Charge!

A few months ago, at the beginning of this pregnancy, work was pretty darn slow, but wouldn't you know it, now that I'm getting large and having a hard time getting through my shifts, it has been pretty darn busy. Add to that I've been charge nurse the last several shifts I've worked, which I just absolutely love. Sense any sarcasm there? I've done it long enough I'm comfortable with the pain in the arse-ness that comes along with being charge nurse - I just would rather take care of patients and not deal with all the BS that comes along with it. One pain is figuring out staffing for the next shift. With the skill mix, a "flex list" and flex dates, it gets more complicated than it is for other floors. We have to have the right skill mix: nursery nurses, labor nurses, techs, secs, etc. and throw in there trying to see into the future as to what is going to come in during the day. I have to look at the number of patients we have currently, their acuity, and what is scheduled to come in, and then either try to find more nurses to work if they are short, or put nurses "on call" if it isn't busy. The hospital is really pushing keeping our staff ratios within budget so there is a lot of pressure to decide staffing based on what you have right then, not what could come in. But that can bite you in the butt if you aren't careful. So any "extra" nurses I always put "on call" instead of flexing completely off. That way they are available should a bunch of patient come in. Decisions and phone calls have to be made at 5:00am. But that leaves 2 hours where anything can and will happen. Like the other night. I made staffing decisions at 5:00. We had one momma who would be delivering - her doc was in the room, she was pushing and was very close - or so I was told. Well, about 6a.m. she's still not delivered - and ends up with an emergency c/s when baby decided he'd had enough of this labor business and wasn't going to come out vaginally. Then another patient comes through the door at 6:30, repeat c/s X 4 in labor and as she's being wheeled up, another pregnant momma had followed, with ruptured membranes. Plus we had 2 c/s already scheduled that would obviously be bumped. The first c/s didn't screw with the staffing for days much, or the patient with ruptured membranes, but a repeat c/s is a one-on-one nurse load for awhile and would require another nurse. No biggie in my head - pull one of the labor nurses off of postpartum, and call in one of the people on-call. But no, the day shift charge nurse threw a fit because I had put a labor nurse on call. With what we had at 5am, if I had left that other nurse on, she'd have been upset that I left them so overstaffed. It's a lose-lose situation sometimes and right now, honestly, I don't have the patience for it. I'm tired, uncomfortable, moral is very low on the unit right now and I'm burned out. I need a vacation and being charge isn't helping with the burn out. I know that is a a bunch of garbly-goo and maybe doesn't' make any sense, but trust me, it's irritating. Especially when I'd rather be the nurse taking care of the patient in labor or going back for the c/s, instead of being in charge and making the phone calls to get everyone there. And I'm scheduled to be charge on several more shifts over the next few weeks. Ugh. Oh well. Seven more weeks, well, more like 6 more weeks until I deliver then I'll have a nice break from work.