. The board looked horrible, there were no where near enough nurses, I didn't even have anything to do with the twins who walked in, I got someone's recovery (why...I'm not sure) and a random ante from someone else. The recovery...ok, no big deal. The ante...a little bigger deal: she's been there for an hour an a half, the baby wasn't on the monitor (she was "too big and hard to trace"...) there was NO paper work or computer work done on her, the doctor hadn't been called, pretty much she'd gotten on a gown and sat in a bed...for an hour and a half!!!! THAT made me a little upset.
So I went down, flipped her on her side and found the baby, got the scoop of why she was there, called the doctor, got orders, helped 3 other people get up to the BR/roll to the OR/very random things, started her IV, tried to get my recovery moved, got told that I was the next one up for triage and that there was a term ROL here in a room for me, put moving my recovery on hold, triaged the ROL, got her situated, gave report on her to someone else, moved my recovery, came back found out the traige had gone from 3cm to 9cm in about 45 minutes, found out my ante was feeling better, did ALL my charting, sat down to breathe...
Round 2 of the night included: helping with the unblocked delivery of my "ROL", sending my ante home after 2L of fluid, setting up delivery packs for day shift, taking over on 2 other antes so a different nurse could go home, taking a ROL at 0530 and then ALMOST getting to catch a baby when mom precip'd in the bed (7min on the monitor, 2 contractions, in PERFECT control, with her 2 y/o standing wide eyed in the corner). I was a little bummed about that one, it was total group effort and when we pulled the covers back and saw the head crowning I grabbed the gloves off the delivery table and was ready to catch the baby, had my hands on the head when the laborist walked into the room. 30 seconds from baby catch #2! :( Maybe next time. At least I had gloves on this time! I have learned that 7mins on the monitor 2 contractions and exactly 1 hr from waking up to contractions to delivery is how I want to have MY babies!!!
Topped off the shift with giving report to a VERY grouchy day nurse who was NOT happy about getting antes and somehow it was my fault...go figure.
Moral of the story (in my personal head, but what do I know?):
#1: don't put nurses on call just because you can pull the strings to make it "ok" for the moment (cuz when it hits the fan it hits fast and nurses don't just magically appear when you need them)
#2: It's easier to have an extra nurse and send them home than to not have enough nurses and wait for them to come in
#3: When you're calling nurses in, don't just stick patients in a room and wait for the called-in nurse to take care of them. They're still patients in the 30mins before the called-in nurse gets there...treat them as such! What if my ante had had a nasty/cuttable strip in the hour and a half she was there before I got her? "Someone's coming" is not a reason not to take care of them before that "someone" gets there! Paperwork/orders/computer work goes with it...getting dumped on when you walk in the door is NOT a way to make friends...
#4: No rooms is a good reason not to move patients from L&D to post partum...not being willing to call a nurse to take them is NOT a good reason. We wouldn't tell a laboring mom "sorry, we have no nurse for you" us labor nurses would suck it up and take her and we'd start at the top of the list and start calling...all the postpartum nurses doesn't help us in that situation, so why do extra labor nurses get to "fill in" and take postpartum patients instead of calling in mom/baby nurses? Somehow that doesn't seem to balance out...
#5: The UP side to a DOWN night is that you can always look to starting with a clean slate the next night (or two...)
#6: I did get a workout in before work which was an added bonus, and I got to go in for time and a half when I got called back in :) Car payments here I come!!