The Night Shift

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I started working the night shift many moons ago… a new grad rite of passage. I had to get through one year- and then a day shift position would open up, they said. So for a year, I worked the zombie shift. With a one year old at home and limited childcare, I was always sick and sleep deprivation took on a whole new meaning. It became a lifestyle. I couldn’t wait for my year to be up and to be able to work “normal hours”.

While I waited that transition period out, I went about achieving my goal – “To be the Best OB nurse that I could be”. I stared at the experienced nurses with starry eyes… “One day I want to be like them”. I longed for their wisdom and efficiency. I wanted to run an OR like a boss. I wanted to propose a new plan of care to a provider and have them take it because it was a good one. I wanted to perform exams with accuracy and not feel the need for someone to check behind me all the time. I wanted to do a delivery without tearing up. I wanted to feel relaxed in an emergency and resuscitate a baby without feeling like I was gonna to shit my pants. On my downtime, I practiced the things I struggled with, studied strips, asked providers for the reasons and thought processes behind the decisions they made and grilled the veterans for their pearls of wisdom. If I was lucky, someone would break out a diagram or draw me a map… and if I wasn’t, I was chastised.

By the time my year was up and a day-shift position was posted, I had fallen in love with the staff who taught me how to nurse. I had come to rely on them, knowing that the second I pulled the emergency bell, they would magically be by my side to guide me. So I stuck it out a little longer. My physical ailments of working nights had begun to work themselves out and I decided I wanted to gain more experience and a higher level of comfort before I moved to a different group of staff.

As I gained more experience I came to discover the treasures buried in this shift.

Labor knows no bedtime and babies come when they want to. Providers go to sleep and go home at night, often times because they hold office hours in the morning. So, you are forced to think and act. In the quiet of the night, you become autonomous. Without a provider immediately ordering you what to do, you begin to develop plans of care on your own and suggest them for the doctor/midwife’s approval when you call. Assessments and exams fall to the nurses and with all the practice, you become very comfortable with the tasks that would normally fall to residents at other hospitals. You catch babies when patients arrive late in their labor. Surgery is never scheduled and the chaos of taking a patient to the OR at 3am becomes a learned dance. You are the eyes and ears of the doctors when they aren’t there. Your senses become highly tuned to the early signs of a problem because a baby and a mom’s life depend on you.

Administration are in their beds. Resources outside the unit are scarce and by default, your coworkers become your right hand. Providers aren’t hanging around watching your monitors. You can’t call for back-up staff at 3am or ask your manager to leave a meeting for a unit emergency. You learn how to “figure it out” when it’s busy and how to stay awake when it’s slow.

So here I am, 12 years a night shift OB nurse and I wouldn’t have it any other way. The aspects of the shift that at first terrified me… in the end… have gifted me with experience and skill, confidence and character. I have learned when to not “bother” doctors and when to “demand” them, so as to advocate for my patients. I’ve had the joy of delivering a patient’s baby and doing it well, and the privilege of holding their hand and wiping their tears when the outcome wasn’t good but a provider wasn’t there yet to break the bad news. I have prepped and pushed a patient into the OR before the surgeon was on the floor. I’ve accompanied a high risk patient in transport via ambulance to another hospital because OB nurse transporters weren’t available at night. I’ve run for 12 hours straight without a bathroom or a meal break because there was no help to be had. And I have proudly performed a variety of dance and music numbers for my coworkers when things were slow… it works much better than caffeine! (Ethics discussions and random polling are also engaging for the sleepy mind). But mostly, I’ve gained the respect of providers and nurses alike and achieved the goal I set as a new nurse.

In the blink of an eye, I am the veteran…pushing my baby birds out of the nest to fly as new L&D nurses. And they all ask…

“How do you stay awake? How do you stay so calm all the time? And when will my insides stop going crazy every time I have to resuscitate a newborn or manage a delivering patient with no provider in the room?”

Inside I smile.

