sniff, sniff...is something burning?

Oh, that's just me. Burning out.

In the past month, I haven't taken care of an actual patient. Nope. I've been doing triage, ambulance triage, and I've been in charge. Twelve hours a day. Oh wait, I lied. I DID take care of a patient once...a few weeks ago...when I relieved a nurse in a patient area for an hour. So in the last month, I've done one hour of patient care.

Contrary to what some think, I enjoy taking care of people who are sick. I like assessing them and discussing their care with the doctor and making them more comfortable, and possibly, helping them to get well. I like being able to intervene to stop their diseases from getting worse or killing them. I like educating them about how to keep themselves well.

I also like triage and ambulance triage, but in moderation. These are two very hard jobs.

In triage, you decide who is sick NOW and who can wait, and sometimes it is not as straightforward as it seems. You have to look at someone, and figure out...hmmm...is this cold pneumonia? Can this person be seen in fast track and sent right home? Is this baby likely to go south in the next half hour or so? You also see TONS of not-sick people who believe they are dying, and who will harass you at every possible interval: "Why he went back and not me? I was here first! I vomited! ONE TIME! Why you call this an emergency room! This is an emergency!" OR "Nurse, my daughter cut her lip and was bleeding! I KNOW it seems to have stopped, and I KNOW you called plastics to come look at it, but I don't understand WHY she can't go inside and lie down! She is OBVIOUSLY in severe discomfort!" (and the child is romping around the ER, cute as a button, coloring in a coloring book.)

It makes you lose faith in humanity.

When you do ambulance triage, you greet every ambulance that comes in, quickly assess the patient and listen to EMS's information, decide if the patient needs a cardiac bed or not, get the patient to the bed, finish your assessment, and then go type it up, put the patient in the tracking system, distribute the printed triage to the doctors (alerting them to any serious emergencies), and report on the patient to the nurse. There is a LOT of literal running around. Sometimes you get backed up on busy days. And if it happens to be a day when the director of emergency medicine is there, woe is you! This person, who is the doctor version of a clipboard nurse, decides that "Bedside triage is BEST!" and just orders EMTs to stuff patients in any available bed. Without telling you or the charge nurse what he is doing. So you have to scuttle around, trying to figure out who hasn't been triaged yet, trying to find the EMTs or paramedics for each patient (god forbid they should stay by the bedside until you get there), and move patients around to beds that are appropriate for them. And you PRAY you didn't miss some little old lady whose EMTs left because someone else signed their paperwork. Oh, and on busy days, the other nurses HATE you because you are bringing in an endless stream of patients to them. Joy.

I won't even go into being a charge nurse. It's just all of the above, plus dealing with the clipboard nurses and doctors from upstairs, and settling staff disputes, and more.

Sometimes triage and ambulance triage are a nice break. You don't have to commit to anyone and you get to see a lot of interesting things. When you do triage, you get to sit in a chair. But do either of those things every day you come to work for a month? Some nurses like it. I don't. I'm getting stale and burned out. My nursing skills are suffering. My time management skills are suffering. And I don't like to complain to the charge nurse when I don't like my assignment, because it puts a burden on her to move things around. So I'm going to the ED's director of nursing and gently pointing out that the ICU has lots of vacancies for nurses who enjoy patient care, and if I don't start taking care of more patients down here, then I'll start doing it up there.