It’s been about two months since I started in the
permanent charge nurse Clinical Care Leader position, and I have to tell you, it ain’t what I expected. I’m not complaining. But this might be the hardest, most challenging job I ever had, and that includes the hot summer I worked in the kitchen of a Greek restaurant whose owner pinched my bum. Some reflections:
1. You can’t be everyone’s friend. A cliché that’s actually, really true. The people you thought were on your side start to look at you sidewise,and the people who didn’t much care one way or the other really begin to hate you. Let’s face it: sometimes you make decisions that piss people off.
2. You can’t please everyone. Corollary to the above. No matter what you do, or how carefully you consider each decision, there will be someone, somewhere second-guessing you, and then bitching loudly about how they would have done things differently.
3. The faint of heart, thinned skin and unconfident need not apply. Probably true of emerg nurses in general, but more so for charge nurses. Having the hide and temperament of a rutting rhinoceros is a definite prerequisite. After being called racist and being told to eff-off in the span of a week, I feel like I need body armour.
4. Cool not hot. When the place is falling down, two VSA’s* have arrived on the doorstep simultaneously while an indrawing, tripoding† three year-old is at the Triage desk, Plastics is having a tantrum because there’s no more 4.0 Plain Gut left in the department, and Weanus is walking towards you with look on his face that would frighten children, a charge nurse running around screaming like the Four Horsemen of the Apocalypse have just galloped through the ambulance is not helpful. Keep it cool, because
5. All disasters pass. When the place is falling down, the effect is temporary. Really. Beds upstairs will appear, Weanus will go off muttering, the VSAs will die or survive — in short, all crises are temporary, by definition.
Except when they’re not.
6. I work with some amazing nurses and some distinctly nasty personalities. Some times they are the same people. I used to think this was a contradiction. Now I am not so sure.
7. Sick calls are highest Friday nights and Monday mornings. Except on statutory holidays, when for some reason we are always fully staffed. Don’t think I don’t notice.
8. Physicians start treating you with respect. I have specialists, who in my ten years at Acme Regional, have never once spoken to me directly, suddenly asking about my summer holiday plans and buying me coffee. It’s weird and creepy, but also a pretty sad commentary on perceptions of power in large hospitals.
9. Your colleagues have no idea what you do. I mean, they could probably describe it generally, but somehow think it mostly involves sitting around and directing traffic. The short list of what I do? Let’s see: bed allocation and patient flow in the ED, staffing, staff assignments and scheduling, supply ordering, allocation of beds for admitted patient on the floor, dealing with angry/complaining/grieving patients/nurses/physicians, being the liaison with other floors and departments on a day-to-day basis, helping to carry out new policies and procedures and ensuring compliance, mentoring and role-modelling, attending various committee meetings important to the emergency department. . .
Maybe I should develop a list of core competencies.
* See Glossary
† I.e. in respiratory distress.