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Oh, and the patients? Well, surprise, there’s no decrease in acuity. We still have all the cardiac and vasoactive drips, our chronic vent, the recently extubated, complicated wound care, blood to give, and those who aren’t too terribly tightly tied and like to climb out of bed and do “face plants” on the floor, not to mention a few who think they have a private duty nurse who will cater to their every whim. This morning we got a call “Can you take a labetolol drip?” (this is a continuous infusion of a heavy-duty blood pressure drug which can take a nasty turn if you’re not careful) and the oncoming charge nurse said “No, not even if we had a bed, which we don’t.” Technically we *might* take such a thing, but it would be dangerous with the number and acuity of our current patient load. Oh, and the category I forgot.the gynormous, those weighing over 300 lbs., who are killing our backs and shoulders.

And how do they justify all this? It’s being done in the name of “productivity,” a model designed by the bean counters who have no clue about what really goes on out here in the world. Everything is measured by some formula which appears to be completely divorced from the reality of caring for the sick. “But we have to make money to keep going!” they wail. Right, and how many of YOU do we need? How much middle management is required to keep an outfit going, and why does the CEO need to make that much money? My dearest dream is that part of the curriculum for all programs in health care administration will include a year actually working as a tech, and at least 6 months closely shadowing nurses in a variety of units. In the best of all possible worlds.but it will never happen.

The result is burnout, despair, and a lot of bodies heading for the door. Our assistant manager left for one of the critical care units; one of our best day nurses took an assistant manager position at a smaller inner-city hospital; another went back to New Jersey; and almost everyone else has applications out or is looking either in the system or out. Of course there’s a hiring freeze on in the system, it being the end of the year and all.

I thought about posting an account of what happened last night, but just thinking about it makes me exhausted all over again, and considering what we might have overlooked is painful. Meanwhile our other 7 patients went unattended, and one nurse was there for nearly 20 hours. ame in for day shift, stayed over for 4, and it was her patient that tanked, so she was there past 1:30 charting. Please tell me how this can be safe?

So this week it’s back to work, and my first night back I picked up a new admit. It seems that the Short Stay unit is pioneering a rapid admissions model, but I hope this patient wasn’t indicative of what they’re going to do, because they didn’t do much of any of the admitting process. That would have been bad enough, but my unit had only 2 nurses for the patients they had, and she made #7.and there was no tech. Needless to say, nobody was very happy. The patient is a 62 year old female with cancer who’s been in either the hospital or rehab since March. She looks far older than her stated age and has already made herself a DNR. At this point she was just sick, diagnosed with pneumonia and a heart rate in the 140s. She was on an amiodarone drip and it didn’t seem to be working all that well. She was also on antibiotics even though her white count was only 6.6, not indicative of bacterial pneumonia (hello, antibiotic resistant bugs!) and basically felt like hell. She just wanted to be left alone.
A couple of other rather unremarkable patients kept me at least somewhat busy. Last night I came back to find she was still there and I also had another patient who was a total train wreck. This one had been in NeuroVascular ICU since January! She’s an old (1999) heart transplant and dialysis patient who showed up on New Year’s Day with altered mental status and seizures. Her course had been one horror after another.brain abscess, craniotomy to drain that, prolonged time on the vent with failure to wean, which led to a trach, blood clots which meant she got a filter to deal with that, PEG tube with feedings which she sometimes did not tolerate, just one thing after another. She came to us on the one day I had off before I started this weekend. And guess which one is NOT a DNR? Last night she refused her 4 am feeding, did not want a bath, and only wanted the bare minimum of care. Well, if I’d been in ICU for 7 months, I wouldn’t want to be messed with either! When you’re in there, someone is always doing *something* to you, there are lights on most of the time, and the noise level can be pretty hideous, if not your alarms, the ones in the next room.who wouldn’t want nights of dark and quiet and minimal messing-with? I personally think baths on night shift are pretty barbaric unless the patient doesn’t really know what time it, and both my ladies were alert and oriented x3 and well within their rights to refuse a 5 am bath.

All this only strengthens my resolve that I will NOT be that kind of patient. I do not want to be in the hospital having things done to me if my outlook is that bleak and I have no better quality of life than these ladies. Of course I don’t want prolonged dialysis either. It’s a tossup whether dialysis or a trach would be worse, but I guess it would depend on how well I could get around. In point of fact, I don’t want either. Just give me my pain meds, leave me alone, and let me go wherever it is I’m going. Thank you very much.