NURSES' STATION 101: THE FRONTLINE, FLATLINES, AND BURNOUT (eBook)

Introduction:
Did I Really Sign Up for This?

It’s 05:00 a.m., dark outside, and I’m still half asleep. As I walked down the hall to the elevator to report to my unit, I was overwhelmed with that familiar smell of the hospital that I never got used to during all of my clinical rotations in nursing school. That hospital smell. What was it? Probably the industrial chemicals that are used to cover up fluids and smells that are hard to cover up. It was kind of unsettling to me. Well, it was a familiar smell that lingered in my nose and caused a bit of anxiety because it reminded me of where I was, and that I finally made it. Each new day that I walked down that hall I was reminded that I was not a nursing student anymore but a newbie registered nurse. A registered nurse with a full six months of critical acute care hospital experience. Wow! I made the six-month mark. Having just graduated from my program with high honors, I thought I might know a thing or two and that I would conquer the world of 6 North, which was a very progressive step-down open-heart unit located in a level one regional trauma center, and it was also my very first job as a brand-new nurse.

On this day, I felt more anxious than I usually felt reporting to my unit. It was my first time being in charge. I felt overwhelmed with this responsibility that was suddenly thrust upon me. I kept overanalyzing why they put me in charge as a very new nurse in a very critical unit. Was it because I was a male in a profession dominated by females? Oh no, that would be construed as sexist, right? Was it because I was smart or serious about doing the job? Maybe, it was because they just didn’t have anybody else that wanted to do it. Nevertheless, today it was on me. Who knows why I was chosen, but it was my job and I had to stay focused. I made a concentrated effort to keep my hands from shaking as I made the assignment. I didn’t feel like I knew enough to be in charge. In an instant, a million worst-case scenarios flashed through my head. What if I didn’t assign a nurse to a patient and the patient didn’t receive care, or important treatments were delayed, or worse yet, completely missed. I kept running scenarios in my head as I tried to focus on the task at hand. Anyway, our patients were critical, and I had to keep in mind their acuity levels while also focusing on our staffing ratios, skill mix of the staff, ancillary personnel, late calls, sick calls, etcetera.

Our surgery program averaged about seven hundred open hearts per year. The step-down unit that I worked in was directly connected to the heart surgical intensive care unit (ICU), and many patients were “fast-tracked” out of the ICU to us. These patients were often transferred with their atrial and ventricular wires coming out of their chest so that in an emergency, we could connect them to a digital external pacemaker. Many times, our patients were transferred to us with their wires already connected to the pacemaker. In this instance, in a handoff report, we were notified that sometimes the patient had no underlying heart rhythm and that they were totally dependent on the functioning of this pacer and on the nurse’s vigilance in monitoring the patient. Oh yeah, we were really very serious about getting a good report and knowing the functionality of these external digital pacers. They reminded me of those big bulky cell phones from the eighties, except these bulky devices were attached directly to patients’ hearts, so you don’t really want a dropped call if you know what I mean. Always know where the backup batteries are and what button to push for the asynchronous pacing mode!

