From April 3, 2009: Nursing is a 24 hour job....

The way our unit works, there are 2 different kinds of shifts. You have the new grads working 8 hour shifts (0700-1500, 1500-2300, 2300-0700) and everyone else working 12s (0700-1900, 1900-0700). Therefore there is often an overlap where for 4 hours (1900-2300) you have way too many nurses for the number of patients on the floor. On these days, *someone* has to go "on committee." Often it's the 12s, and for 4 hours they become extra Resources for us. Other times it's us 8s, and we end up doing audits (checking to make sure things were done correctly) and other boring paperwork-type activities. Or, like me, you can beg to go home early if you're not doing anything of actual importance. This means you have 4 hours to do all the need-to-do's that may arise.

So I had the opportunity to put in a half-shift, and I was pretty jazzed about it. I started off my shift with 3 patients, one needing to be discharged ASAP. I did my damnedest to get him off the floor, and off he was at 1615. Down to 2 patients. Yay. Oh but what's this? I get an admission at 1630. Admissions take *ages* to get in order, between the initial assessment with all its questions and the new orders and the MAR that shows up 2 hours later, etc etc etc. Luckily I had a resource to do the initial assessment because I had to get meds into my other patients. I'm also told that one of my patients needs to be transferred to a lower-acuity unit because she's no longer on tele.

While I'm working on my med pass, my manager walks by and says "By the way, Mr Worst Patient Ever will need a sitter." "Huh? When did you plan on telling me I was getting a transfer?" "He's being transferred to our unit and he's yours."

He gets to our floor at 1830 and I thank god he's a transfer, not an admit. I then find out that the other unit didn't do *any* of his 1800 meds before sending him my way. So I scramble to get his meds in him before I have to hand him off at 1900. The only thing missing is his pain med. Luckily he noncomplianted himself so badly he wasn't quite the same pain-in-the-ass as usual and didn't say a word. I just told him that one of his meds wasn't in the system yet and the next nurse would take care of it.

Somewhere in this time I manage to get some of my charting done. I don't know how.

Right around 1900 I get the MAR for the new admit but it's time for shift change. I apologize to the oncoming nurse (always apologizing... sigh) for not getting more done in my paltry 4 hours. I let her know about Mr WPE's missing med, and tell her that I didn't get a chance to go through my new admit's orders because the UA *just* finished with the chart, etc etc. She said "Well, I don't mind so much, just go through the med orders and sign them off so I can give the meds."

It's 1930. I'm supposed to go home. But I am green and don't want to rock the boat and alienate the seasoned vets, because they are all that stands between me and complete failure as a nurse somedays. So I sigh and start going thru the MAR.

I'm grumbling slightly to myself about not getting my stuff done on time when R leans over and says "You're choosing to be here." "Eh?" "You got to put your foot down. You're here because you want to be not because you have to be. Nursing is 24 hours. You got to remember that."

But the way some nurses look at you when you dare suggest that you ran out of time in your shift... It's enough to make you stay overtime so you don't have to see that look again.

Someday I'll put my foot down. Maybe.