On Call

Working at a Level I Trauma Center means that I have to take call.  My colleagues and I sign up for at least one slot per week over a six week period of time right after our new schedule comes out.  Sometimes we pick up our friends’ call slots or take on extra call which is a nice option if you’re trying to pay off student loans, credit card debt, or that new hardwood floor you installed.

One night I was on call from 11:00 PM to 7:00 AM in the morning.  Something told me to go to bed early that night so that I had at least a few hours of sleep after working a 10 hour shift from 7:00 AM – 5:30 PM.  As usual, my gut instinct was right.  It was summer in Big City after all.  My phone rang at 12:09 AM

“We need you to come in.”

I mumbled, “OK be right there.”

In a matter of 30 minutes, I was at the hospital, dressed, and ready to work.  I was part of the team that was “on deck” just hitters are in baseball.  One team already started working on a patient with a gunshot wound to the abdomen, so we were available for the next trauma.  While we waited, my coworkers and I prepared the empty ORs for the next day’s cases.

I guess it had been a busy evening because the overnight staff had not eaten or taken any breaks.  I was asked by the charge nurse to take over for the circulating nurse who was working the case in progress.  When I walked in, she let out a big sigh of relief.

“What’s going on?” I asked.

I recognized an Orthopedic resident with whom I worked with regularly.  Apparently, my friend was taking on the details from the young doctor for what was to be the second procedure performed on this patient.

OR Nurses are crossed trained over several surgical specialties, but we all have one or two which we are the most comfortable and confident.  Part II was not my co-worker’s expertise; it was mine.  Immediately, I started rattling off a list of what we were going to need for repositioning, instrumentation, and supplies.  As I took over care of this patient, my co-worker collected the items I needed and left them outside the door to my room while I worked out a plan for the transition.  The surgeon and the Ortho residents also provided input on other supplies.

One more staff member on call came in — a teammate of mine from Ortho.  Halleluiah! We could not believe our luck!  We had everyone we needed in place.  The transition from one complex surgery to another could not have been smoother.

In retrospect, the success of this surgery depended on three factors:

  1. Expertise – knowledge of the procedure and the items needed for it
  2. Teamwork – sharing the knowledge and then acting as a unit to prepare and execute
  3. Communication – a constant exchange of information that helps the team operate in sync

These three elements are crucial to the success of delivering the best patient care in surgery whether during a regular work day or while on call.  This is not a guarantee that the outcome will be positive; however, ultimately, we can truly say we did everything we could do for our patient.

 

Timeout

In surgery we do something known as a “timeout.”  We verify identity of the patient, the procedure that will be performed (and later, has been performed), and all pertinent information. This occurs three times while a patient is under our care in the operating room.  It happens when the patient enters the room (a “sign in”), before incision (“pre-incision”), and at the end of the procedure (“debrief”).  It allows the surgical team to ensure a patient’s safety as well as review any issues that might have been encountered.

At the end of my work day and my work week, I do my own timeout.  It helps me answer these questions:

  • What challenged me today/this week?
  • How did I handle it?
  • What did I learn about myself?
  • What did I learn about others?
  • How can I improve?

Maybe this sounds too touchy feely or too deep, but I honestly love my job.  When I stop taking it seriously, it’s time for me to find something new.  Taking care of my patients is a big deal to me and I just want to be the best that I can be.

Asking myself these questions also allows me to take better care of me.  It prevents the onset of nurse burnout.  One of my fears is that I go back to the person I was in my last job as an assistant nurse manager in surgery at a busy Level I Trauma Center.  The stress from that role made me a different person.  The job wasn’t fun and neither was I.  My family and friends can attest to that!  When a friend bluntly told me that she “will pull [my] hair out if [I took] another management job,” I knew it was bad.  I didn’t realize the extent until I left to go back to being a staff nurse.  What a difference!  I show up, work hard, and then at the end of the day I go home and can leave the work at work.

But anyway…

In my Personal Timeout, items tend to fall in these categories:

  • Moments That Made Me Laugh
  • Times When I Wanted To Quit
  • Reminders of Why I Do This Crazy Job

Today is the end of my work week.  I worked four ten-hour shifts and it’s time to call it DONE.  So here is my Debrief…

Moments That Made Me Laugh

  • My ornery nurse friend who would not take crap from a resident when he tried to do things his way versus the way the attending surgeon usually does it.  Sometimes you have to remind them that they are not the attending!
  • The CRNA who sang along to a Spotify Throwback Thursday playlist and didn’t realize she was doing it until the surgeon mentioned it.  He was entertained and she was embarrassed!
  • A coworker who announced that she is trying to be more positive by forcing an unconvincing smile.  It looked painful…  We told her to “just do you.”  No point in looking constipated!
  • The 80 year-old woman who was trying to get up on the operating room table while waking up from anesthesia.  She told a resident to “shut up” several times as he was trying to calm her down.  Feisty little lady!

Times When I Wanted To Quit

  • The combination of having a new employee to teach, a surgeon who was in a hurry, and an annoying sales rep made my head pound.

Reminder of Why I do This Crazy Job

  • My patients and their families and their appreciation of my care
  • Being able to share knowledge AND learn from my colleagues
  • Working with people who know the meaning of TEAM

 

I really do love being an Operating Room Nurse.  It is hard to think about finding satisfaction in doing something else.  At this point, I am not actively searching for a new position.  Surgical nursing is a very physical job and I know that I need to figure out where I want to be in the future.  Hopefully, I can figure that out before my body starts protesting!