Nursing Shortage

Nursing Shortage

This week I stayed at the hospital from Monday morning until Friday afternoon. Both of the long-term American pediatric nurses that I have been working with were gone this week and there weren’t any nurses coming with the short-term team this week. It was trial-by-fire time, for sure. To contrast the lack of nursing power there were four American pediatricians here this week. That was awesome. It was an exhausting week, but one of the best learning experiences I’ve ever had. Instead of having another nurse to turn to, I had doctors always at hand. I followed them as they made their rounds and discussed the plan of care for each patient, they wrote orders and progress notes in my same language, and they were super friendly and willing to discuss patient care with me at any time. Since I was the only American nurse they came to me anytime they had a nursing question or needed something done for a patient, so I got to do everything under the sun. They had to jump in and help with nursing care several times, and it was crazy to me when they asked me how to do something. I couldn’t have asked for a nicer or more patient group of MDs to work with and I had a great time hanging out with them in our rare off times. We had a cook-out one night and went to the UN base to eat a couple nights. Other times we just sat and talked about how our perspective was being changed. I was deeply blessed by them.

Monday and Tuesday I was the third nurse on duty, which meant I had to take a full patient load myself since three nurses is the minimum needed to cover the unit. I’m getting more confident about managing patients myself. I make a plan in the morning, review all my charts and orders, make notes about what needs to be done, what meds need to be given, and I get to work. Monday I took care of four babies. Tuesday I had four 6-8 year olds. It was refreshing to have bigger kids that I could actually talk to after having babies so much of the time; although the term “talk to” in this case is very loosely applied, since I speak very little of their language.

Over my head

“It turns out the droplet of our knowledge is a bit lost in the ocean of our unknowing.” –Donald Miller

Wednesday I was the fourth nurse on, so I was the float nurse and didn’t take a patient load. I hoped it would be a chill day of feeding babies and running to pharmacy since I was pretty exhausted. That was so not the case. Around 10:00 a kid was brought in who was having almost continuous seizure activity. The vast majority of my focus and energy for the next three days was devoted to this three year old little boy.

That first day one of the MDs and I stayed at the bedside and tried everything we could to bring the little guy out of his seizures. I would give him some anti-seizure medication and we would watch him and wait. He would seize some more and I would give him more medication.  I gave him enough anti-seizure medications to knock out an elephant. We couldn’t take our eyes off of him, since we fully expected him to stop breathing at any moment from the drugs we were pumping into him. But still he kept seizing and still we gave him more medication. I carried his little body to CT scan, X-Ray, back to CT scan. I assisted the doctor in doing a lumbar puncture on him. The MDs identified a brain lesion that was causing the seizures, which looked infectious but could have several possible causes. By Wednesday evening he was not seizing and still breathing, so I sat down and breathed a little too.

Thursday I was a float nurse again, and once again I spent most of my time giving the little boy anti-seizure medication. The pediatrician team brainstormed possible causes of the brain lesion, because ultimately without fixing the cause of the seizures they won’t stop and the boy won’t live. We started treating him for a couple of different infections. It was hard to believe that only a few days before this had been a normal little kid- running, playing, laughing. We were starting to feel frustrated and discouraged that we couldn’t keep him out of his seizures, we couldn’t figure out the cause, we couldn’t fix him. The pediatricians were consulting other MDs, emailing neurologists in the States, we even had a neurosurgeon from the US come in this week who was consulted. It is amazing how one little kid can take a dozen doctor’s worth of brainpower and make it not seem very powerful at all. In all of our knowledge we know so little, are so little in control.

On Friday I was the third nurse again, so I had four patients, one of whom was the little boy. It was crazy from the very start. The boy was having seizures from the time I walked in, so instead of being able to slowly get my bearings and make my plan for the day I had to just jump straight into action. Then I discovered that the night nurse had missed several medications and let some IV fluids run out, so I was playing catch up right from the beginning. I cut my finger when I broke open a glass ampule, rushed to get caught up on medications, and felt my mental state become less and less composed.

Then the little boy started gasping. He had impressed us by continuing to breathe despite all the meds we had been giving him for days, so by all means it should have happened much sooner than it did, but mid-morning Friday the Peds team decided we would have to support the boy’s respiratory system with a ventilator. Knowing this would be far beyond my ability level, I recruited the CNO (chief nursing officer) for help, so the MDs would have a nurse helping who had a clue what they were doing. But I was still front row, hands on for the whole thing and I was scared out of my mind. “If I ever needed you Lord, it’s now.” For you lay persons, intubation involves completely sedating the patient, putting a tube in their trachea, and letting a machine breathe for them. Nursing folks- I’d like you to appreciate that here, in order to verify tube placement, I had to carry the intubated kid, while someone else walked along bagging him, another person carried the O2 tank, over to another building where the X-ray is, then parade back in the same manner. Just keep in mind to be thankful every time you call x-ray and they show up at your patient’s room and take the image right there in their bed.

