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Flip Side Of The Coin

Hey Summer,

Saw your post regarding ICU bed availability. Let me offer the flip side of the coin. Staffing, just because beds are available does not mean there are nurses to staff them. ICU is normally a 2:1 ration, and for very good reason.

ICU nurses are now being required to take a 4:1 assignment which is not a safe situation. So, patients back up into the ER. Which is also not a safe scene. When an ER nurse has 3 ICU holds and 3 ER patients who are also considered critical until proven otherwise, everyone suffered, I, as an ER nurse do not know all the things an ICU nurse knows, protocols, specific lab values, critical IV drips, etc, etc.

I am trained to see and recognize a wide variety of critical issues, I can multitask in an extremely chaotic situation. Even in the ER it is typically a 4:1 ratio and now we are at 6:1, which means that I cannot provide necessary care to my patients, especially when 2 of my critical patients are in the hallway without the ability to monitor vital signs and cardiac rhythms, not enough IV pumps to go around and you are doing total patient care because there aren’t enough CNA’s/Techs to help you clean and turn patients…

I didn’t mean for this to turn into a rant. Our healthcare system is broken, there are increasingly sick patients no matter what anyone thinks or believes about covid, the reality is that we are overrun with critically ill patients which is bad enough with it all the more minute things that could have gone to urgent care or even waited a week or 2 to see their primary care, or the homeless person that simply wants a warm place to sleep for a couple hours.

Staff that is exhausted and leaving the field which increases the shortage and management/CDA/government/WHO - who don’t really care and/or are making things worse.

The last 2 years have broken me. I have watch more people die in 2 years than the entire previous 8.5 years. I’m expected to do more with less, I’m personally attacked for things out of my control. I work long hours without eating, drinking, or going to the restroom. I have increased health issues and increased back pain from trying to move patients along instead of having the appropriate number of people to help. No matter what kind of shows I wear, my feet are swollen and killing me. I can’t lose weight because stress is so high, and the calories that go in are the ones I can grab in 2 seconds before I fall into bed exhausted at the end of my day exhausted. My brain hurts from trying to assess my patients, and deciding who needs what first, when I simply do not have time or equipment to provide appropriate care to so many sick people.

I do all this with patients yelling at me, cussing at me, sometimes (more and more often) being physically violent - pinching, hitting, spitting, biting….

Families that are angry because their family member is still not received the care the family thinks they need (appropriate or not). Doctors that are yelling because the 50 millionth lab that tacked on hasn’t been drawn yet, meds are late, care has not been given as they want it given, and management that keeps pushing you to take just one more patient.

I have worked tons of hours since this pandemic stated. Two full time jobs at times, overtime, more overtime, and then made to feel guilty by management because I didn’t pick up more overtime.

All this above has made nursing so much more difficult because nurses, CNA’s, RT’s, care so much about the well being of their patients. Not having the supplies or time to care for your patients the way they really need and deserve hurts deep down in the soul. Every day you have to shut off a part of yourself so you don’t care as much about the personal insults from everyone that expect you to magically fix things, and shut off the pain of not being able to care for your patients like you want to.

This summer (2021), I reached my breaking point. I have always made a good ER nurse because I can deal with the problem at hand calms and logically and then deal with my own emotions later. While patients dying is sad, I have always been able to take satisfaction in the fact that our team did everything possible to help save that person and that I had done my best. I never had a patient dying make me cry. The family’s sadness is what always touched my heart.

With everyone stretched way beyond what we should be and resources not available - there isn’t the satisfaction in a job well done. Instead there is a lot of “shoulds”, guilt, and pain. I’ve still done my absolute best with what I’ve been given, but I know it should have been different.

I had a patient in the hallway this past summer (2021). She was old, had surgery recently but pain wasn’t under control. The nursing home sent her in to us for evaluation - IV, labs, vital signs, imaging of her belly, etc. I’m in the hallway pushing meds through her IV frantically because she needs them stat… She just stops breathing. She’s an DNR, and had already said she was ready if it was her time. I had a passing staff member get the doctor. I started crying and couldn’t stop, the feeling of total helplessness when you know it shouldn’t be this way and no one cares.

I took a month off thinking I could get my head straightened out, usually it takes 2 weeks, then I’m okay to go back to work. A month wasn’t enough. I still cry randomly. I’m constantly depressed. I have nightmares regarding work and then can’t go back to sleep. I’m exhausted. I can’t do it anymore and I am leaving the bedside like thousands of my compatriots. Which makes the original issue that much worse.

I am currently working in a 51 bed ER. Tomorrow when I go to work, 30-40 will be admitted patients waiting for a room upstairs. At least 1/3 will be in the ER so long that they will be discharged from the ER having never seen a room upstairs. There will be another 30 lining the halls in whatever stretcher, chair, recliner, or wheelchair we can find to sit them in. There will be another 30 in the waiting room - IVs, labs, imaging done while they wait. They are pulled to triage, given meds and returned back to the lobby. Some will make it back to the ER, and some will be discharged from the lobby.

I really did not intend for that to turn into a rant. I rarely talk about it because honestly, unless you are a healthcare worker people just don’t understand. My co-workers feel the same and are just as stressed. They don’t need my crap on top of theirs too.

Now, I need to get some sleep instead of lying awake dreading the new day.

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