1. McCoy, Cindy PhD, MSN, RN-BC


What gets you through the night shift?


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Carol's patient is in ventricular tachycardia again. In her 70s, the patient's been without brain function since she went into cardiac arrest while singing in her church choir. When I hear Carol call to me, I raise the side rail on my patient's bed, hurry across the cardiac ICU, and snatch the crash cart. As I shove it close to the bedside, Carol grabs the defibrillator paddles and shocks the patient. When the monitor shows no change in rhythm, Carol delivers another shock. This time it works; we watch for a minute to make sure the rhythm continues, then Carol goes to call the physician while I check the patient's iv, endotracheal tube, and urinary catheter.

Figure. Illustration... - Click to enlarge in new windowFigure. Illustration by Annelisa Ochoa

We're understaffed, with six patients between us. Sometimes, at the start of a night shift, it's hard to feel positive when you know it might not be possible to provide the best care. We're several hours into the shift now, and saving this patient's life feels good. When Carol returns with her orders, we quickly prepare the medication and the new iv infusion.


I return to my patient, who has dozed off, then make a hasty round of the other patients: an iv bag needs to be replaced, a patient needs assistance onto a bedpan, another needs to be repositioned.


Since Carol's patient seems to have stabilized, I make a trip to the waiting room outside the unit. As I open the door several sets of sleepy eyes question me. I always dread this part of the job. No one wants me to call her or his name. I beckon the patient's daughter to the door, quietly explain the event, and ask her if she'd like to come in and talk to her mother. She smiles and follows me onto the unit. Even though her mother is sedated and on a ventilator, the daughter stands and talks to her, stroking her hair, holding her hand. I leave as Carol comes in to speak with the daughter.


My total-care ventilator patient needs a bath. I've cared for him every night for two weeks. In his early 60s, he crashed his car after a myocardial infarction. Since then he's had heart failure and acute respiratory distress syndrome and now has an abdominal dressing because of an infection at the site of an exploratory laparoscopy.


I can tell from his expression that he's depressed. Some of the other nurses don't like to work with him because he can be irritable if you do things for him without telling him first. I figured this out early and we get along fine. He's awake and alert and communicates well-mouthing words and using hand gestures-even with his tracheotomy tube. He likes to watch country music videos; we turn the TV on and I sing along. As I perform tracheotomy care and change his abdominal dressing, I talk to him about his family, their pets. After I bathe him, he and I decide that we will try sitting him up in the chair for a while. His wife usually comes in at about 6:30 AM, and we plan to surprise her. Carol and I enlist the help of the respiratory therapist, and together we help him up into the chair at the bedside. Although I have much to accomplish before the end of my shift, I decide to wash his hair and shave him. When he is clean, groomed, and smiling, we prop him up. He seems to tolerate it well.


The sun starts to come in through the windows. Carol makes a fresh pot of coffee. There's still a bag of dirty linens to empty, a drug cart to be exchanged, the schedule to review, and the crash cart to be restocked.


My patient's wife peeks around the unit's door at 6:30. Visiting hours don't begin until 9, but I always let her in early. I tell her we have a surprise for her. As she enters her husband's room, I watch from outside the door. His smile matches hers. I give them a few minutes, then go in. "Thank you so much," she says. She is crying. "He is going to be okay. I know it now. He looks like himself today."


I ask him if he'd like to go back to bed, but he says no. I leave them together holding hands.


Since I became a full-time teacher, it's moments like these that I miss the most-even more, maybe, than saving lives.