Once the little boy was on the vent, we could increase the anti-seizure meds as much as needed to stop his seizures and keep him totally sedated. I successfully started a new IV on him, which was my first one on a little dark-skinned kid, so holla! When he was settled and stable on the vent I went to assess my other patients and make sure they were still okay. I literally turned around and looked at one of my other patients, post-op hydrocephalus kid, and he is having a seizure. You are freakin kidding me. So I draw up yet another dose of anti-seizure meds and as I’m giving them to him I say, “okay you, I can only handle one person having a crisis at a time, and it is NOT your turn!! So you better straighten up!” I’m happy to report that his talking-to had the desired effect and he was seizure-free for the rest of the day. It took the rest of the day just to catch up. I was stressed that I gave meds an hour late and didn’t change a diaper for far too many hours. I’m still learning to take things as they come, to not stress the little things. I’m learning that I can’t do it all and that’s okay.

Around 2:00 I was caught back up on all the tasks I had missed during the intubation excitement. The pediatricians practically pushed me out of the unit to go eat since I hadn’t had a morsel all day. Did I mention that I had a sinus infection and felt like crap this whole time? Somehow I made it through the day, through the week. I learned and did so much. I was poured out, all my energy, all my brainpower. And as I left the hospital Friday afternoon I was doubtful if the little boy I had worked so hard for was even going to make it. We give it all we have and it might not change anything. I prayed and prayed over that boy and didn’t see him get better. It’s a beat down. But ultimately it makes me have to cling to the Father even more. Because I can’t give any more or less than everything I have to give, and at the end of the day I just want His will to be done, whatever that means. I’m ready for Jesus to come back. I’m sick of babies dying. I hate babies dying.

Failing

Through the Lord’s mercies we are not consumed, because His compassions fail not. They are new every morning; Great is your faithfulness. –Lamentations 3:22-23

As I’m learning and doing more each day than I ever have before, it’s exciting to know I’m growing. I’m getting incredible experience. But I’m also realizing my shortcomings which, although difficult, I’m grateful for. This weekend I’m broken by the ways I failed this week. On Friday I was a stress ball. I was thrown in the way deep end and half drowning. During my flustered hyperactivity, patient’s moms would come up to me and ask for a diaper or ask me to address the malfunctioning AC unit. In my stress, several times I just waved them off and was totally unable to come up with a single kreyol word other than “later.” I was so rude to them. To these moms that spend 24-hours a day on a plastic chair next to their suffering, maybe dying kids. Not having time, not having composure, not having the language ability to be polite is no excuse for me. I feel rotten.

The mom of the little boy having seizures asked me to change his diaper all the time. Usually at the most inopportune times, too. Or she would change it herself, which would invariably cause him to have seizures since he was so hyperirritable. I found myself annoyed by her at times, and even waved her off once when I was doing something else and couldn’t think of how to tell her I couldn’t help her right then. I have a heavy heart when I think about that now. This lady traveled from three hours away. She has nowhere to go sleep, no ability to go check on her other kids, no ability to understand just how grave her son’s condition is. And most likely, her precious son is about to die. And even if just for a moment, I was rude and uncompassionate towards her. I want to be a good nurse. I want to be good at my skills and smart in my treatment. But more than anything I never want to be that person again. Before skills and knowledge, I want God’s love to come out of me. I want to be compassionate. I never want stress to get in the way of kindness. I know that I’ll probably fail at this again and again. I’m so thankful that I’m forgiven. I’ll never stop needing forgiveness.

Pray

Pray for my body. I’m recovered from the GI distress from a couple weeks ago, but since then I’ve had a small bout of food poisoning and now I have a sinus infection. I was pretty worn down last week. I’m going to take a few days to rest this week and hopefully recover from all that.

Pray for my babies. If there are happy, healthy babies and kids in your life, give thanks every moment. Pray for healing and health for my kids. Pray for Jesus to make everything new. Pray for the day to come when no more babies will die.

Pray for my growth, that I would be more like Jesus in my interactions. That I would show Christ’s love to my patients and their families. Pray for me to learn Kreyol so I can communicate love to Haitians and that boundary would be broken. Pray for me to be patient and forgiving towards myself.

I love y’all. Thanks for loving me.