I came by the job naturally.
Y'see, way back in the misty dawn of Time Before Nursing Ratios here in sunny Califrutopia, I really was given my own personal flock. While gainfully employed as full-time ER staff at the Busiest ER On The Planet(TM), I was assigned as the official third nurse in triage, which meant I was the one in charge of all patients either
a) too sick to sit in chairs, thus on gurneys, but not sick enough to get a room yet, or
b) admitted, too sick to go home, but not sick enough to require a room and constant monitorring, and no bed available upstairs, thus pulled out in the hallway.
And on this particular far-from-extraordinary day, that meant I was personally responsible for some 63 patients. Really. No $#!^, 63 people. (This was in addition to the department's normal load of full rooms, full waiting rooms, and ambulances with critical/trauma patients q 5 minutes, 24/7/forever.) Shepherd Of The Gurneys.
Which meant I had to do vital signs per protocol. Plus attend to requests for pain meds, water/juice/crackers, urinals/bed pans, and of course, should beds be ready upstairs, call report and transport them to the floor (tech help? As if...) and move the pending ones as yet untouched by physician hands into available rooms, based on the flow of acuity in this sea of humanity.
The sicker ones were in a "parking lot" right behind the other triage nurses, and the balance, some 50 or so, were distributed up and down the hallways all around the department.
If you remember the scene in Gone With The Wind where the camera pulls back to reveal Scarlett amongst the acres of Confederate wounded at the Atlanta train station, you're on the right track.
If we allow for a blazing speed of 5 minutes per person to find them, do their vitals, and attend briefly to any personal needs, that means it would take me over 5 hours to get from A to Z and back to A. Not accounting for new arrivals, admissions departures, and such petty things as potty breaks and perhaps wolfing down a sandwich for moi.
So the first thing I did, which took most of the first hour, was simply record a personal census of the names and locations of my people, and arrange their charts into some semblance of order. When I looked at them, I noted, unsurprisingly, that the guy I took over from, with the same assignment, had posted regular vitals on them at just about exactly 5 hours and change intervals, just as I'd calculated would be the case. So much for Q 2 hour vital signs. Making sure my supervisor was aware of the situation got me the Universal Management Salute, shrugged shoulders, and wasted 60 seconds. After that, it was off to the races.
I vitaled like a monkey on crack, and everyone other than paramedics coming in with full arrests learned in about 5 minutes to get the hell out of my way for the balance of the shift, whether I was getting morphine, a bedpan, or pushing a patient-laden gurney to the floor. Miraculously, I got every admitted patient upstairs, eventually; took in another ten or twenty new arrivals, and slotted everyone into a bed, as time wore on. No one died, no one waited for pain meds, and I actually got relieved for just enough time to, in fact, wolf down a sandwich and go pee once in 12 1/2 hours. I think there were less than 5 patients left the next morning to hand off.
Meanwhile, even at Hell Central, they had enough money in the budget to allow for extra facilities staff to strip and rewax the floors, because JCAHO was coming soon.
Not enough money for more staff, mind you, but enough to pay for two months of extra maintenance, floor repairs, fresh curtains, and another dozen items of senseless frippery to
Why yes, Emperor Nero, your fiddle solo was masterful! Shame about the capitol, eh?
Having survived Ordeal By Fire, I kept the scrap I'd used and carried, containing the original names plus additions, to that night's assignment list. I carried it every day hoping and praying that when we were being surveyed by the Brainless Minions of Stupid Shit that exemplify JCAHO on its best day, one of them would have the nerve to start asking me questions, or try to tell me how to do my job better. O please let that happen.
Yeah, and monkeys will fly outta my butt, too.
The JCAHO geniuses don't like talking to staff, especially night staff, at busy ERs, probably because just like everyone else, they don't like getting their asses handed back to them on the end of a pitchfork with some pithy comments for seasoning.
In doing some cleaning and de-cluttering recently, I came across a certain well-preserved scrap covered with names from not really that long ago, looking exactly like it did the last time I shoved it into a scrub pocket on my appointed rounds that night.
I wasn't Supernurse, and the nurse I took over from did the same job I did. My only takeaway, then as well as now, was that if you keep sending nurses in the emergency medical system up on that kind of high-wire, one day gravity's going to kick in, and the results aren't going to be pretty. We're people, particularly well-trained and schooled specialists with critical skills, knowledge, strength, and enthusiasm like you wouldn't believe.
But if you keep driving the car at 140MPH all the time, when something breaks, there's going to come a reckoning for ignoring the laws of nature. You can ignore reality, but you can't ignore the consequences of ignoring reality.
If you can't deliver smaller flocks, you damned sure better start getting more shepherds, and taking better care of the ones you have.
Nota bene.
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