“Keep wanting to get better. Keep practicing and it will come. And hang with us zombies on night shift and we’ll be there to have your back and keep you awake.”

If they watch carefully, they too will blossom into wonderful, autonomous nurses with a little attitude and a lot of character… and if they watch extra careful, they might just notice that I still need a back-up or a second opinion sometimes and once in a while, they might just catch me tearing up in a delivery.

This post was first written by me for and published by an online nursing magazine and a hospital newspaper. I am now re-posting it here.

Tired…

A typical shift for me, a healthcare worker on the frontlines, looks like this…

(This is my account, written in the second person. This is not meant to be an exact account of every worker, as all of us on the frontlines work in different areas, come from different backgrounds, and have on our shifts, different experiences. I assure you, however, that we are bound together by our passion to serve and that we are all affected by many of the same feelings expressed here. We are ALL Tired.)

 

You arrive to the hospital 30 minutes before your shift. You need 15 minutes to sit in your car and mentally prepare. Listening to soothing music, meditating or reading funny memes, you try your best to decompress before popping your trunk- That’s where all your work things live now… in your contaminated trunk. You grab your bag, lunch box, and designated ‘work water bottle’ and then tie a cloth mask to your face- a beautifully crafted gift by an former coworker.

Walking through the empty parking lots, you pass tents and trailers that will serve as overflow space, if you run out of beds inside. The same front doors that you’ve been walking through for 17 years, are now locked. And the entrance that is normally bustling with people, is blocked off and deserted. Security officers check your badge before you’re allowed to enter.

There are no tanks or landmines, rifles or camouflage, and you’ve never been in the military, but you feel like you’re entering a war zone. Around you, everyone is masked and many wear devices that make identifying the faces and voices of people you’ve worked with for years, a challenge. You’ve worked these same halls your entire professional career and now it feels like you’re on the set of a scary movie. New walls have been put up, units moved, you are in the same familiar work place and yet it’s so different. It feels like you’re standing in an different dimension, watching the world end. But you’re not…you’re saving it. Taking a deep breath, you press the button for the 2nd floor- Labor and Delivery.

In the locker room, you change into hospital scrubs and replace your pretty, soft, cloth mask with a surgical one that you’ve worn now for days. Your head is covered and a face-shield is attached to your waist for easy access, as you shuffle out to the floor. An announcement is made to clear the nurses’ station. There can’t be too many people in one place, so only the oncoming shift is allowed to stay. Standing 6 feet apart, you get report and learn of the latest findings and practices; because quite frankly, they change daily. Based on your assignment, you determine what other gear you’re going to don for the night. As the shift disperses to relieve the aching faces that worked the twelve hours before you, you each say a quiet prayer to yourselves that your next twelve allow you all to make it home safe in the morning.

Only those who know OB or who have been touched by loss know that Labor and Delivery isn’t always “the happy place,” that people like to call it. And working as a perinatal bereavement coordinator couldn’t bring you any closer to the raw and devastating losses that are sometimes felt there… and yet you are crying new tears of grief these days.

Some of the reasons are quite frankly, because of prudence and good practice on the part of your institution. You are incredibly thankful to work for an institution that has proper PPE for its staff and uses science to dictate proper procedure. And you can’t imagine the terror of working without it. Despite the limited knowledge available about the virus and despite the global shortage of supplies, your institution and your state are working hard to combat both challenges; and you believe they are doing an excellent job! Fortunate as you are though, it doesn’t make it easy.

It’s not easy when…

Your sweet little twenty-some year old patient, afraid as she was to deliver alone says, “I’m glad you’re here with me… I think you took care of me before… but I’m not sure because I can’t see your face.” What a scene this must be for patients here to welcome their new little bundles.

A single mom elects to deliver with no support because in doing so, she would have denied the baby’s father a right to come. One visitor-no swapping out. These are basic infection control principles… that sadly affect some more than others. And you are the “lucky ones”- other units have no visitors.

