PixelRN

Should nurses cover for the housekeeping and food service staff when they go on strike?

Our hospital is facing a possible strike by the service workers. In the event of a strike, the hospital is requiring the nursing staff to fill in for the services workers. That means that I am required to sign up for extra shifts (12 hours extra per week) in order to cover such duties as answering phones and housekeeping.

I think this is a bad policy for so many reasons.

First of all, it's mandatory overtime.

Second of all, I have worked hard to become a nurse. I consider myself to be a professional. Do other professionals have to cover service workers when they strike? Respiratory therapists? Pharmacists? Physical therapists? Doctors? No, the responsibility falls exclusively on the nursing staff.

Third of all, it implies that I am taking the hospital's side in the case of a strike. I don't even consider myself to be pro-union, but still it seems wrong for me to have break someone else's strike if I do not choose to do so.

Last of all, I do not want to put my health in jeopardy by having to clean hospital rooms for 12 hours. Not to sound like a wimp, but I get lower back pain just from cleaning my own bathroom. Plus there's the minor detail of being 35 years old and 5 months pregnant.

And then there's the question of safety - I haven't been trained on the proper cleaning of a hospital room. This is pretty dangerous when you consider that the majority of our patients are MRSA and VRE positive.

I almost let this matter go. I had been told that the strike is unlikely to happen. But when it came time to put my schedule in, I was required to schedule 12 hours per week of overtime for the entire month of December. I thought this was rather excessive, so I started to do some research. I found the ANA's position statement on mandatory overtime. It defines mandatory overtime as "the hours worked in excess of an agreed upon, predetermined, regularly scheduled full-time or part-time work schedule". Therefore I have declined to schedule myself for the extra shifts, because I believe that would imply that I have agreed to work them. Tomorrow I'll meet with my nurse manager and human resources to discuss the matter further. I'd like to see the official policy in writing, and how it was expressed to me at the time I was hired.

The strange thing is that aside from one or two of my colleagues, the nursing staff seems to be very complacent about this policy. It doesn't seem to bother them in the least.

Of course it would be simple for me to express my dissatisfaction by finding another job. There are plenty of other hospitals in my area. The only problem is that I am halfway through my pregnancy and cannot afford to put any of my benefits in jeopardy.

So what do you all think about this? I would love to hear your feedback.

It seems like every time I take a class (and there are many offered at GHOAT), whatever I have learned about I will soon see in action in the MICU. Last week I took the ACLS certification course. So naturally I came to work the next day fully expecting to either shock someone or perhaps do some chest compressions, or maybe both.

And there she was. She had been in the MICU for a while (never a good thing), and had had a bad night. Every system had gone south. She was in multi-organ failure. Her worsening and hopeless condition had been explained to the family the previous day, but the family still wanted to forge ahead and "do everything." In short, she was an ACLS algorithm waiting to happen.

It's funny, when I first used to come into contact with these situations, I would feel outraged: Here is a woman lying bed, She is oozing serous fluid from every little scratch and old insertion site all over her body. She's unresponsive and all her systems have failed her. She is practically, but not quite dead, and now we have do all this invasive "stuff" to her because we have somehow failed to explain to her family that it's fruitless to continue on with this medical care. It somehow seems amoral. But the situations are never that simple. We have the dreaded "family meeting" (the meeting where the docs tell the family that chances are, their loved one is going to die). It always makes me think of the movie "Dumb and Dumber," where the girl tells Jim Carey that there's only "a one in a million chance that she'd ever go out with him." Jim Carrey is jumping up and down with glee. "Why are you so happy," she says? "Because you said I have a chance!"

But alas, this is not another one of my rants about how everyone in the MICU is dying a horrible death and they should all be showered with palliative care... No, this is a story about ACLS.

So realizing that this is my fate for today, I go on to take care of my practically dead patient. I still talk to her and let her know what I am doing because, after all, who knows? Maybe she's still in there somewhere. She may even be hovering over the bed, just killing some time, waiting to meet her maker. Perhaps she is finding amusement by watching me blunder about in her room. She's been in A-fib all night but now I am watching her heart rate increase even more rapidly. 120s. 130s. 170s. I call the medical team to the room and right away the fellow says, "Time to cardiovert!"

