On Call

I was on call at "Mountain View" from 8 PM Friday to 8 AM Monday. Friday I had gone out to dinner, then gone to bed late [for me] about 10:30.

Friday: 11:19 PM.
My first call came 11:19 from the evening and night nurses on an allegation, which I walked them through: yes, you have to send home the staff member [which would put them short an aide and be a severe inconvenience]; yes, chart on the patient and put her on alert; yes, initiate an incident report; call police? At this point I had them phone the Director of Nursing and she informed them that the whole thing stemmed from a previous allegation which has been disproved, no sending anyone home--wait, have they clocked out--and no incident report. I get to sleep somewhere around one AM.

Saturday: 10:05 AM.
Received call from the weekend nurse manager that a night shift nurse called in, and that the usual practice when that happens is to split up a run so two instead of three nurses could cover it. The only nurse to call, according to "Janet", is someone who is pregnant and probably wouldn't come in. We decide to leave it at that.

Saturday: 8:09 PM.
Received call from "Mary" about newly readmitted Mr. Burpee calling out loudly for no discernible reason for the last three hours, despite morphine and Ativan, until his wife got there. It's a male room: can the wife stay there? I said she can visit and when they do personal care, leave the room. Resident is not supposed to go back to the hospital. I ask if Haldol is available, suggest calling the MD; it turns out that they don't know who the on-call doctor is for the MD. I suggested calling the MD's cell phone and apologizing and asking who the on-call MD is. I call back to follow up in an hour and it turns out that Mr. Burpee is now quiet and they opted not to phone MD.

Saturday: 9:35 PM.
Received call from "Laura" night nurse asking who is coming in to replace the nurse who called off? I explained what Janet had told me, to split the shift, and that we had agreed not to fill the vacancy. Laura said that when she was manager on call, she always came in to fill a shift, and was I going to come in? I said I hadn't been planning to, and she became angry and said, "Thanks for all your help!" Clunk.

Saturday: 9:50 PM.
Received call from evening nurse, "Francisca", who said she had phoned Janet to ask Janet to call Laura about the staffing issue. I said that I hadn't slept well last night and I had trusted what Janet told me about splitting the run and I wasn't prepared to work.

Saturday: 10:05 PM.
Received a series of texts from "Alison" the DNS clarifying that I did not call people to try to fill the night shift because I trusted what Janet had told me. Alison said I should notify the facility that the census is low, try to get people to stay late &/or come in early, and offer to go in. I found a day shift nurse to come in at 4:00 AM, dressed for work and came in to help with the night shift from 11:30 PM to 4:00 AM. When I got there I apologized to Laura and said what Janet and I did wrong, and that if I had been in her place I would have been angry too. She was very gracious. I learned to use the facility's very weird glucometer, gave several people their meds, almost all of them through gastrostomy tubes, and unplugged a recalcitrant tube which clearly had not been flushed after the last feeding. I went home feeling somewhat heroic.

Sunday I slept till 8 AM when I thoughtlessly answered a call from a phone solicitor, dozed till 10 AM, gave up and showered, spent time on the internet, and was downstairs eating lunch when the phone rang again.

Sunday: 1 PM:
Received a call from Janet that an evening shift nurse had called in and she had not been able to replace him. My heart sank. I swore. I went through the 7 Stages of Death, "DABDA": Denial, Anger, Bargaining, D-something, Acceptance, and Death. [Wait, that's only six. Guess I need to bone up.] I packed a lunch and dressed and went to work. I worked on the cart on my wing, having gotten an excellent report and worked out a game plan with the day nurse, and had to deal with severe staffing issues for the CNA's [there had been four call-in's.] We had one able-bodied aide and one on light duty for 30 residents. It required a show of force to the other side to get them to trade an able CNA with our light-duty CNA.

I was checking blood pressures, blood sugars, and popping pills out of bubble packs until I was able to take a lunch from 7:30 to 8:00, completed an incident report on a skin tear, and very ready to go home by 9:30 PM. There was only one medication I couldn't find and I found out it was at the bedside, where the resident's family members administered it. The family was very nice about it. About 8 PM I received a call from the hospital asking if I would take a readmission and I was very firm and clear in my "NO!"

After report and counting with the night nurse, and still on call until 8 AM, I instructed her not to call me during the night unless there was a chain saw massacre.