A father paces the room and finally cries when he sees his baby because Dads are not allowed in the Operating Room anymore…and her C-section meant his inability to see his child enter the world.

A covid-positive patient is forced to labor and deliver alone, medical staff only. We must keep the other parent/caregiver uninfected to be able to care for the baby.

A mother holds her stillborn or a husband, his dying wife’s hand and they know there will be no family called in to say good-bye and no funeral. There will be no gathering of friends and family for support. And they will go home to an empty house to grieve, because god help them if they lose another.

You are pulled to an area of the hospital you’ve never worked before and you feel like a fish-out-of-water, but you can’t even complain because you see that your colleagues are drowning. You do everything you can to help them- running labs, wiping hoods, holding hands… They most assuredly have it worse and you are tired and sad for them.

Your throat hurts from talking so loud for 12 hours, because no one can hear you under all that gear. It takes 3x as long to interpret using a video/phone translator and the hearing impaired are at a clear disadvantage without having lips to read.

You sweat for hours under the layers of PPE. And your face and ears ache. Yet you know that not everyone is as fortunate. Former colleagues across the country are posting about having none and while you are so thankful to have protection against this deadly virus, you also hate the gear, and you feel guilty for doing so.

Dehydrated and hungry, it’s hard to grab a quick drink or a bite to eat, when running into the break room means “waiting your turn” (because yes, healthcare workers too, socially distance, even when they’re at work). And properly removing your gear so as not to contaminate yourself, requires two people and precision. The only plus to not drinking, is that you don’t have to pee.

 

In emergencies in the past, you’ve delivered babies with your bare hands and held a woman’s sweating face so close, that you could feel her breath on your own… You’re not a squeamish or fearful person. But now, you can’t respond without a respirator and a face shield- because if you don’t preserve your own safety, there’ll be no one left to care for the Mommas still waiting to deliver. And it goes against every nurse instinct inside you to put yourself before your patient.

You love your job. It’s the job you dreamed to have since you were a young girl… and yet now, you dread going in. The “Heroes Work Here” sign posted in front of the hospital is sweet and the free meals are amazing. The support from the community has been unprecedented! As always, you are proud to be a nurse and are honored to work alongside the other healthcare workers. But this job is both mentally and physically depleting, every time!

You see what this virus can do and you are just as afraid of accidentally transmitting it as you are of contracting it.

At the end of the shift, when you’re exhausted, you’ll change back into your street clothes (always leggings because they cling and don’t drag, a designated “work jacket” and different shoes). You’ll save your surgical mask in a paper bag while you put your cloth one back on to walk to your car. It’s a welcome change, to get that damp-with-breath paper off your face, even for a short walk. Returning your things to the trunk, you are finally free to remove your mask and welcome the cool air hitting your face. You sanitize your hands again before you do so and before you grab the wheel. Driving home from night shift is no longer your final task and you dread “more things to do”, when you just want to collapse in your bed.

Just inside your back-door, a towel and bleach wipes will be waiting for you to clean your shoes. Then you kick them off, remove your socks and walk downstairs to the laundry room-careful not to touch any of your family or pets that have come to greet you. The towel, your clothes and cloth mask go straight into the wash and you, straight to the shower. Having scrubbed every inch of your body, finally, you can kiss your family. And you fall asleep with wet hair.

Each day before a work shift, other dirty clothes are loaded into the washer to avoid wasting water on small loads the following morning. And when you leave out the house, you are jacket-less, precariously carrying food items and coffee out to the car, so as not to bring your lunch box inside. Make-up is a no-go because it dirties the mask that you are now required to re-use (not-a-one-of-you imagined that would ever happen in the US of A). Jewelry too- gets left at home now. Even your showering and shaving schedule is adjusted, based on when you work. It seems your every-move, now revolves around this virus.

In between shifts, you have your own kids that you are home-schooling, your own family  you beg not to infect, your own creative meals to make with groceries you last bought weeks ago, your own challenges and worries that are just part of being human. And like everyone else, you are trying to stay sane- and those are your “days off.”

