We’re all familiar with the insane nursing shift, the one that brought a TV shows worth of drama and unexpected catastrophe all before you ate lunch that day, the one you won’t soon forget. While many patients and situations follow conventional patterns, humans, the business of healthcare, are inherently unpredictable and often choose to exercise that distinctive quality at the seemingly most inconvenient moment. The range of disturbances can vary from a minor disruption like a patient vomiting in the middle of shift report to a random line of V-Fib resulting in a messy code and a tragic death. We can’t control our patients or foresee the various ways they surprise us on a daily basis and so we learn to evolve in our profession in order to maintain our sanity. As nurses, we become intimately accustomed to the frantic and indeterminable pace of life in our unit and come to expect the unexpected. It’s always better to be prepared for the worst.
Humans aren’t programmable like a computer or machine. They don’t fit a mold and for the most part, can only be generalized in the broadest fashion. Each one is unique from the start and only develop more idiosyncracies along the way including mental problems, chronic conditions, and self-care deficits. People are literally constantly moving and changing as cells duplicate and die, babies are formed and grow, and cellular mutations arise. With so many actions and reactions occurring in people’s bodies every second, it’s not surprising that we often hear unexpected news or detect a suddenly abnormal lab value. It’s actually amazing that so many aspects of our nature go according to plan.
We are all too familiar with our own changes as we have a growth spurt or detect a new wrinkle or realize we can’t run as quickly as we used to as a teenager. Because we understand the human condition personally and because we’ve been wired to respond to challenges with solutions, we can define ourselves as nurses as human problem-solving experts. Sometimes I think nearly everything I do in a twelve-hour shift is responding to one problem after another.
As nurses, we learn to input new information, form a plan of action, and adapt to the changes. A nurse with honed critical thinking skills, the seasoned ability to process information quickly and respond correctly, is worth his or her weight in gold. Many brand-new physicians owe their success (and prevention of killing someone) in their first years of practice to such aptly observant and smart nurses.
As a novice nurse right out of school, you probably don’t already possess those critical thinking skills. Those specific talents can be taught to some degree but are mostly developed and refined through experience. After working for five years on your unit, you now know how to easily handle a situation that would’ve sent you into a panic attack your first several months. Compared to your innocent days, you now know how to talk to difficult patients and get them to comply with a suppository. You’ve inherently absorbed the ability to manage predicaments that would’ve sent you to the bathroom crying previously. Like any profession, nursing hopefully follows an upward curve, with more experience leading to more knowledge and better patient care.
When I first started in the ICU, I was terrified of starting an IV line, mostly because I hadn’t gotten much experience in nursing school. After a few epic failures at the cost of my patients, a kind coworker pulled me aside and showed me where I was operating in error and how to insert the catheter effectively. Thankful for his instruction, I gained a skill that had otherwise been obtuse to me. Months later, I was struggling to keep my patient’s IV line patent as he kept bending his arms and thrashing about in the bed. Rather than trying to insert another line somewhere besides the crook of his arm or use a more effective restraint, I sat at the bedside encouraging him to remain still and restarting the pump every few minutes like a well-qualified babysitter. Even later in my career, I received a patient with absolutely horrible veins, attempted several sticks, then stopped completely, paging the doctor to inform him that I needed more advanced access.
Can you see the progression? As with any job where you start from the bottom, you learn basic skills then develop more eloquent ways of using them to solve your problems. In the beginning, I wouldn’t have recognized that my patient with horrendous veins needed a central line rather than sticking him ten or twelve times. I didn’t have the mental and physical resources to come up with an alternative solution that would’ve proven more beneficial for both my patient and me. I was green and nervous and now I would like to say I’m much more confident, although you’ll never know all the answers. There’s always room to learn.
One particular day will stand in infamy in my mind. I was new, inexperienced and submerged deep in a host of problems much too complex for me at the time.
I received an admission from the ED, a teenager who had swallowed a bottle of pills in a desperate but ineffective attempt at attention. While they had intubated him downstairs and pumped his stomach full of thick, black charcoal to absorb the overload of medications, the tubes and lines only agitated him more. He came up thrashing about, yanking at the restraints with all his available strength and looking at me with manic eyes. With the help of my coworkers, we managed to stifle him with more IV medications and he drifted off into a sedated sleep. Not quite trusting him, I frantically charted an assessment, keeping one eye on his four soft restraints.
Then I turned to my patient in the opposite room.
In the midst of the drama with the teenager I had almost forgotten the depth and magnitude of pain throbbing at the next bedside. A man had suffered a stroke, one that the doctors deemed “incompatible with life.” They offered no surgical option and no medication could be tried. As the pressures built up in his brain, the life was literally being squeezed out of him. And we were all helpless to do anything about it.
His family wailed at the bedside. They laid hands on him, pleading with God for a miracle, some sign of a chance. They wrestled hope desperately, trying to catch it before it slipped away completely. As I tiptoed around the room, trying to be quiet and respectful, more visitors arrived. Then more, and then more. I believe the entire church had stuffed themselves between the cloth curtains as I stood innocuously outside of the room. I wanted to give them their privacy and give the patient the respect owed to a dying man. So I let them gather and pray and didn’t interrupt.
Meanwhile, my teenager awoke in a fury. Banging his hands and legs against the bed, he raised his head up and I saw the inevitable with awful dread. With a thrust of his stomach, he began spewing black charcoal out of his mouth, out his NG tube and onto the bed like a scene out of a horror film. The black spread everywhere instantly as we rushed towards him, trying to keep him from hurting himself. An IV came out along the way and blood entered into the mix. As my coworkers and I grabbed at any available flying limb, one nurse clamped down on my arm with her bloody glove, gripping it with all her strength.
“Yeah, that’s my arm, not his.”
“Oh sorry! That’s gross.”
I washed my arm as someone gave him more medications.
Directly opposite, my dying patient’s family members grew louder and louder, wailing and screaming and beseeching God. Someone started chanting in another language and my coworkers stared at me. I was afraid someone was going to produce a snake out of a purse. With one hand still on my teenager, I panicked, unsure of how to proceed. The disruption was growing to a disturbing level and I felt solely responsible.
My teenager vomited black charcoal violently, staining the room with the mess.
The family members yelled and shrieked at an unmanageable volume.
There was too much noise, too much overstimulation!
And I simply stood in the hallway between the two rooms, literally helpless against the situation. I couldn’t help but laugh, as I truly didn’t know how to handle two such dramatic instances at once. How did I get myself here? What did I sign up for in taking this job? And could you ever imagine such a horrible day as this one?
My manager heard the commotion and came out of her office. After glancing between my patients, she immediately called the charge nurse and someone came to relieve me. It was three in the afternoon and I hadn’t eaten lunch or gone to the bathroom since the start of my shift. She jumped into action, knowing intuitively what I didn’t. She had the benefit of experience that was still foreign and vague to me. I had problems that, with my limited knowledge, I couldn’t solve on my own. I needed help and thankfully, found it at the hands of those around me.
We’ve all had those overwhelming days, those stories you will tell at family gatherings for years to come. We’ve gone home and cried, or called in the next day, unable to face it again in the midst of our exhaustion. We’ve thought maybe we were crazy in signing up for this profession. No one said it was going to be easy. No one said it would come naturally. But as the years and months pass, as we grow more proficient at managing the insanity around us, we become better people, better nurses. We learn to solve problems of every shape and size and do it well.
And as a concurrent benefit, you’ll always have a good story to tell, those stories you will never forget.