I am in a small hospital ICU as the resource nurse. Now when I took this position, the unit I work in was quite different from what it is today. Then we had 4 beds, with 2 patients per nurse. Our days while sometimes very busy and sometimes quite hard, but they were always – doable. The quite hard days were far and few between which allowed us to forget about them easily.
With the advent of Covid-19, however, this has all changed. We have hard days almost every day now. Too many patients are suffering to make positive outcomes the norm. Our hospital decided to open all 8 beds in our unit, and staff accordingly. My job as resource/charge nurse, while simple before, is now becoming difficult. Why? Because all of our nurses are leaving to go to where the money speaks: Covid-19 travel nursing. Honestly, I cannot blame them. The money offered is fantastic compared to a small town hospital. I understand their decision, but it leaves me to train all the new staff.
Today I had 2 orientees and 2 nurses that literally got off of orientation the day before. One of those new nurses is a new grad. One orientee had no ICU experience. We ended up intubating a unstable Covid patient, advocating for a central line for the same patient because the residents were going to wait until the surgeon on-call got out of surgery do put one in and she needed one NOW, doing a lumbar puncture on another ventilated patient (this was attempted the day before unsuccessfully as the doctor pushed the patient so far into the mattress the day before that the tube became bent in half and dislodged. We had to take it out and reintubate), move out two patients to the med-surg floor, receive another med-surg patient that was Covid (no Covid beds on the med-surg floor so the ICU gets them all), received one more ventilated patient that had only one working IV, call a tele-consult for another patient (this process is so time consuming), and we were all. Just. Swamped. We have no CNA, no secretary. The phone rang all day from family members needing updates.
At 1800, one of the residents came up to me and told me that the hospitalist wanted us to prone the slightly stable covid patient we had intubated earlier that day.
And I said NO.
NO. NO, we are not going to prone this patient right before shift change. NO. She was barely stable, barely sedated on drips that were at the maximum level, and her O2 sats were in the low 90s at best…and she was quite the kilogram heavy patient. NO. This is not right time to do this. By the time they got enough staff to go get the proning bed, gown up in PPE, start the paralytic, and go in to flip the patient, it would be well past 1845, a great time for let’s say… the tube getting dislodged? How about a drop in O2 saturation that was fatal, right at the end of the day?
NO.
I have never said no before.
I have always done everything that was asked of me at work. I have never said NO!
I called the supervisor, confessed, and told her how to spell my last name if she needed to write me up.
She laughed and agreed with my decision. And after all the worry that I was making wrong decisions all day long, that little bubble of joy made me feel so much better.
The Nurses' Lounge 