We have spoken often in my nursing classes about the physicality of nursing and the need to protect our bodies from injury when providing patient care. The “Fundamentals of Nursing Practice” course covers proper body mechanics for lifting, turning and a host of other nursing activities; and the lessons from that very first nursing school class are reiterated in every clinical setting. In just about every health care facility in which I’ve had clinical, patients are required to be turned every two hours (at least) to prevent the development of pressure sores; patients are transferred from beds to chairs and back; procedures require repositioning ranging from propping up limbs, to flipping people 180 degrees from back to stomach and vice versa. All of this adds up to a hefty number of pounds lifted over the course of a twelve-hour shift. I had anticipated the physical stress that comes with day-to-day patient care (at least to some degree) but I can’t say the same for the degree of mental fatigue.
I’m completing my final senior practicum on an intensive care unit and the mental fatigue aspect became especially evident after a pair of 12-hour shifts over Spring Break. Writing in 2007, Dr. Atul Gawande cited research that determined each intensive care unit patient required one hundred and eighty seven actions per day. “Actions” included things from administering a medication to suctioning a patient’s mouth to improve their breathing. Notably, all of these “actions” carry risks. I’m a cautious person by nature but nursing school has given me a deep (very deep) fear of making an error. We’re taught to check and recheck and check again. We check to make sure we’re giving the right medication in the right dose to the right patient at the right time through the right route. Monitor alarms are double-checked, patient identification is checked, safety equipment is checked, two nurses check blood before giving it to patients to make sure it’s the correct kind and that it’s going to the correct person. Check, check, check, check, and check again.
I do appreciate the numerous stopgaps that are in place to avoid nursing errors. But after working a couple of back-to-back 12-hour shifts in a hospital with new-to-me medications and unfamiliar diagnoses I’m pretty sure I would have had to check my own ID to tell you my name if you had asked me. And I promptly went home and had a dream about making an error.