Under Construction

Meaning me, of course.

I worked a (rare) Night 12 a few days ago. It was the usual dog’s breakfast of high acuity, walking wounded without end lining up at Triage, and the particular Emergency Department hell of having no beds for, you know, emergency patients, the department being a stunt double for a med-surg unit. But there was a small ray of hope. Or rather it was okay news-sucky news situation. We were to get  a bed, the element of suckiness resting on the fact the bed was on 5 North, my perennial nemesis, where, I swear, reside the most obstreperous nurses in the history of the Universe.

(Excuses I have heard over the years from 5 North for not taking patients: too busy, patient too sick, patient too combative, patient [with normal vitals] too unstable, patient a drug abuser, patient HIV positive, on break, short-staffed, still on break, patient restrained, patient not restrained, swabs not resulted, patient unsuitable, no one to take report, too close to shift change, just about to go on break, you just sent us a patient, the bed isn’t clean, the patient hasn’t left the bed, the room needs to be cleaned, too late in the night, too early in the morning, the patient will disturb the patient in the next bed, it’s a male bed and your patient is female, still on break — well, I could on.)

So I told the primary RN to call up report. We need to move some patients in.

They won’t take report, came the reply. All the nurses are on break.

“What the hell?!? All the nurses?!?” I was incredulous. “How can all the nurses be on break?”

I called up to 5 North. “Can I speak to the charge?”

“She’s on break.”

“Can I speak to any nurse?”

“They’re all on break.”

“All of them?”

“Yes.”

“Who’s looking after the patients?” As one might imagine, I was becoming a little agitated.

“I am,” came the reply.

“Who are you?”

“I am,” said the voice on the other end, “the nursing student.”

Dear sweet Lord, I thought. “Let me summarize,” I said.  “You’re looking after 24 patients all by yourself, because all the RNs are on break?”

“Well,” said the student in a tone which made it clear she thought she was dealing with a plain idiot, “there’s a nurse sitting beside me.”

‘”Oh,” I said, thinking I had misunderstood the entire situation. “Can I speak to her?”

“No! She’s on break. I told you”

After which I lost it, just a bit. “So when your patient in 55 falls out of bed and fractures her hip because she’s been ringing the call bell for fifteen minutes because you’re trying to clean up the patient in 37, what are you going to do?”

“Oh, I’ll call the nurse to help.”

“But she’s on break!” I was nearly shouting.

Click. The student hung up on me.

Well, I thought. That didn’t go well. But then, after I went home and thought about it, wasn’t I guilty of the same bullying behaviour towards this student I have written about so critically? I heard afterwards I had reduced her to tears. Didn’t this make me the poster child for nurses eating their young? The student, after all, was not responsible for being placed in an compromising position, and being made to run interference against a nasty ED nurse (i.e. me) was fairly despicable. I should have recognized the circumstances and adjusted my own response accordingly — regardless of who answered the phone. In the heat and stress of the moments it’s all too easy to engage in awful behaviour and justify our bullying afterward in terms of providing good care or best practice. It’s all a lie. There isn’t ever justification for bullying. All I can say in my defence: I’m a work in progress. Like everyone

[Update: Yes, I misspelled "construction" in the title. I need a sub-blogger minion to proofread.]

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  1. #1 by Jenn Jilks on Friday 18 November 2011 - 1716

    I totally disagree with you, TERN!
    You handled it with humour. It is just WRONG that ALL are on break.
    The student let herself be manipulated by staff, and she needs to know this is wrong.
    Having a break is important, don’t get me wrong.
    But sitting at the desk ‘on break’, implies that you are being manipulated and she needs to know that this is not acceptable in Ontario.

    You go, woman. I hear you roar, and you roar on behalf of all of the patients in the system.

  2. #2 by rnraquel on Wednesday 30 November 2011 - 1353

    I think the ones eating her alive were the RN’s who left her in charge of a whole unit. WTF?

  3. #3 by DOEcomic on Thursday 08 December 2011 - 2052

    I don’t know if it was bullying or calling out someone that needed a reality check. Obviously one of two things was happening; the student nurse was too timid to get a nurse because they (the 5 North nurses) had explicitly told the student to not bother them or the student nurse was actively screening calls. Either way she needed a reality check. The one thing I have learned in nursing is that most things are not personal. It is a stressful environment and sometimes we need to just speak frankly to one another and leave the sugar coating for less stressful times. You had a job to do, get the patient a bed. I am shocked you have to go through all those hurdles. At my hospital, if the nurse won’t take report or is not able to in a timely fashion, the ED will send the patient up and provide report at the bedside whether the nurse likes it or not. And since when did nurses actually get a lunch break? I can’t imagine the day when I would be able to utter the phrase, “I can’t, I am on break.”

  4. #4 by Sandy on Saturday 14 January 2012 - 1623

    …. I don’t even have words. Some of the people who get to call themselves RNs scare me..

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