Life as a Newbie Nurse and My First 'Sundowner'
As a new nurse, almost everyone has to pay their dues working nightshift for a while until the older nurses retire or transfer to the less strenuous positions in the hospital in order to save what’s left of their backs and feet. I was hired immediately during my first interview partly because of my alma mater (a private womens' college known for its excellent nurses) and realistically more likely because the hospitals were beginning to feel the first pinches of the coming nursing shortage.
3-North was an ICU Step-down floor and known as one of the most difficult (if not THE most difficult) units in Winston Central, as I would soon find out. It was definitely a trial by fire. All nurses must go through what is termed an orientation phase where they are teamed up with another nurse called a prefect or trainer until they can integrate what they've learned in the books into a real practice, are familiar enough with the procedures of the unit, and have the (blind) confidence necessary to take care of patients on their own and my first couple of weeks there were rough since I was training with the dayshift nurses - all of whom were "too damned busy to bother with a newbie".
Most nurses will agree that there is a world of difference between dayshift nurses and nightshift nurses. The dayshift nurses were usually more competitive and...less helpful, okay - RUDE - unless you were lucky enough to fit in to one of their 'clicks' right away, (which was not my fate). This was partly understandable because they were the ones who had to deal with the walking giant egos, otherwise known as doctors and their harried assistants. Not only that, they had too many patients at a time who were too sick, or what we called high acuity, to be on 'the floor' instead of the ICU in addition to the constant comings and goings of the physical and occupational therapists, case workers, fresh post-op patients, and various and sundry procedures they had to oversee with each patient - not to mention the families and their constant questions, fears, demands and inter-family politics to juggle on top of all the rest.
Being moved to nightshift earlier than normal was a blessing. I was shocked at the difference in not only the pace of the unit, but the personalities of my new co-workers. Night nurses and most other hospital personnel were what you could term 'laid back' and their sense of humor was worlds beyond in improvement over the hectic day shift people. I was assigned to a male LPN as a prefect, in spite of the break in protocol this represented. Registered nurses were supposed to train registered nurses and licensed practical nurses were supposed to train other licensed practical nurses. The difference was an extra year of school and a much deeper knowledge of pharmacology, among other things. LPNs weren't allowed to administer or hang IV drugs without the signature of an RN. This was often a 'bone of contention' for the experienced LPNs because they felt they were doing the same job as the RNs, but getting paid less. I can't argue with that for the most part and may discuss that in another post.
My prefect turned out to be a blessing as as trainer, however. He had numerous years of experience and was a better nurse than most of the staff rolled into one because of his knowledge of medicine, overall intelligence and cool head in a crisis. I felt lucky the more I got to know him and became quite fond of him over time. He watched over me and showed me many of the 'tricks' (he could get an IV in a patient when no one else in the hospital could do so) that make an excellent nurse as opposed to a good nurse.
As the weeks went by, I quickly developed a bond with my fellow nightshift workers and everyone worked as a team. We usually had more patients than the day nurses, but things were more calm - for the most part. Once in a while we would have a bizzare night full of adventure. They always seemed to come in threes. This particular night we had already had to call the house supervisor over a drunk, unruly family member who belligerently insisted that her son was not receving the care she thought he deserved and a mentally ill young gentleman who had decided to tear out his IV and run down the hall naked trailing a stream of blood from the open IV site. He managed to get down the stairs and outside. The security officers along with my prefect finally managed to find him by following the trail of blood and to calm him down and lead him out of the middle of a five-lane road and back into the building.
After the aforementioned crises we were finally able to sit down at about 4 am and catch up on the tremendous amount of charting, arrangement of medication sheets and other paperwork for the next day. No sooner had we taken a few deep breaths and starting chatting about our husbands, kids, house renovations and the like; there was a sudden bloodcurdling scream from the room directly across from the nurses' station.
That particular room was a double occupancy room. In the bed closest to the door was a lady whom we were evaluating for a possible heart-attack, who was quite nervous and needed a peaceful environment. She happened to be my patient. In the bed across the room beside the window was a tiny elderly woman who couldn't have weighed more than 90 pounds fully dressed and soaking wet with boots on. She was admitted for dehydration and the general malaise that so often occurs with the elderly when they live alone.
During the day this same little lady had captured the hearts of the entire staff with her charming personality and sense of humor. She had been as mild- mannered and sweet as humanly possible and several of us felt the urge to simply take her home and make her part of the family. Upon entering the room and switching on the lights, however, we discovered this same little angel had been transformed into a wild-eyed 'wrangler' standing on the bed over her terrified roommate intent on wrapping the lengthy phone cord around the ankles of the poor woman! She had done an excellent job of doing so before anyone could stop her.
This scene would have been extremely hilarious had we been rehearsing an episode for Bonanza or Wild Kingdom but given the reality of the cirumstances and the condition of her human prey, we quickly talked her down off the bed and my co-workers gingerly led her back to her own 'corral' while I gently untied my trembling, shell-shocked heart patient. Needless to say, I quickly arranged for a private room for my patient for the remainder of the night.
The sweet little woman was only my first experience with what is referred to as a 'sundowner' in the slang terms of a hospital staff. There is no predicting who will suddenly develop the super-human strength and creative ways of acting out common to a sundowner. That's why I developed the habit early on of making rounds on my patients at least every 30-60 minutes no matter how quiet the night may appear.