See, I just knew that there was an ACLS algorithm in store for me that day! And it's an algorithm that I am not experienced with - synchronized cardioversion. Of course I aced the asystole and PEA algorithms because that is mostly what we see in the MICU. I'm all about pushing epi, atropine, and bicarb until the cows come home. But anything that involves electricity I am hopelessly inexperienced with. So I put the pads on her. The resident is turning on the AED and a nurse is showing her how to set it up for cardioversion. They set it to 50 joules and SHOCK.

OOPS. They forgot to put it on "synchronize" mode. Now my patient is in V-tach. So now she gets the REAL SHOCK. 200 Joules. And moments later she' s in a normal sinus rhythm. Just. like. that. It's amazing. She's still dying, (and would later die that night, surrounded by her family.) But I watched her heart being manipulated by electricity and it was truly amazing.

The moral of the story is that now I will never allow that mistake to happen to one of my patients. This is a very scary but true thing about nursing. Once you make a mistake (or witness a mistake being made on your patient) you will never allow this mistake to happen again. I will always remember my first cardioversion, and how easily you can send someone into v-tach by neglecting one small step. In fact, there is no such thing as cardioversion in my book. It's called SYNCHRONIZED cardioversion.

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Faithful readers, (and I wonder how many of you are still there out there since I have been neglecting my blog for my adventures in reproductive endocrinology) you may be wondering how I have managed to start posting again. Ah, the magic of pregnancy. You see, I am now at week sixteen. A few days ago I woke up and decided to clean my entire house. Instead of cleaning maybe a room or two and then pooping out (like I usually do,) I ended up actually cleaning the entire house. I was shocked when I looked back at all the work I had accomplished. The next day I did a twelve hour shift, came home, made dinner, and actually did the dishes. What in the heck is going on? I wondered. Well yesterday I was reading a pregnancy book and it said that week sixteen is when you get all of your energy back. It's like clockwork. And I intend to milk it for all it's worth because who knows when the energy will disappear again? I'm guessing sometime around week 20.

I did not have a good feeling about this patient. She was what was known as a "trainwreck," something wrong with every system. Had an operation, many complications, slow recovery, rehab in a nursing home. When I went in to assess her though, she was not intubated and was able to communicate her needs to me so I figured that she wasn't so bad off after all. But her oxygen saturation kept rising and falling and she was having very frequent PVCs. I started to develop a bad feeling about her.

She was relatively comfortable until about halfway through the morning. Then she started calling for me. I found her short of breath, anxious, and diaphoretic. I asked her if she was in pain, she said no. "I. JUST. CANT. BREATH!!" She managed to say. So I went up on her oxygen more and more, but to no avail. I ran out to get a doctor. "Okay," the resident said, "I'll be right there."

I rushed back to her room. I held her hand and tried to talk her though the anxiety. She looked up at me and said, "I'm going to die, aren't I?"

Oh crap. My more experienced colleagues had warned me about this. When a patient looks up at you and tells you they are going to die, their instincts are usually right on target.

I lied and said, "No. You are not going to die. We are going to get you through this."

"But who are all those people in the white robes?" she said.

Oh double crap. Now she's seeing the angels. I ran out to get the resident. "You really gotta come to room 7. Quickly." As I rushed back to her room I noticed an unusually large number of physicians walking around the MICU that day with long white lab coats on.

I asked her, "Are those the people with the white robes on?" I pointed to a group of doctors.

"No," she said between short breaths. "These people have white hoods on."

Oh triple crap. This is it. Here we go. She's seeing the light. Now I'm the one feeling short of breath. It's only a matter of time now before I am going to have to pull the code bell.

Just then I glanced outside of the room. I noticed a new resident walking by. A new muslim resident. A new muslim resident with a white head covering on. Moments later a pharmacy resident walked by, also a muslim, and also wearing a white coat and a white head covering.

I pointed to them. "Is that who you mean? Are those the people with the white hoods?"

"Yes! What are they doing here? Am I going to die?"

"No. You are not going to die." And that time I was being truthful.

Finally a couple of residents came in to the room. They diagnosed her immediately. Flash pulmonary edema. She missed dialysis while being transferred to GHOAT. Meanwhile we had loaded her up with fluids because she was a GI bleeder. Within minutes she received morphine, a couple of sublingual nitroglycerin tabs, and a huge dose of lasix.

Within minutes she was feeling much better. As a matter of fact, I was too.