The Fuckening
Is it inevitable? Not always. Is it most shifts though? Yes.
It’s around 3 pm. I’ve been at work since 6:30 am. I haven’t eaten and have peed once. I gave up on getting everyone their 30 minute lunch somewhere in the last hour and everyone’s getting fifteen minutes, one at a time, to step away and grab a bite to eat. I’m walking down the first hallway to check on the staff in the back; I’m avoiding the second hallway because there’s a patient is extremely upset about being in the hallway. I’ve explained we are utilizing hallway space to make sure people receive timely treatment, rather than waiting longer for a private room to open up, that this way we can manage pain and nausea immediately rather than delaying treatment. There’s also a very sweet elderly lady on oxygen, who needs the next open room because she has a significant cardiac history and needs telemetry monitoring. As I walk down the hall, I’m asking myself why the hell I’m still doing this ER thing anyway.
It’s a question I ask myself a lot these days, along with how much longer I can continue under the current circumstances. Our hospital has been packed since August, the ER is constantly full and holding admitted patients, and seeing a higher volume of sicker patients. Patients are unhappy, staff is exhausted, space is an ongoing problem.
I’ve been a nurse for 19 years, the last eight in the ER. I’ve had a love hate relationship with my job the entire time, which matches up pretty well with my romantic relationships, but that’s another series of stories. I love the chaos, the fast pace, the madness, the trauma and the codes, that one day everyone is critical and you’re saving lives one after the other. I hate the sense of defeat that comes with some shifts, I hate failing to save a life, I hate the way necessity dictates some people wait for a very long time because while their matter may be medical and require care it is not life or death, and mostly I hate the lack of control I have to fix everything in a timely fashion.
This day is one of THOSE days, coming in to half of the ER bays occupied by admitted patients waiting for rooms to open on the inpatient wards. That limits the rooms and space we have to treat incoming patients.. The bed situation in the rest of the house isn’t good—minimal discharges and already beds being reserved for surgical and procedural patients. Not only will the admits we have stay in our department for quite a while, we’re going to quickly add to those numbers. Immediately I assessed which patients could be moved into the hallways if needed—no one with COVID, or other infectious disease processes, no one requiring constant cardiac monitoring, none of the mental health patients—they require privacy in order to truly share their needs and receive adequate screening for treatment/resources.
By 10 am hallway beds are in use. Nurses keep coming up.. Several of the rooms now hold COVID + patients. More patients that require private rooms. In an ideal world, every patient in every ER would have a private room, but this isn’t the ideal world. We have to make the most out of what resources we have available. We’re down to rotating through 3 rooms and the hallway beds, as well as a set of recliners behind the triage area. While it is not ideal, it is efficient. People are being seen quickly, the doc is hustling, the minute someone has discharge pop up a nurse is running to get them out and free up space.
Then it happens. It happens most days, usually between 12 pm and 5pm. I’ve heard coworkers refer to it as “The Fuckening” before. It starts with multiple ambulance reports. One after the other. Meanwhile, triage starts radioing in. “I have a chest pain. I have a known COVID positive with low sats. I have a known ectopic sent from primary care. I have more behind them.”
Any patient that can be in the hallway is now in the hallway. The ED is officially at capacity and moves onto a high volume status. These just means EMS will alert the patients we are very busy and treatment might be delayed. They still can choose to come and usually do. Then another radio report, this one a trauma alert. And another.
I call the house supervisor who coordinates bed placement. I tell here we need beds NOW. She says there aren’t any but she’ll see what she can do.
And the last hours pass, in a chaotic burst of activity. Everyone’s running and giving 110%. I won’t even remember half of what happened to document in shift report. Is this a specific shift? No, it’s a mixture of different ones. Every day brings the challenge of so many patients and so little space. It’s a tight feeling in your chest, that you’re never going to get enough done, that no matter what nothing is done fast enough or well enough.
It’s the same provider saying “I need a room for a pelvic exam,” over and over. It’s the staff nurse coming for help because a patient is tired of waiting and wants to make a complaint. It’s the constant apologizing. “I’m sorry, sir, there are no beds available. Just bear with us a little longer.” It’s the fear of missing something.
It’s the sense of dread, that not only is today one of THOSE days, but that there are so many still to get through.
That’s what being an ER nurse is today.
I do it because I do love it. But we all have our limits. It’s exhausting to walk out those doors and know that you gave it everything you had, and it still wasn’t enough.
the Midwestern One