I had the opportunity to return to the facility on the border. This time I spent the 8 hour drive listening and learning Spanish instead of crying. I felt very excited and proud of my accomplishments when I left last week. I went into this assignment with confidence, but I was quickly humbled.
I had 39 patients assigned to me (the only nurse): 14 of these patients were “feeders”. This means that they were unable to feed or hydrate themselves and require someone to perform the task. That may not sound too difficult on the surface, but they often have neurological deficits/swallowing difficulty which require an extended amount of time for each of them to consume an adequate amount of calories/nutrition/hydration. 10 of the patients had PEG tubes and required all nutrition/hydration/medications via their tube. 32 of the patients were incontinent and required total care for turning/repositioning/incontinence care. Now, let me “paint” the scenario for perspective:
While you are trying to perform the above cares for your patients, you encounter one that appears to be experiencing new onset neurological changes, and you discover that he is hypoglycemic. He does not respond to the treatments on hand and requires an emergent transport to the ER. You call 911 and family members while continuing attempts to stabilize him until EMS arrives for transport…… At the same time, you have a patient with sudden onset dyspnea, 3+ peripheral edema, adventitious lung sounds, and obvious distress. These are classic symptoms of CHF exacerbation, but he does not have a diagnosis or history of CHF. He also needs emergent transport to the ER. Once again, you call 911 and notify family members while trying to keep him stable until EMS arrives. While trying to care for these two acute episodes, you can only hope that the other 37 patients are okay. But…. you walk into one room and find a patient on the floor and in another room you find a patient has pulled out her PEG tube and placed it on the bedside table (while the feeding continues to pump through it everywhere). You can hear patients calling out in hunger and others calling to have their clothing/bedding changed due to incontinence. The call lights are going off everywhere (loudly). It is at this point that you are informed that all the nurse aides in the building have walked out and will not be returning. You are also informed of a new admission (they are already en route), and the director wants to know why you won’t answer the phone to get a report from the transferring facility. Your scheduled medications or treatments are behind for this shift because you can’t even get the basic needs met. Before you realize it, you have been working for 12 hours and have not eaten or drank anything. You are exhausted but can not stop to take a break……….. At the end of your shift (16 hours), you will be asked if you followed the facilities policy/procedure: “Did you get MD orders to send the patients to the ER? Did you complete SBAR’s on the patients that were transferred to the ER? Did you complete progress notes, contact family members, complete incident reports? Did you put their orders on hold, change their status in the EMR?”, as if these tasks would take priority over the direct patient care that was needed (and as if you had the opportunity to sit down and document anything).
That is how it went. I found myself feeling like it was all surreal (I was in denial) at times, and then hopeless, helpless, and defeated at others. I would have cried right there, but didn’t have time to focus on any type of reaction. I just kept pushing on through the physical and mental exhaustion. I strove to continue to provide the needed cares despite the futility. I am not writing this to condemn the facility in any way. Nor is my intention to seek attention or pity. I debated even sharing it for fear of judgment. I am writing it to try to process an individual experience that I had, which happens all too often across our profession. This situation is why we need more nurses/nurse aides (it is also the reason that there is a shortage of us).
I left the facility feeling “dead on my feet”, but I did not leave my shift feeling relieved (as some would assume). I left with a huge weight of guilt on my chest. Guilt because I had the option to leave and go home while the patients had no choice but to stay in an environment that was barely providing for their physical needs, much less their emotional needs. A place that is supposed to be their home. A place that should be comfortable and provide rest. I carried this guilt with me for the 8 hour drive back home, and still feel it right now as I type. To be honest, I think I am experiencing a trauma response related to it. I am broken. All I can think about is their sweet faces and pleas for help, I don’t know if I will be able to find peace.