(Actual names of persons and places have been changed to protect the not-so-innocent & to stave off any undue lawsuits.)
3-North was an ICU Step-down floor and known as one of the most difficult (if not THE most difficult) units in Winston Central, as I would soon find out. It was definitely a trial by fire. All nurses must go through what is termed an orientation phase where they are teamed up with another nurse called a prefect or trainer until they can integrate what they've learned in the books into a real practice, are familiar enough with the procedures of the unit, and have the (blind) confidence necessary to take care of patients on their own and my first couple of weeks there were rough since I was training with the dayshift nurses - all of whom were "too damned busy to bother with a newbie".
Most nurses will agree that there is a world of difference between dayshift nurses and nightshift nurses. The dayshift nurses were usually more competitive and...less helpful, okay - RUDE - unless you were lucky enough to fit in to one of their 'clicks' right away, (which was not my fate). This was partly understandable because they were the ones who had to deal with the walking giant egos, otherwise known as doctors and their harried assistants. Not only that, they had too many patients at a time who were too sick, or what we called high acuity, to be on 'the floor' instead of the ICU in addition to the constant comings and goings of the physical and occupational therapists, case workers, fresh post-op patients, and various and sundry procedures they had to oversee with each patient - not to mention the families and their constant questions, fears, demands and inter-family politics to juggle on top of all the rest.
Being moved to nightshift earlier than normal was a blessing. I was shocked at the difference in not only the pace of the unit, but the personalities of my new co-workers. Night nurses and most other hospital personnel were what you could term 'laid back' and their sense of humor was worlds beyond in improvement over the hectic day shift people. I was assigned to a male LPN as a prefect, in spite of the break in protocol this represented. Registered nurses were supposed to train registered nurses and licensed practical nurses were supposed to train other licensed practical nurses. The difference was an extra year of school and a much deeper knowledge of pharmacology, among other things. LPNs weren't allowed to administer or hang IV drugs without the signature of an RN. This was often a 'bone of contention' for the experienced LPNs because they felt they were doing the same job as the RNs, but getting paid less. I can't argue with that for the most part and may discuss that in another post.
My prefect turned out to be a blessing as as trainer, however. He had numerous years of experience and was a better nurse than most of the staff rolled into one because of his knowledge of medicine, overall intelligence and cool head in a crisis. I felt lucky the more I got to know him and became quite fond of him over time. He watched over me and showed me many of the 'tricks' (he could get an IV in a patient when no one else in the hospital could do so) that make an excellent nurse as opposed to a good nurse.
As the weeks went by, I quickly developed a bond with my fellow nightshift workers and everyone worked as a team. We usually had more patients than the day nurses, but things were more calm - for the most part. Once in a while we would have a bizzare night full of adventure. They always seemed to come in threes. This particular night we had already had to call the house supervisor over a drunk, unruly family member who belligerently insisted that her son was not receving the care she thought he deserved and a mentally ill young gentleman who had decided to tear out his IV and run down the hall naked trailing a stream of blood from the open IV site. He managed to get down the stairs and outside. The security officers along with my prefect finally managed to find him by following the trail of blood and to calm him down and lead him out of the middle of a five-lane road and back into the building.
After the aforementioned crises we were finally able to sit down at about 4 am and catch up on the tremendous amount of charting, arrangement of medication sheets and other paperwork for the next day. No sooner had we taken a few deep breaths and starting chatting about our husbands, kids, house renovations and the like; there was a sudden bloodcurdling scream from the room directly across from the nurses' station.
That particular room was a double occupancy room. In the bed closest to the door was a lady whom we were evaluating for a possible heart-attack, who was quite nervous and needed a peaceful environment. She happened to be my patient. In the bed across the room beside the window was a tiny elderly woman who couldn't have weighed more than 90 pounds fully dressed and soaking wet with boots on. She was admitted for dehydration and the general malaise that so often occurs with the elderly when they live alone.
During the day this same little lady had captured the hearts of the entire staff with her charming personality and sense of humor. She had been as mild- mannered and sweet as humanly possible and several of us felt the urge to simply take her home and make her part of the family. Upon entering the room and switching on the lights, however, we discovered this same little angel had been transformed into a wild-eyed 'wrangler' standing on the bed over her terrified roommate intent on wrapping the lengthy phone cord around the ankles of the poor woman! She had done an excellent job of doing so before anyone could stop her.
This scene would have been extremely hilarious had we been rehearsing an episode for Bonanza or Wild Kingdom but given the reality of the cirumstances and the condition of her human prey, we quickly talked her down off the bed and my co-workers gingerly led her back to her own 'corral' while I gently untied my trembling, shell-shocked heart patient. Needless to say, I quickly arranged for a private room for my patient for the remainder of the night.
The sweet little woman was only my first experience with what is referred to as a 'sundowner' in the slang terms of a hospital staff. There is no predicting who will suddenly develop the super-human strength and creative ways of acting out common to a sundowner. That's why I developed the habit early on of making rounds on my patients at least every 30-60 minutes no matter how quiet the night may appear.
(Actual names of persons and places have been changed to protect the not-so-innocent & to stave off any undue lawsuits.)
posted by Brooke Lee at 1/31/2006 05:33:00 AM
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