Yet I wouldn't change my career for the world (maybe for $45million & Tom Welling)
Most of you know I am now a (grown-up?) nurse. I work in a tertiary neonatal intensive care unit which means very early premies (23 weeks & over), congenital disorders/diseases, & babies born with disorders/disease passed maternally (substance abuse, diabetes, viruses, etc). Some kiddies need 1:1 care; at most, there can be 3 babies to 1 nurse. The past few years weeks, the unit's been short-staffed, especially at night. This means sometimes, one or two unlucky schmucks have an increased patient load. Usually, the least acute babies can be given to one or two nurses. You don't want a nurse's attention split when s/he has to take care of a baby receiving 5 types of drugs, on a ventilator, in an incubator with skin so fragile you can't wipe their bums without breaking it.
Being that I'm not yet trained to work with severely sick patients, I take care of the "light" kids. The ones who're maybe days or weeks from going home. They just need to learn a few things like controlling their temperature or eat as opposed to receiving food through a tube or remember to breathe/keep their heart rate up. Compared to their roomies, they're coasting. So, yeah, short-staffed nights means me & one other new grad get the 7-8 "light" babies.
This is the sub-acute side of the NICU.
There are 2-3 nurses a pod. You go on break opposite your podmate & look after their patients while they're gone. When you DO go on break, you try to get all the important things like meds & feeds done so you podmate doesn't go crazy having to feed/medicate 6-8 kiddies all at once.
The numbered kiddies are my patients. The others in light purple are of the same level of care. The orange are one level higher. The dark orange are one above that. The ones that're smushed together are twins who're co-bedding in the same crib.
This is how my last night went.
Time: 1845 hours
I know I'm getting 4 patients again but, oh, look it's a different 4 patients than I had last night. Get report from dayshift. All the babies eat every 3 hours. No parents visiting tonight (thank goodness, love them, but they're like having an extra set of patients and oh.my.GOD it doesn't need to take that long to change a frakkin diaper, I have things I need to get finished & also while you're dithering, your baby's temperature is dropping which probably means he's going to have a non-breathing spell). Baby 1 bottles every 3 hours. Baby 2 alternates between bottle & tube. Baby 3 only tubes & is in an incubator. Baby 4 bottles & tubes. Everyone eats every 3 hours which means 2100, 2400, 0300 & 0600. Okay, I get first breaks. Woot? No one in a crib is getting their beds changed; sorry, no time & it's not visibly soiled. sorry, sorry, sorry. Check bedside safety equipment on all bedsides. Roll up linens for Baby 3's nest. Roll up towels for Baby 2 because he's too big to be in a nest, no wonder he's temping high. Baby 1 has formula; measure out 4 feeds, label with name, date, time & type of forumla. Babies 2-4 need supplements in their milk, pour out milk in proportions required for supplements, pour out supplements, have someone double check my calculations & co-sign, mix, then pour out required amounts for feeds. Label with name, date, time, type of feed & meds in each feed.
1945: Close enough. Baby 1 is temped (temperature taken), assessed (fontantelles, heart, lungs, belly, muscle tone, anything else? no? chart, move on), diapered --GASSY BABY-- weigh naked, re-dressed bundled, pop in a soother. shush, baby, shush, Move to Baby 3. Temp, assess, diaper, weigh naked, dress, clean incubator while baby is in dresser drawer-- this is safer than putting a baby in a sofa which is too soft & will smother them. Baby 3 back in incubator, belly down-- ONLY in the hospital where she's attached to a monitor which will tell us if she's not breathing--, soother in mouht, shush, baby, shush. Move to Baby 2, holy shit, it's 2030, temp, assess, diaper, weigh naked, dress, clean cot which baby is in dresser drawer, back in cot, soother, shush. Move to Baby 4, tempt, assess, diaper oh shit oh shit, stop pooping while your diaper's off you silly little monkey, okay diaper AGAIN, weigh naked, soother, shush.
2100: Fetch milk.