Okay, back to the assignment that I had made. Every patient was assigned a nurse. Check. Followed nurse-patient ratio guidelines. Check. Monitored for sick calls, so far there was none. Check. Wow! This was not so bad. My hands stopped shaking, and I perceived some silence and calm at the nursing station. The evening nurses were in rooms delivering their last medications and ordered treatments. As I paused to look up at the assignment board to triple check my work, I heard a nursing assistant scream from the patient room directly across from where I was standing. She screamed and she screamed loud: “Help! Help!” I felt my anxiety return one hundred-fold, except this time my anxiety was fueled by pure adrenaline coursing through my veins. As I ran toward the room, I could feel the intense heat from my face as I began to get flushed. My heart started to pound. This was no ordinary pounding; it felt as though I could feel my heartbeat in my throat. As I entered the room, I saw the nursing assistant fruitlessly trying to prop up a patient that was lying on his right side, facing me. I didn’t hesitate as I moved quickly into the room toward the patient. The room was dark. As I moved in closer, I could see that the patient’s monitor was off. His telemetry pack was lying on the floor. I started to be able see the patient’s color. He was blue. And as everyone is aware, blue skin and blue lips are not a good color for a person unless you are working in Vegas with the Blue Man Group. As I approached the patient, it was obvious that he was not breathing. I leaned into him to assess for a carotid pulse as I simultaneously darted for the code blue button behind him. I pushed the button and set the alarm off. He was still warm as I was trying to find his pulse. I did not feel one. The nursing assistant continued to yell for help as the code blue alarm was flashing and ringing in concert with her cries for help. This was disconcerting, to say the least. I yelled to the nursing assistant to grab the crash cart, and her response was to stand still and continue to yell for help. I struggled to turn the patient to a supine position. I started cardiopulmonary resuscitation (CPR) while thinking, where is the code team?! It felt like an absolute eternity. Why was no one else here? Why was no one responding to this code? The code blue alarm siren felt absolutely deafening to me, somebody must have heard it. And I can’t imagine that somebody could not hear the screaming nursing assistant. She was louder than the code blue siren. Finally, as I continued compressions, a very experienced heart surgical respiratory therapist came in with the crash cart. He started to give me directives. He seemed calm and nervous at the same time. Is that even possible? His hands were not visibly shaking as mine were. He directed me that he would continue CPR and that I would need to attach the patient to our crash cart monitor. I attached the patient to the monitor, then I quickly kept checking the connections because I could not see a rhythm on my screen. The respiratory therapist firmly reminded me that I needed to turn the monitor on. Oh yeah, right. So, I did while uninterrupted CPR was in progress. We paused to check the patient’s rhythm. I, as a new registered nurse, had very recently completed my Advanced Cardiac Life Support (ACLS) certification. I needed that certification to work in this unit. Through that certification, cardiac treatment algorithms were drilled into our heads. We relentlessly reviewed our rhythm strips so that we could easily identify what these life-threatening dysrhythmias looked like. But studying those rhythms in a book and seeing it in real life right in front of you was a totally brand-new experience for me. What I was seeing on that monitor, I could very easily identify. But this time, that monitor was attached to a human being and not a simulation device. It was very clearly ventricular fibrillation, up close and in person. I had a sudden epiphany. This person was technically dead. The rhythm on the screen wasn’t a simulation; it was coming from the man lying in front of me. This was someone’s relative. Someone’s father, brother, or husband. It was very clear—he needed our interventions immediately. Ventricular fibrillation is an unorganized heart rhythm that does not produce any cardiac output, meaning no pulse, and the first line of treatment to convert ventricular fibrillation into an organized life-giving heartbeat is defibrillation. The respiratory therapist looked at the screen, then looked at me, and said, “You need to shock him. You need to shock him now.” Back in the day, our crash cart brand was the “Code Master.” It was a bright-yellow monophasic defibrillator with the old-school paddles that were more commonly used at the time, and we delivered what was called stacked shocks, meaning three stacked shocks that ranged from a dose of 200 joules up to 360 joules. The level of joules equates to the defibrillation dose or the amount of the electrical current you are going to administer to the patient’s heart. As I was looking to set the appropriate joules on the turn knob, the respiratory therapist exclaimed to turn the knob all the way up to the right and hit the charge button. My hands were shaking even worse now, but I was able to maintain my composure and do just that. He continued to instruct me to pick up the paddles and apply them to the patient’s chest while not touching the patient. He kept repeating to hit the charge button. “Hit the charge button!” he repeatedly droned. I did as I synchronously applied the paddles to his right upper chest and the apex of his heart. I strained to see through the profuse sweat falling off my forehead all the while listening to that escalating sound the machine makes when it is actively charging. He then emphatically said to shock him. He continued to instruct me to press the two buttons located on the top of the paddles. “Lean into it, don’t touch the patient, and press the buttons now!” I did. I felt the energy in my hands, discharge from the...