I have worked night shift before, but never in this capacity. The past two years have been a career roller coaster ride. I finished my Bachelor of Science in Nursing (BSN) last June of 2013, and the roller coaster only accelerated. I've been a registered nurse (RN) since completing an Associate's Degree program (ADN) in 1997. I thought the BSN might improve my career. At least, it was supposed to insure employment stability.
Some obscure time soon many RN's in the U.S. will have to have a BSN to keep the jobs they already have. The American Nurses Association (ANA) would like to phase out all but four year training programs. The literature supporting this move says there are better patient outcomes for people cared for by BSN graduates. All registered nurses (RNs) take the same board exam whether they finished a two year (ADN), three year (Diploma), or four year (BSN) program. Amazingly some BSN nurses still think they take a different test. The NCLEX is the NCLEX no matter what program completed to qualify to sit for it.
To be fair, some of the career issues are self-induced. That is for another post. For now, I am here, where I ended up, and have hopefully exited the ride. Not sure I'm up for another.
On December 31st, I began my current position, bringing in the new year. I hope to stay here for a long time. I am a direct care nurse on a vent unit in a sub-acute care facility. I like it here. I am still sort of catching my breath. I am working straight night shift, and my schedule rotates regularly every two weeks, alternating with the other primary night shift nurse working on the same unit. This covers 6 shifts per week. Another nurse works the 7th night. Unless one of us needs a certain night off, the schedule does not change; nor does my assignment.
In the past two years I have been a cardiac nurse, have pulled femoral artery sheaths, the tube they put in your groin during a heart cath, (and trained others to do so), been a nurse supervisor in a nursing home, and have done MDS's (minimum data sets, or assessments of care provided in nursing homes for insurance billing) while writing a power point on Ohio's "Nursing Home Bill." I have worked as a travel nurse in a city hospital where I helped care for a large Somolian population, as well as numerous other nationalities and sub-nationalities I had never heard of. I also worked alongside 1st generation Somolian-Americans. I have floated to neuro, orthopedic, ICU, and step-down units. I have used five electronic medical record systems, Veriscan bar coding, finger print computer sign on pads, unit wireless telephones, overhead paging, and the Vocera wearable intercom system. I've had several parking passes, and have learned and formed numerous passcodes. I have used 4 different kinds of IV pumps. I have taken CPR and Advanced Cardiac Life Support (ACLS) from profoundly different teachers through different instruction models, including from a bored instructor who skipped most of the class material, gave answers to the CPR test and gave out cards, as well as from an award-winning ACLS instructor from a prominent medical system. What a contrast!
What is not new:
being a nurse
drawing blood from central lines
venipunctures
IV pumps
Advanced Cardiac Life Support
making pills more palatable for people who are sick of taking them
putting in Foley catheters
people coming down off of a high becoming psychotic
people wanting more pain medication than they need/an amount that would be lethal to me
trying to keep disoriented or sedated people from falling and hurting themselves
old women in a lot of pain refusing tylenol
What is a blast from the past:
signing initials in a book for every pill I administer
identifying confused patients by asking coworkers who they are
clocking in and out without a fingerprint
some of my coworkers (one used the same sitter during nursing school 15 years ago)
keeping track of refrigerator temperatures
What is new:
trouble-shooting ventilator problems
learning lip-reading
a regular, routine work schedule
feeling tired all of the time on my days off (more tired than before)
being awake all night on my days off
the people who are online when I'm awake
using a walkie-talkie in a health care setting
I browsed the internet last month, looking for tips on adjusting to a changing circadian rhythm, and on existing on a different schedule than most of the rest of the world. I found a few helpful websites. Mostly I found articles about weight gain and long-term health issues for those who work nights.
What I miss:
discussing monitor strips and cardiac medications with doctors
acing cardiac monitor tests
alone time in hotel rooms
fixing dinner for/shopping with hosts
finding interesting shops in the city, like neat ethnic markets, and The Raisin Rack
transient, eclectic friendships with fascinating people
a mixed culture
cars pounding with rap music at traffic lights
What I like:
being at home, with my family
participating in my daughter's homeschooling
working with people who know me and still like me
a regular, routine work schedule
getting to know patients for longer than a few days
learning lip reading
A word about lip-reading. It is far more useful than I ever anticipated; and it is an art. I am teaching myself Spanish right now also, after visiting the U.S. Mexico border last fall. Lip-reading is every bit as much of a foreign language as Spanish or American Sign Language, and ever more useful for a nurse than many skills I have learned. When that dying patient was mouthing words that I wished I had understood; if only I had known this then. Most long-term ventilator patients are completely lucid. They can take the time to write what they want to say, if they are able. Some only retain some facial movement. On night shift, they want to talk. And they do not want to write it all down. All these years, I have learned to look away when listening, to focus on what someone was saying. This job has forced me to look AT people. More specifically, it has forced me to look at their mouth, and their jaw movements, and to focus on what each part was doing. Are the teeth coming together to form an "s," or is the tongue behind them to form a "th?" Does the jaw drop for the "ah" sound, or is it only half dropped for the "eh" sound?
Spanish is helping me learn to communicate with people of another ethnicity. Lip reading is helping me learn to communicate with my own family members; even my pets, as I "hear" an array of communication I was never able to hear before.
One thing about tiredness is that habits limit what you do with your time. We don't get cable TV, so that is out. I've grown weary of Facebook. When everyone is asleep, and you don't feel like cleaning, what do you do? I have started a family recipe book that is nearly finished. I have started watching the Netflix videos I order, but on my computer. The internet here is limited, so I get them in the mail. I work more in my office on papers that have piled up. I have done a little sewing. I do Spanish exercises. I read news articles, and blog. But the one thing I don't mind doing at night, when I'm feeling tired, is cooking. Last night, I made three kinds of crackers.
I have not made crackers for years. The first batch did not call for enough water, and ended up being mostly crumbles. The second batch turned out okay. The third batch was best. A box of Wheat Thins costs between $3 and $4. The ingredients for a cookie sheet full of crackers, about the same quantity, costs a fraction of that. What's more, you can put whatever you want in them. I have a lot of old spices in my cupboard that need used up. I have 3 containers of caraway seed. I have a 50 lb sack of rye flour in the freezer that I thought at one time I might make sourdough bread with. It turns out the rye with caraway crackers tasted the best. Where have I been all these years?
There is an old Quaker belief, that when something is from God, it will be affirmed somehow. For instance, when someone speaks in meeting, and you feel it is a message for you, but you aren't sure, something will happen to let you know that it is, for sure. Someone else will speak also, and what they say will affirm what the first person said in a way that is only relevant to you. Or someone will come to you after meeting and say something that affirms it. Or an event will tell you so. Such a thing happened to me this past week. After so many changes, I wonder if there will be another change, or whether this is where I am supposed to be. This past week I received a summons for jury duty, for the summer months. I was chosen for a jury years ago. I was working in the same facility. Of all the incredibly odd things to happen.