As you mindlessly scroll through social media and the news, you see herds of protestors, un-masked, demanding that the country/state re-open. Your heart aches because you know that they are desperate for work and you know how blessed you are to have a paycheck. And yet, with that paycheck comes great risk. “Healthcare workers are Heroes” suddenly feels like a stab in the back, when these reckless acts, threaten the very thing you are working so hard to prevent-transmission. Because you know how tired you all are now. You know that WITH the quarantine, you are all treading water… and if it were lifted right now, you’d drown. You’d do anything to keep people out of your ICUs and yet, you wish you could show them what it’s like-to be on a vent, to be alone, to die alone; not to scare them… but to protect them! The same way you used to scream at your kids when they ran into the street, you want to scream at the protestors, but you’re too tired.

You see the complaints of the people “stuck at home” with their kids and you know that your patients who have had recent losses are seeing the same posts… your patients with infertility are seeing the same posts… your friends who are living alone… are seeing these same posts… and you want to scold them for their insensitivity and lack of perspective… but you know their exhaustion as a parent is real… and you’re tired, too.

You hear the conspiracy theories and inaccurate statements “It’s just a flu”, “People will die anyway…”, “The government is taking away our liberty”… and you want to school them on why this is different, on public safety, on how to control the spread, on how to save as many lives as possible, on the sanctity of life over money… but you’re too tired.

You want to say forget it, “survival of the smartest,” let the protestors and the ignorant get their due infection … but you can’t… because you’re a nurse… and nurses fight for every life! And you don’t want anymore people to die… even the ones who don’t understand. And that grief and that conflict makes you tired.

So you turn off your phone and you wipe away another tear and you pray.

You pray that someone helps these people who are about to lose their homes and businesses.

You pray that your next shift isn’t the day you watch someone die alone.

You pray that your service doesn’t bring this virus home and lead to the demise of your family members.

You pray that you never see the day that the critically ill out-number the available equipment.

You pray that you continue to have the strength to fight this war…

Because you know, that for every healthcare worker who reluctantly and exhaustedly puts on and wipes off their shoes every day- no job, no house, no amount of money, or government position… for them, nothing matters more than life. And you pray to preserve as many as you can… eventhough… you are so god awful, tired.

 

 

 

 

 

The Blessing of Nursing

Having graduated nursing school twelve years ago, the details of my educational experiences have begun to get a little hazy. The drugs, the statistics, the countless conditions and syndromes in unrelated fields, the care plans … so many lessons I sat through as a sleep deprived 21-year-old are gone. I remember a few instructors faces, hardly any names. I remember some of the lessons and more of the patients. I remember how hard I worked to get that degree and how proud I was when I walked the stage. I felt blessed to be a part of an honorable profession as well as to have a means to support my family.

I remember being warned of nurse burn-out, of the long hours and the strenuous labor. I remember one arrogant nursing instructor telling us, a room full of new grads excited to embark on our career, “You don’t know anything yet. Everything that you’ve learned so far…is nothing.” And I remember hating her for saying that but knowing that inside of that harsh statement was a sliver of truth. I remember looking at the experienced nurses and wanting so badly to be like them. The real education, I was told, I’d receive “on the job”. That was true, and I put my all into learning everything I could as a new nurse.

But there is one lesson from nursing school that I remember clear as day. My instructor for my medical surgical rotation at Shock Trauma discussed with us our patient population. At Trauma you had the VIPs, the rich and the famous, the transfers for the state of art technology, and the city population – those who only ended up there because they were badly injured or they just so happened to live in the city and that world-renowned institution was their neighborhood hospital. 
 “I don’t care who is in that bed,” she said. “You are a nurse and your job is to CARE. Check your biases and judgments at the door and you give every patient you see your very best. No one dreams of growing up and sucking cock for $5…. of being a drug addict… a prostitute… a murderer… of losing all their teeth by the time they’re thirty. If they can’t afford health insurance but are sporting a new tattoo and cell phone, if they’re here because they were in a gang fight, it’s not your concern. Everyone has a story. If you have the time to hear their story, do it! And if you don’t, at least give them your best. You may be the last person they ever see.”

