Monday, January 14, 2013

Night and Day

 You've heard that old colloquialism "as different as night and day". Recently I began to believe that this may not be referring to presence or absence of the sun and more appropriately, at least for nurses, as the differences between our counterparts on the opposite shifts.  This has always been an issue I would assume. I have noticed long ago that a certain animosity exists between most shift workers. I feel like I'm just stating the obvious here and that you guys will read this and roll your eyes as if I've been naive up until now. The truth is I'm just now reaching the point where I want to vent about it in a public way.

Let me put a little disclaimer on this. I will be speaking in generalities about hospitals and RNs/CNAs of opposite shifts. It goes without saying that this is about my situation at my hospital and does not reflect the work and professionalism of all nurses at my hospital or in the profession at large.

I work day shift now. I have worked night shift, so you can't pull the wool over my eyes about how "Hard" night shift is. I'm going to be blunt... Night shift is easier in general. Night shift is where we start our new nurses and it's where we keep the ones that are a little bit off. Sometimes a nurse will stay on nights because it's all they've ever done and their sanity surely depends on keeping their circadian rhythm on track. On night shift you have the luxury of not having admin looming around. You don't have to deal with meals, and you have a lot less family hanging around. For the most part, your patients sleep at night. Of course there are exceptions, sun downers being the most obvious. The bulk of medications are given during the day too. At my hospital, which is not a teaching hospital, we do not have doctors around after 5ish with the exception of the OB if delivering, the ER and emergency surgeries. Rounds are done (primarily) between 7 and 9am the exception being new admits who come up after rounds. So, night shift will hardly ever have to interact with a doc in person. Some of our night nurses admit to not even knowing what some of our docs look like. We don't have a unit secretary, at least not the conventional kind. We have a CNA who sits and goes over IV charting and charges for half a shift. We, as day nurses, are responsible for all the orders the providers spew out during rounds. With all of the discharges occurring between the hours of 8 and 5 there are only a couple of night nurses that can even complete a discharge, including house supervisors.

Now for the venting.

On an almost daily basis, I walk in to find night shift sitting and shopping online or watching TV on their phones or some other kind of shenanigans, with food and drinks scattered about. I am then privileged with a half-ass, substandard report on Pts that, if I had worked the day before, sounds almost exactly like the report I gave them, as if they were reading mine back to me. After they leave, I must scour the patients charts to determine what was left out of report. What meds were left not given or were due at shift change and were not given. And I have to do it fast because the Dr is rounding and will no doubt catch these mistakes and I will be the target of his ire and the face he/she associates with utter incompetence. My shift and I have each other's backs. I will take the heat if my aid forgot to chart or even recheck a temp on a febrile pt. I'm always down to turn/reposition the heavies. And we will answer any call light. That's how we operate, that's our mentality. It is OUR shift and OUR patients. This sense of fellowship or camaraderie was not present when I worked night shift. It was more of an "Us against the world" attitude. Most of them carry some form of chip on their shoulder for the day shift. One reason for this may be because we are generally staffed with more people, but this is only due to the increased work load. Also, recently they implemented a new policy that made night shift responsible for pulling day shifts AM meds (0730-0900) with the exception of any controlled or refrigerated meds and place them in a locked alcove outside of the patients room. This was met with great resistance from both shifts. Nights, obviously, didn't want to have to do it, but the day shift didn't trust night shift to do it correctly and would rather have the extra workload. Admin countered by adding that Day shift must pull night's meds as well from the same time frame. That was met with more resistance. It now stands, at least in policy, not necessarily in practice, that nights pulls AM meds and Days doesn't pull Night's meds. As either a subconscious or passive aggressive form of rebellion it seems that our meds in the AM are almost always wrong. A few nurses absolutely protest doing this.

Most recently, yesterday in fact, I came in for report on 4 repeat patients from the day before and 2 new patients. I noticed in report that one of the repeat patients IV fluids had been stopped and saline locked. Knowing damn good and well that they didn't call the Dr to DC the fluids I asked why the patient was saline locked. I was told that while turning the patient another nurse told her that she thought the patient was saline locked on a previous shift she had worked. So, without checking orders, they simply saline locked the patient and left. WITHOUT CHECKING THE ORDER! Who does that? This is a hospital! This is a new day! Things change, orders are made, treatments are adjusted! This and the STATUS QUO dept! PAY ATTENTION! I know it is a small thing. Hey, it was only running maintenance fluids at 40/hr. But what if it were something else? What if it were vitally important. What if we were running 1/2 NS with 40meq of KCL at 125/hr to correct a low potassium level and they had shut it off and the next shift didn't catch it, then they reported that the patient was saline locked and lack luster noc shift accepted it without question. That's 36 hours at 125ml/hr which is 4500 mls with 40 meq per liter that's 180meq of KCL that the patient didn't get. One day they said, I don't know if the Pt is A/O they've been asleep all night. Turns out they weren't asleep they were unresponsive. THERE IS A FUCKING DIFFERENCE BETWEEN ASLEEP AND UNRESPONSIVE!

Last night after giving report to an eye-rolling, teeth-sucking, sighing, sarcastic, bitter nurse, I began to report off to another and I overheard the other saying that she "wasn't even going to go in a room tonight." ARE YOU SHITTING ME! It's like my whole shift of hard work is negated by their shift of laziness.

Again, I am venting, this is about my hospital, and even within my hospital it is primarily only a few nurses that are responsible for all of this rant.

But it can't be just me that is noticing something like this. I'm not just being negative, right? I feel better already having gotten that off my chest.

Thanks for reading,

As always follow me on twitter @MurseWisdom
Also follow @MurseMafia @That1Murse @JustSomeMurse