Before i completely gave up working as a midwife (2023) keen to keep the flexibility of my casual status, i’d already put my hand up (from about 2015) to do the odd nursing shift again, usually in Gynae which felt like a natural fit, working with woman. I used nursing skills all the time caring for the unwell pregnant or those having a caesarean birth, often with complications after.
I’ve always written or journalled about work, especially after a particularly busy or awful shift, trying to figure out, remember the minutiae, what made it SO bad, often feeling validated on seeing the details of the days work laid out on the page.
This story is based on numerous shifts on the Gynaecology ward.
When bodies falter, nurses have a ringside seat, give care to all, to strangers. Who will the strangers be? Someone’s mum, auntie, brother, cousin, sister, uncle, granny, grandpa. They never know.
This shift begins with bedside handover.
First woman had a large ovarian cancer removed the day before. We make eye contact, we smile, check her ID, note her skin colour, facial expression, position in the bed, is she moving? Is she scared to move?
Note the large vertical wound, the clear waterproof dressing. Is it intact or gaping, any ooze or bleed? Check.
A plastic drain is stitched in, is the tubing unclamped, chamber vacuumed, volume in the bag acceptable? Check.
Drip stand with multiple pumps, 1st, an opiate painkiller. Is it labelled correctly, programmed accurately, drug matches order, IV dressing secure, kink in the line? Check.
2nd, 3rd pumps, subcut anaesthetic. Dressings secure, no leak. Check.
4th, saline plus antibiotics. Check.
Catheter, fixed securely to thigh, no pulling urethra (god forbid,) volume, colour of urine. Check.
Obs machine, charged, ready to go? Buzzer, pain button, drink, within reach?
Check. Check. Check.
Untangling, unwinding, simplifying. Sickest = tidiest. No tripping over shit on floor, uncool, unsafe.
Thinking ahead (always,) the move out of bed, unhooking drains, catheter bags, unplugging pumps.
Handover’s done, 7 patients, 1 empty bed, 2 registered nurses, no healthcare assistants. This is QLD Australia, “Ratios Save Lives.” They really do.
(UK nurse/midwife shortage dire, unconscionable, untenable.)
Aim by shift end? Each woman, clinically stable, pain-free, clean, cocooned, fresh sheets, feeling cared for.**
Into the fray to a chorus of alarms, to call bells, pain relief needed, to retching, a bag full of vomit, a new admission wheeling up the corridor.
Those immediate fires tended, the nurses start proper, no sitting, treading a constant path. Bed, treatment room, nurses station, linen trolley, pan room, back.
First, observations. Blood pumping effectively, oxygenating tissues? Heart racing or too slow? Breaths a minute? Too warm, too cold? Pain out of 10?
Next medications, focused concentration, scrutinising poly-pharmacy multiple charts, no short cuts ever, no accidental deaths, please. Can you imagine?
Then showering, multiple drips, drains, catheters in tow, major physical manoeuvre for both patient and nurse. Quick is key.
Cannulas/wounds waterproofed, (plastic bags, reams of tape) sweat, blood, antiseptic, gently hosed off.
Drying backs, lower legs, feet, scanning naked flesh, skin detectives looking for problem, rash, bruise, sore.
Adorn in clean hospital gown, final push back across floor to freshly made bed, to opioid pain control, to sleep. Scan again, quick recce, everything in place? Move on.
One patient, one episode of care. Things can and do go wrong.
Constant interruptions. Insensible losses of time. Drugs not available. Equipment malfunctions. Doctors uncontactable. BP’s Crash. Temps soar. Blood pours in rivers. Bodies collapse to the floor.
And human factors? Extra time needed, pain crisis, crying, hyperventilating, relatives spewing anger, nurse in the firing line. The emotional energy needed is huge, boundaries a must, we’re not repositories for peoples pain, won’t tolerate disrespect.
End of shift, notes done, we huddle, check in, satisfied, patients as planned ** or commiserate, stretched too thin, patients stable, safe. At whose cost?
We learn not to blame ourselves, work in a team 24/7, handover, go home, rest, re-energise, ready for the next .
Lindsey Crossan Registered Nurse/Midwife
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