Warm all the milk in the buckets while charting. Attach Baby 3's tube to a syringe barrel, pour milk in barrel, hang barrel overhead. Drag rocking chair to bedside so I can bottle Baby 1 at Baby 3's bedside because technically, you shouldn't leave gavage feeds in case they aspirate (breathe it into their lungs). Baby 3's crying & hungry, pop soother in his mouth with one hand while burping Baby 1 with the other, yes, it can be done because I AM MAGIC, Baby 1, why do you need to burp every 10 mls? Burp, burp, burp, done, not quite asleep, sorry, sorry, sorry Baby 1 back in bed with a soother. Baby 2 needs to eat but he only has enough strength to bottle for half the feed. I have to tube the rest. Burp, burp, burp, bundle sleep. Baby 4's turn, also too young to finish the whole thing, it's okay, you make funny faces, burp burp, gave, burp they go to sleep & all of a sudden it's 2200.
Gulp dinner. Feet up. Look at Twitter. Listen to "Breathe Again."
2300: Chart. If you don't chart, it didn't happen & 20 years from now when someone sues the hospital/doctors/RNs, it could come down to this piece of paper make sure your hand writing is legible why don't we have enough pens in this place holy shit it's 2330? Fetch all the milk. Warm all the milk. Baby 1 is temped, changed, assessed. Baby 3 temped, changed, assessed, Baby 2 temped, changed, assessed. Baby 4 temped, changed, assessed. Hang Baby 2's feed. Bottle Baby 1. Podmate is on break & her baby is desatting. Burp Baby 1 while quick walking to the other incubator, silence the machine, rub Other Baby's back, breathe honey perk up come on yay! continue to bottle Baby 1 then put him down on his crib. Baby 2 gets a gavage this time, he didn't even wake up for the diaper change. Baby in another pod is desatting probably 'cause she hates her CPAP & is trying to crawl away from it. Quick walk to the other pod, silence the machine, push Other Other baby's arms down under her body & yell for a respiratory therapist to please help because I don't quite know what to do with this machine. One of the nurses is free; she offers to finish feeding Baby 3 YAY. Feed Baby 4 thank goodness you're back podmate what it's almost 0100? Podmate's Other Other Other baby popped his IV out & needs help starting anew one but her veins are itty bitty teeny weeny & after 2 tries, we need someone else. Chart or it didn't happen & it's 0115.
Find a blanket. Go in lounge. Nap for 45 minutes. Wake up. Sigh. Why is all the coffee gone?
0200. New med profiles are here. Check med profiles against doctors orders. Old profiles in the shredder, old notes in the chart, stamp her sheets for the next day because we didn't have a unit clerk in the afternoon either & only 2 of the nice unit clerks stamps our sheets for us. Baby feeding cycle begins again except Baby 3 has 2 bradycardic episodes & 4 apical dips, tap on the incubator to wake her up because my hands are too full to rub her back and it works except for that one episode where I had to put the other baby down-- I forget which one-- and go in there to reposition her. Other babies are ringing. Wake them up, rub, rub, rub, fix the CPAPs, HAI RESPIRATORY THERAPIST, Baby 4 has the neverending poo AGAIN. Labour & delivery called, they need to do an emergency C-section, WE ARE FULL WE'RE GOING NUTS-- but baby is decelling-- OKAY, OKAY, TRANSFERRING YOU TO SOMEONE IN CHARGE-- except no one's actually in charge because we're short-staffed & the charge nurse has to take patients so I foist the phone off to the nearest coworker I can snag sorry sorry sorry it's 0415.
Lounge. Nap. CONTEMPLATE RUNNING AWAY but that would leave the coworkers in a lurch & they're nice & also I have to go back in 5 days. Decide to eat ALL THE PIE when I get home. If I get home. Contemplate sleeping in the car in the parking lot after nightshift.
0500: Milk. Assess. Feed. Desat, bradys, wake-up baby, breathe, remember not to chill out so hard, rub rub rub their backs, reposition, burp. Chart. 0630 already? Dayshift coming. Dayshift coming & I haven't had time to check the computer to see if all the bloodwork orders have been sent to the lab because we didn't have a unit clerk but it's okay, Katt, says Dayshift, we knew it was crazy, you just go home after report how did you feed 4 babies on a 3-hour schedule?!
