The sitter patient

Okay, so I lied. It's midnight, but it's not so quiet. There's a fair amount of activity going on outside, outside being out in the hall. I'm stuck in my patient's room tonight. He's what we call a sitter patient, meaning: he needs a babysitter. And that sitter is me. I'm not sure if I am a better or worse choice for dealing with sitter patients since I have little kids at home. Taking care of a sitter patient is kind of like taking care of a two year old, except heavier, stronger, and with a lot more stuff attached to them. You know, important medical stuff that they just can't wait to rip off their body. I like to think that I have a slightly higher than average patience level for dealing with this type of patient because of my kids, but sometimes I think that maybe this patience is all used up by the time I get to work. Or vice versa.


Tonight my patient is a fairly pleasant gentleman who became delirious after a series of unfortunate events, starting with a fairly major surgery. Delirium is a pretty serious thing for hospitalized patients; studies have shown that there is a correlation between delirium and all sorts of negative patient outcomes. I understand this, but I have to tell you, this guy is crazy. Hallucinating, talking about (and insisting on) things that don't make sense, pulling at his feeding tube and his catheter. He got a big dose of a sleep aid at bedtime, but he still wakes up regularly to scratch his nose or pull his blood pressure cuff off. Now that most of the care has been done for him and it's time to sleep, my job pretty much just consists of sitting by the bed and telling him to stop and to go to sleep. I'll do this for 5 more hours.


The worst part of having a sitter patient for the evening is being stuck in the room. We're not allowed to have personal drinks in patient rooms so sometimes hours go by with no water, no bathroom break. Definitely no snacks. Sometimes patients will be trying to climb out of bed, over and over again, or otherwise attempting to (accidentally) injure themselves, making the job that much more trying. We can restrain patients if need be, but this is usually reserved for really out of control behavior as this usually just makes people mad. I'm a fan of the chemical restraint myself (hello sedatives!) but these are usually limited as they tend to make things worse for the patient in the long run. So here I sit. Who says nursing isn't glamorous?

The night nurse

I've been working overnights now for almost three years. When I first started nursing I thought I would hate the night shift and decided I would try to get on the day shift as soon as possible. My first job was on a surgical floor and the day shift was really busy, always running around to help patients out of bed, assisting with or giving baths, passing meds, passing more meds... and then the patients' families were always there, asking questions I had no answers to (hello, new nurse!), doctors were rounding... Seriously, it was all I could do just to keep up. When my orientation was over, I switched to the night shift, my new home. And... it was quiet. Sure, I was still running around like a crazy person, but sometime around 2 am there was this blissful period of quiet. Most of the patients were sleeping, the nurses were all charting, and the only noise was the tap, tap, tap of fingers on keyboards. I had time to look up the multitude of questions that had come up so far in the shift. I had time to finish my charting. I had time... to shop on the Internet. Now we're talking. Night shift it is then.


Nurses work the night shift for a number of reasons, some of which I have already mentioned. One of the primary reasons is money. Night shift almost always includes a differential of 10-25% on top of the base pay. Where I work night shift gets 10%. Weekends gets 25%. Night and weekend? You got it- 35% more money. I do like the money, but that's not my primary reason for night shift. Really, it's just... quiet. Now that I work in the ICU I take care of 1 or 2 patients a night. Unless something bad is happening, the goal is usually to maintain until the morning. No trips to imaging, no doctors coming by changing orders around, no families asking all those questions, just me and my (preferably) sleeping patient.


Since I started nursing, I've also started a family. I now have two little boys at home that are in my husband's capable hands while I'm at work. My youngest is still an infant, still breastfeeding as I write this, and it takes some effort on both ends to keep that up while I'm away. The hardest part is being away for so long- a 12 hour shift plus 8 hours at daycare so Mama can sleep plus commute time means I have approximately 2 hours with my boys on days I work. Fortunately, I only work 3 days a week and can make up for it the 4 other days I don't work. I think family reasons are another major reason nurses move to the day shift, but I don't know that I would really get any more time with them if my schedule was switched, seeing as how we'd all be sleeping. Or not sleeping. My poor husband.


So here I am, it's almost midnight. My patient is sleeping, and the only sound is the tap, tap, tap of the keyboard as I type this. Night shift rocks.