Tales from the Unit: City Trauma Nurse

Tales from the Unit-PART 2: You go HIRED! Now what?
Cons of being in a city trauma 1 center on a neuro spine/ ENT / ortho trauma unit.

By: Amanda Kammes, MSN, BSN, RN

Working in a trauma unit at a large city hospital has its pros and cons. Wow, do you learn a lot as a new nurse, but wow wow WOW is it a lot to handle as a new grad. When I graduated from nursing school, I had aspirations of taking my freshly minted nursing licensure to the birth and delivery unit. Unfortunately, my connections, yes my connections, led me elsewhere.

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Don’t get me wrong, I am thankful for the opportunities that were laid in front of me, but neuro and trauma were two of my least favorite topics in school. Regardless, I jumped in head first. 

Con #1 : Patient/Nurse Ratio

Following your six-week orientation, if deemed worthy, you were sent off on your own. 3-4 patients per shift with varying levels of acuity. The better you were, the heavier the load you got. I would walk into work with much nervous anticipation and look at the white board that hung above the nursing station.

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As I read my assignment I couldn’t help but hear the sarcastic voice in my head say things like, “Congrats! Here’s 3 really sick patients–but don’t worry, you only get 3. Thanks for being a good nurse, you get a lumbar drain, a radical ENT patient and an aggressive Glio.”

Or my absolute favorites were when I walked in and found out I was pulled to another ICU or Step Down ICU Unit. Enter voice in my head . . .“It’s your lucky day, you’re the next contestant on Who Wants to Get Pulled to Another Floor, where you have no idea about your patient population and you get ignored by the nurses on the floor so you don’t talk to anyone for a whole shift and you barely know where the bathroom or supply closet is and please little baby Jesus help me survive this shift.”

All the while, having to leave my home unit with a smile plastered across my face and a pit in my stomach.

Con #2: Aggressive Patients

Nothing like a bed alarm going off at 3AM only to find your patient has removed all 4 of his JPs (jackson pratt) and also both of his IVs. He’s disoriented and upset, blood is all over the bed, himself and the floor.

Or how about the patient who woke up post-op, thought he was kidnapped, jumped out of bed, ran down the hall and we had to call security to assist us getting him back to his room! Welcome to nightshift in a Neuro-Trauma Unit! 

Aggressive patients were a regular occurrence on my unit. Whether they had a TBI (total brain injury) that was messing with their baseline, has ICU psychosis or just were generally unhappy because of their medical situation–watching your six was a skill you had to learn, but oftentimes, the hard way first.

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In my time on this unit, I broke a rib getting kicked by a patient while taking off her ankle restraint, had an IV pole swung at me, was called a lot of names, and even had some fists swung at me while putting in IVs or flushing Peg tubes! 

Being a nurse is hard work. You not only are taking care of the patient medically, but you also often are the brunt of their frustrations and/or their behaviors, which are oftentimes out of their control. You are a support system for them, you are a calming presence and manager of their emotions and you are their in-room and in-hospital family. Keeping all of this in mind, when you are being physically abused or at times verbally berated is a tough thing to wrap your head around. Certainly, not all patients are like this; but these are real realities of working in a Neuro-Trauma Unit. Restraints, calming tactics and just getting used to always watching your back and being careful, are all parts of the job not taught to you in nursing school.

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