I grin maniacally. "I AM MAGIC!"
0710: I'm blinking at my locker.
0715: I remember I have to get dressed into street clothes.
0745: How did I get home & why is there pie in my mouth? omnomnom.
0800: Dozing while peeing.
0805: In bed.
Being that I'm not yet trained to work with severely sick patients, I take care of the "light" kids. The ones who're maybe days or weeks from going home. They just need to learn a few things like controlling their temperature or eat as opposed to receiving food through a tube or remember to breathe/keep their heart rate up. Compared to their roomies, they're coasting. So, yeah, short-staffed nights means me & one other new grad get the 7-8 "light" babies.
This is the sub-acute side of the NICU.
There are 2-3 nurses a pod. You go on break opposite your podmate & look after their patients while they're gone. When you DO go on break, you try to get all the important things like meds & feeds done so you podmate doesn't go crazy having to feed/medicate 6-8 kiddies all at once.
The numbered kiddies are my patients. The others in light purple are of the same level of care. The orange are one level higher. The dark orange are one above that. The ones that're smushed together are twins who're co-bedding in the same crib.
This is how my last night went.
Time: 1845 hours
I know I'm getting 4 patients again but, oh, look it's a different 4 patients than I had last night. Get report from dayshift. All the babies eat every 3 hours. No parents visiting tonight (thank goodness, love them, but they're like having an extra set of patients and oh.my.GOD it doesn't need to take that long to change a frakkin diaper, I have things I need to get finished & also while you're dithering, your baby's temperature is dropping which probably means he's going to have a non-breathing spell). Baby 1 bottles every 3 hours. Baby 2 alternates between bottle & tube. Baby 3 only tubes & is in an incubator. Baby 4 bottles & tubes. Everyone eats every 3 hours which means 2100, 2400, 0300 & 0600. Okay, I get first breaks. Woot? No one in a crib is getting their beds changed; sorry, no time & it's not visibly soiled. sorry, sorry, sorry. Check bedside safety equipment on all bedsides. Roll up linens for Baby 3's nest. Roll up towels for Baby 2 because he's too big to be in a nest, no wonder he's temping high. Baby 1 has formula; measure out 4 feeds, label with name, date, time & type of forumla. Babies 2-4 need supplements in their milk, pour out milk in proportions required for supplements, pour out supplements, have someone double check my calculations & co-sign, mix, then pour out required amounts for feeds. Label with name, date, time, type of feed & meds in each feed.
1945: Close enough. Baby 1 is temped (temperature taken), assessed (fontantelles, heart, lungs, belly, muscle tone, anything else? no? chart, move on), diapered --GASSY BABY-- weigh naked, re-dressed bundled, pop in a soother. shush, baby, shush, Move to Baby 3. Temp, assess, diaper, weigh naked, dress, clean incubator while baby is in dresser drawer-- this is safer than putting a baby in a sofa which is too soft & will smother them. Baby 3 back in incubator, belly down-- ONLY in the hospital where she's attached to a monitor which will tell us if she's not breathing--, soother in mouht, shush, baby, shush. Move to Baby 2, holy shit, it's 2030, temp, assess, diaper, weigh naked, dress, clean cot which baby is in dresser drawer, back in cot, soother, shush. Move to Baby 4, tempt, assess, diaper oh shit oh shit, stop pooping while your diaper's off you silly little monkey, okay diaper AGAIN, weigh naked, soother, shush.
2100: Fetch milk.
Warm all the milk in the buckets while charting. Attach Baby 3's tube to a syringe barrel, pour milk in barrel, hang barrel overhead. Drag rocking chair to bedside so I can bottle Baby 1 at Baby 3's bedside because technically, you shouldn't leave gavage feeds in case they aspirate (breathe it into their lungs). Baby 3's crying & hungry, pop soother in his mouth with one hand while burping Baby 1 with the other, yes, it can be done because I AM MAGIC, Baby 1, why do you need to burp every 10 mls? Burp, burp, burp, done, not quite asleep, sorry, sorry, sorry Baby 1 back in bed with a soother. Baby 2 needs to eat but he only has enough strength to bottle for half the feed. I have to tube the rest. Burp, burp, burp, bundle sleep. Baby 4's turn, also too young to finish the whole thing, it's okay, you make funny faces, burp burp, gave, burp they go to sleep & all of a sudden it's 2200.
