All hospital nurses know about that silence in the parking garage after your shift, the one where you shut the door and sit in your car and just zone out after your shift.
Here’s a little known secret that the ER holds dear.
Waiting for a helicopter to land is AWESOME.
You take the gurney out, stand by the wall, and wait as the noise of the rotors grows louder and louder and the little dot becomes larger and larger. Sometimes leaves and gravel blow against your face and exposed skin and it stings but you don’t even care. The noise of the chopper makes everything else obsolete. You can’t hear alarms beeping. Or your radio. Or the call lights or the phones or that family member that’s put at the desk again.
It is the most relaxing thing I’ve ever felt at work. Like meditating. Sure, in a couple minutes they will actually touch down and you’ll have to get the patient and do a whole bunch of things simultaneously, but at the moment, it’s just waiting. Alone.
Why is the most relaxing part of my day?
Let me tell you about how my days usually go....
A day in the life of an ER charge nurse.
(Gathered from several years of experience at different facilities)
5 am-wake up and shower. Tell yourself in the shower this is YOUR DAY. It’s going to be a great shift. No way like the last one.
6 am-begin caffeine loading on commute.
635 am-arrive 5 minutes late. Tell yourself not to look at the tracker board walking to the time clock
636-look at tracker board. Think “this is gonna be a real shitshow”
640-begin taking report from night shift charge nurse. Allow extra time for them to vent about their shift yesterday.
645am-make assignments. Check to see who has been in both the Covid and psych hold areas as well as triage to ensure everyone’s getting rotated fairly.
650am-review assignments in morning huddle. Move the person in the COVID pod because they were there yesterday and it wasn’t recorded. Listen to everyone moan about their last assignment. Announce there are inpatient holds and expect to be holding all day. Ask they let you know which patients can be moved to hallways and which require private monitored rooms due to diagnosis/infectious processes etc.
7am-go out to the floor. Start making calls to the psych screeners to see if anyone can be placed or is missing any documentation. Start placing new patient arrivals. Check the mandatory psych charting/inpatient charting.
730am-start an a difficult IV. Attempt to start rounding.
740am-respond to a rapid response on the floor. Juggle radio calls for patient placement and the rapid response.
8am-return to ER. Return a call to a patients family member who is angry about the wait for inpatient bed.
Apologize for approximately 10-15 minutes for situations completely out of your control.
815-notice several facilities have gone on high volume via the local EMS page. Think about getting food because it’s probably the only time you’ll have.
830-go to huddle of charge nurses.
Listen to everyone’s staffing. Count possible discharges. Relay number of admit holds and pending admits. Feel your soul start to wither.
9 am-return to dept. patients are coming in and you figure you can get your rounding done and help your staff out by doing the initial triage & starting their IVs.
10 am-mid shift help arrives. You’ve already put patients in their zone and started them. They were going to be your float nurse/lunch relief but you’ll get the noon midshift to do it.
11 am-EMS radios in a trauma activation. Every nurse has 5 patients, already over the ideal 1:4 ratio. No problem. You can take it until the noon midshift arrives. The 1pm nurse will do lunches. A late lunch is better than no lunch. Prior to your trauma arriving, inquire of those admit beds are coming. Yep yep promise we’ll get some.
1130 am-busy with the trauma. More patients arrive. Open another zone for the 12 nurse. It’s ok. You’ll keep the trauma and have the 1pm nurse do lunches.
1145 am-a patient requiring 1:1 monitoring for suicide precautions arrive. You call for a sitter but the house doesn’t have one.
Rearrange the holds so a sitter can monitor 2-patients at once. Receive a call from a facility asking for paperwork faxed for possible acceptance! Yay!
12 am-second midshift arrives. Still no beds for inpatients.
1230 am-everyone has 5 patients except you, who has the 1:1 trauma.
Another critical is inbound. Your trauma is stable, you can take that.
1pm-Last midshift arrives. Your trauma goes to OR. Your other critical is pretty stable. You and the 1pm start lunches.
115 pm-some ER discharges start happening. The triage nurse is running a fast track zone out of triage-minor complaints like sutures, ear infections etc. Then a patient with stroke like symptoms arrives and a code stroke is activated. You pull your 1pm from lunching and have them take the stroke patient.
145 pm-the stroke is getting TPA and will be a 1:1 for 2 hours.
230pm-you have successfully gotten some people to lunch by watching multiple zones at once while fielding a barrage of calls about COVID testing.
3pm-more patients arrive. Hallway beds are now a thing. Triage nurse is carrying several patients in fast track. Everyone is getting pissy and snippy with each other.
330 pm-you have to huddle with the hospital charges again. You ask about beds. Still no beds but yes there will be discharges! There will be beds!
4 pm-eat a pb&j. Try to get lunches finished. ICU has a bed! Your critical can go up!
445 pm-ICU patient is up. You’re looking for a patient who lost their eyeglasses last week. Every time you pass a hallway bed they glare at you. You wish you had the time to stop and explain you would give them a room if you could put the patients who need monitoring or on chemotherapy or have infectious diseases need those rooms. So you internally promise you’ll go back and do it.
5pm-ICU takes the code stroke! Hallelujah! You send the 1pm nurse to give the 10am nurse lunch but also give her a couple new patients in hallway beds. Ask everyone to get their discharges out ASAP.
515 pm-bad accident. Multiple traumas inbound. But GOOD NEWS! A few beds just came available upstairs! You rally help from the floor that always bails you out and have them come move admits. You transition the patients in the trauma rooms to those just emptied. You started filling the trauma bays with regular patients around 1.
Your psych nurse has her pod under control so she takes a trauma. The 10a will be back soon, so you pull the 1p to take a trauma and you take one.
530 pm-traumas arrive. EMS tells you they’re also out on a cardiac arrest. Ok, but 2 of the traumas are stable. One nurse can take them!
You’ll delay the 12pm nurse lunch, and you’ll take the post cardiac arrest.
545 pm-MORE BEDS! You send a blast for transport help and call for help cleaning rooms. One of the zones discharges every patient! Hallelujah! She can take the critical coming in and everyone can move their hallway beds into rooms! Night shift is gonna love you!
6pm-post code arrives, very critical. You and whoever’s free stabilize it.
620pm-critical patient BP stable on 3 vasopressors. You go and talk to the family.
625 pm-shouting from the psychiatric area. You go & spend 20 minutes calming the person down. The nurse is in tears. Ok, situation better.
640pm-night shift charge nurse is looking for report. You didn’t even know what time it was. You give report.
645-A STEMI is coming by helicopter.
650-get helicopter patient off the pad. Get the STEMI a second IV, ASA, Nitro, slap the fast patches on, and cath labs coming down the hall!
7pm-transport any remaining patients with beds upstairs and clean the rooms for night shift.
730-review trauma charts. Do more charting. Do end of shift counts.
Also, sometime during this shift, you took 20 ambulance reports, started a dozen IVs here and there, did 10 EKGS, and a hundred phone calls.
815-finally clock out. Drive home. Shower.
Repeat the next day.
This is why I love the five or ten minutes getting by eardrums rung and my face blasted off by a landing chopper.
I would live out there if I could.