When bodies falter, nurses have a ringside seat, leave our homes every day to work in hospitals, GP surgeries, aged-care homes, call-centres, prisons or in the community, giving professional care to whoever turns up in front of us on any given shift. To strangers. TLC is dispensed to the dying, the ancient, the very young.
Who will these strangers be? Mum with dementia, auntie with cancer, IV drug abusing brother, angry cousin, dysphoric adolescent, suicidal sister, alcoholic uncle, functionally declined grandpa, 40yr old sister with the mind of a child. The nurses never really know.
This shift, on a woman’s surgical ward begins with bedside handover, introductions are made, ID’s checked, we smile, we say hi, we scan, note the patients skin colour, affect, facial expression, position in the bed, are they moving, scared to move?
This first sickest patient- a complex ovarian cancer removed the previous day- has a large zip-like vertical incision in her abdomen, neatly sutured closed, covered with a clear waterproof dressing.
Alongside her bed sits a drip stand with four pumps attached, above the 1st pump a bag of lethal pain killer hangs. Is it labelled correctly, pump programmed accurately, drug matching the order, IV cannula dressing secure, any sign of infection, kink in the line?✔️
Untangling as we check, simplifying, thinking ahead to moving the patient out of bed, the unhooking of drains and catheters, unplugging of pumps, unwinding of lines, this way and that.
2nd and 3rd pumps give a micro dose of numbing local anaesthetic into the skin of the wound, check them too, are dressings secure, no leaking.
4th pump gives an hourly volume of saline, a Y-connector allows antibiotics to be given simultaneously. Check ✔️
Abdominal dressing, is it intact, any bleeding, ooze, gape in the stitches? A plastic tube rudely sticks out of the wound, a drain held by thick black suture, is it unclamped, is the squeezy chamber vacuumed, is the volume of blood/fluid draining acceptable? Mark the bag, record it.
Urinary catheter, is it fixed securely to the inner thigh to stop pulling at the urethra (ouch) check the volume and colour of urine draining.
BP machine, is it available, ready to go? Is everything plugged in, battery loss is too painful at critical moments.
Handover received for all remaining seven patients between us two nurses then off we go into the fray to a chorus of alarms and call bells, to pain relief needed urgently, to retching, a waving a bag of vomit, to a new unexpected admission wheeling up the corridor.
We radiate calm, tend immediate fires then start proper, preparing to be on our feet most of the shift treading a path between bed, treatment room, nurses station, linen trolley and pan room.
Space is limited, every inch grabbed back, surfaces cleared, patient belongings put away, equipment returned, unused blankets folded, extra pillows removed, all making clinical care easier.
If there IS an emergency valuable time can be lost untangling lines, moving shit from the floor to let relevant teams in. Sicker the patient, tidier it needs to be
* * The aim by end of shift is for all patients to be clinically stable, pain free, clean, cocooned in fresh sheets and blankets, feeling well cared for, curtains pushed back, natural light coming in.
Observations first, blood pressure, heart rate, oxygen saturations revealing all. Temperature too, looking for signs of infection.
Next medications, a massive responsibility, focused concentration needed every single time, no short cuts ever, especially when scrutinising poly-pharmacy multiple charts of the elderly.
Physio’s take the sickest patients on the first lung expanding, leg pumping walk, brave promenades up the corridor, hospital gowns flapping, compression stockinged legs, trampoline socks gripping the floor.
Some are keen for a shower, we go for it, multiple drips, drains and catheters in tow, a major physical manoeuvre for both patient and nurse. Quick is key.
Peering at their abdomen in the mirror the sight is often too much, “don’t look!” Cannulas and wounds waterproofed then the sweat, blood and pink antiseptic stripes are gently hosed off.
Nurses don’t bat an eyelid at the sight of naked flesh, while drying backs, lower legs, feet we scan, skin detectives looking for problems, rash, bruise, sore, a dressing undone.
With the patient adorned in clean hospital gown, the final push back across the floor to a freshly made bed, to opioid pain control, to sleep. Scan again, quick recce, is everything in place before moving on. One episode of care for one patient, the two nurses responsible for seven others.
Things can and do go wrong.
Constant interruptions. Drugs often not available when needed (a micro moral injury, knowing the drug is due.) Equipment malfunctions. Doctors difficult to contact. BP’s Crash. Temps soar. Blood pours in rivers. Bodies collapse to the floor.
Nurses who need or like plans to work out in a linear way find this all frustrating, scary even. It can be both.
And what about the human factor, patients needing extra time and attention, a pain crisis, a heightened emotional response (crying, raging, acute anxiety,) relatives worry coming across as anger and blame, nurses often in the firing line. The emotional energy needed some days is huge, boundaries must be developed, we’re not repositories for other peoples pain, we won’t tolerate disrespect.
End of shift, the nurses check in with each other, hopefully satisfied, their patients exactly as planned ** or commiserate, feel bad, stretched too thin, patients fine but the perfect, lofty nurse goals for them not quite achieved.
We learn not to blame ourselves, it’s a 24/7 job, we work in a system, within a team so we handover to the next shift, go home, rest, re-energise, ready for the next .
Lindsey Crossan Registered Nurse/Midwife