Gulp dinner. Feet up. Look at Twitter. Listen to "Breathe Again."
2300: Chart. If you don't chart, it didn't happen & 20 years from now when someone sues the hospital/doctors/RNs, it could come down to this piece of paper make sure your hand writing is legible why don't we have enough pens in this place holy shit it's 2330? Fetch all the milk. Warm all the milk. Baby 1 is temped, changed, assessed. Baby 3 temped, changed, assessed, Baby 2 temped, changed, assessed. Baby 4 temped, changed, assessed. Hang Baby 2's feed. Bottle Baby 1. Podmate is on break & her baby is desatting. Burp Baby 1 while quick walking to the other incubator, silence the machine, rub Other Baby's back, breathe honey perk up come on yay! continue to bottle Baby 1 then put him down on his crib. Baby 2 gets a gavage this time, he didn't even wake up for the diaper change. Baby in another pod is desatting probably 'cause she hates her CPAP & is trying to crawl away from it. Quick walk to the other pod, silence the machine, push Other Other baby's arms down under her body & yell for a respiratory therapist to please help because I don't quite know what to do with this machine. One of the nurses is free; she offers to finish feeding Baby 3 YAY. Feed Baby 4 thank goodness you're back podmate what it's almost 0100? Podmate's Other Other Other baby popped his IV out & needs help starting anew one but her veins are itty bitty teeny weeny & after 2 tries, we need someone else. Chart or it didn't happen & it's 0115.
Find a blanket. Go in lounge. Nap for 45 minutes. Wake up. Sigh. Why is all the coffee gone?
0200. New med profiles are here. Check med profiles against doctors orders. Old profiles in the shredder, old notes in the chart, stamp her sheets for the next day because we didn't have a unit clerk in the afternoon either & only 2 of the nice unit clerks stamps our sheets for us. Baby feeding cycle begins again except Baby 3 has 2 bradycardic episodes & 4 apical dips, tap on the incubator to wake her up because my hands are too full to rub her back and it works except for that one episode where I had to put the other baby down-- I forget which one-- and go in there to reposition her. Other babies are ringing. Wake them up, rub, rub, rub, fix the CPAPs, HAI RESPIRATORY THERAPIST, Baby 4 has the neverending poo AGAIN. Labour & delivery called, they need to do an emergency C-section, WE ARE FULL WE'RE GOING NUTS-- but baby is decelling-- OKAY, OKAY, TRANSFERRING YOU TO SOMEONE IN CHARGE-- except no one's actually in charge because we're short-staffed & the charge nurse has to take patients so I foist the phone off to the nearest coworker I can snag sorry sorry sorry it's 0415.
Lounge. Nap. CONTEMPLATE RUNNING AWAY but that would leave the coworkers in a lurch & they're nice & also I have to go back in 5 days. Decide to eat ALL THE PIE when I get home. If I get home. Contemplate sleeping in the car in the parking lot after nightshift.
0500: Milk. Assess. Feed. Desat, bradys, wake-up baby, breathe, remember not to chill out so hard, rub rub rub their backs, reposition, burp. Chart. 0630 already? Dayshift coming. Dayshift coming & I haven't had time to check the computer to see if all the bloodwork orders have been sent to the lab because we didn't have a unit clerk but it's okay, Katt, says Dayshift, we knew it was crazy, you just go home after report how did you feed 4 babies on a 3-hour schedule?!
I grin maniacally. "I AM MAGIC!"
0710: I'm blinking at my locker.
0715: I remember I have to get dressed into street clothes.
0745: How did I get home & why is there pie in my mouth? omnomnom.
0800: Dozing while peeing.
0805: In bed.