I took that lesson to heart. Since that day, I’ve sat on countless beds hearing countless stories. I’ve always taken the time to build a rapport and establish trust and whenever possible I let them share their life with me. I’ve let them talk and I’ve learned how and when to ask questions. The situations that I’ve encountered are endless. I’ve met educated people from normal socio-economic backgrounds that were addicts. I’ve cared for teens who grew up in foster care that were more mature than the average 30-year-old and others who suffered from mental illness and substance abuse as consequences and coping mechanisms from their years of abuse. I’ve heard the intimate details of an arranged marriage. I’ve learned the personal views and seen the beautiful faces of women who in public quietly peek through the opening of a Burqa. I’ve served celebrities and refugees alike. I’ve been face to face with abuse, neglect, poverty, and fame. I’ve seen the scars of cigarette burns, female circumcision, gun shot wounds and IV drug abuse. I’ve returned to work to find a $100 bottle of Champaign waiting for me and been presented a tattered rose and a hand written note with the words “You are my angel” scribbled across it.

I’m not a trauma nurse. I’m a labor and delivery nurse.
And I don’t work in the city. In fact, the county I work in has one of the highest education levels and the most money of just about any county in the United States.

I can tell you first hand that no one is immune to misfortune. No one gets a free pass and no one’s fate is sealed. Money, education, background, race, marital status…. a pregnancy…. doesn’t protect you from the horrors of the world. Some however, are given a much steeper hill to climb than others. Some are dealt a very heavy hand from the beginning. And when you learn just how heavy that hand is, you gain perspective.

I’ve seen the best and worst days in people’s lives. I’ve seen a miracle baby pull through and a 50-year-old finally become a Mom. I’ve held a mother when her child died and I’ve watched a married couple hand over their baby for adoption because they couldn’t afford to care for another child. I’ve supported the legs of a prisoner shackled to the bed, delivering a baby she won’t be allowed to raise. I’ve wiped the tears of millionaires and the faces of the homeless. I’ve helped hundreds of women deliver their babies and I can tell you, they all bleed red. They all sweat. They all cry from pain. And after delivery, all of their breasts fill with milk. For some, the hospital beds and food are the worst they can recall and for others they are the best. For some, our unit holds their most precious memories and others, their darkest nightmares.

With my “on the job” experience, I’ve learned the ins and outs of pregnancy, labor and delivery. I’ve got the drug dosages memorized and obstetrical emergencies have become a learned dance. I’m a good IV stick and a unit resource. For the doctors, midwives, nurses and techs, I am a trusted and experienced clinician. But what I am the most proud of aren’t my clinical skills, anyone can learn those. What nursing has taught me, that I am most proud of, are my human skills.

A patient once told me, “I love you guys (nurses). You guys don’t see color or money or the way I dress. You see a soul. And you care for that soul.”

Whatever biases and judgments I once had … they’re gone now.

That is the blessing of nursing.

Of all the things in my life that have taught me compassion, non-judgmentalism, and an understanding for the human spirit, nursing has taught me the most. When you come to me, you come to me looking for a nurse, and that is exactly what you will get. All judgments, any preconceived notions, are checked at the door and I am here to serve. And the more one serves, the easier it becomes to shed that judgment and bias on the every-day. After twelve years of nursing, I am most certainly a better nurse, but more importantly, I am a better person.
I hope I’ve made a lasting impact on the patients I’ve cared for… and I do believe I have. But more importantly, they’ve made a lasting impact on me. My soul has grown and my heart has softened because a nurse taught me a life-long lesson. She taught me to listen to people’s stories. Nursing has allowed me to nurture that in my soul just as much as I’ve nurtured the souls who find themselves in my rooms.

 

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Happy Nurses Day to my fellow nurturers, you make this world a better place!