Shift #6: Part 1 – My Very First Waterfall Set
I know what you may be thinking, “What the f–k is a waterfall set?” A waterfall set, is a total of four back-to-back shifts. The first two are day shifts from 7 a.m. to 7 p.m. (12 hour shifts), followed by two night shifts from 7 p.m. to 7 a.m (12-hour). This is then followed with three to sometimes four days off in a row if you co-ordinate it well.
Now that you know what a waterfall set is, you can appreciate that I am proud to say, I did it. I completed my first waterfall set rotation. It’s too bad that there isn’t a merit patch that I could sew onto my well-coordinated nursing scrubs!
With the waterfall set over, I ask myself, “How do nurses do it?” It was exhausting and I’m physically sore. In addition with this ‘creepy’ feeling of moving through the nights like a restless ghost, pale and silent, drifting from room to room. Maybe this is what it might be like to be a zombie. A zombie trance – from those old movies – not the newer ones where they run and eat people, but where they just walk looking and searching, endlessly. In my case, either looking for something more to do, or looking to take a break!
The seasoned night nurses seemed to float effortlessly through the darkness as if they were part of the night. I didn’t find comfort or ease. I couldn’t adapt to the night as easily as it looked for the nurses. I was still a day dweller. I can appreciate, again, all the added skills (super powers!) required to be in this profession. No textbook or instructor can ever explain it – you just have to do it, to understand and respect it. So yes, with my waterfall set complete, I woke up today well rested, relieved to have the next few days to catch up on sleep without worrying about staying awake for 12 hours through the night, but still thinking of those who do it and, now, having done it, with a great deal of new-found respect.
But let me tell you how this waterfall set went from the beginning.
For this placement, I am on the orthopedic and trauma unit. My first impression, compared to the stroke unit at my last placement, it’s extremely fast paced and busy. That’s sort of funny, fast paced and busy on an orthopedic unit! But yes – lots of action and go-go-go!
After a brief introduction to the floor, I stepped into the work. I was taking vitals, doing head-to-toe assessments, giving medications, performing injections, flushing IVs, and charting. My preceptor seemed to trust me as she readily allowed me to take part in these clinical activities. I learned so much in just one shift.
This same shift delivered my very first code. My very first code, and, of course, it happened while I was on my break. My first break at the new hospital! When I returned, it was like walking into your own surprise party, but no one notices you. Everyone is wearing party hats and there you are standing in the middle of the room, alone — no hat, no drink, looking like some sort of loser that no one invited — even though it’s supposed to be all about you…or so you felt it should be!
The unit was in a state of controlled chaos, with at least twenty nurses crowded into one small space. I heard calls of “Grab the glucose machine! What is it? BP? Pulse? Shit! Bag!” And, “Bring me the machine that goes, BING!” No one said that, but I thought of Monty Python! I stayed at the edges, in the shadows of the doorway, watching and wondering what was happening. It was clear that hypoglycemia was being considered, look at me using my terminology (!), but I could not help but wonder if there was something more going on.
It was overwhelming at first. Not as chaotic as you see in a hospital drama on TV. Not like that. It was chaotic, but not like TV… it was more of an orchestrated and controlled chaos. Everyone moved with purpose despite the noise and urgency. I watched my preceptor, calm and steady, giving instructions and ensuring every detail was documented. In that moment, I saw the nurse as part of a synchronized team. It was beautiful to watch. Everyone had a place. Everyone had a purpose. Everyone knew what they had to do – and they did it with precision. Fast! Here! There! Go! Now! That’s it! Good! Shit! Do it again! Critical thinking was required, batteries not included, this was adrenaline, managing priorities and action prioritize actions to save a life.
There was no consideration of political leanings. No thought about religion, how much money this person made, or what school they went too. None of that mattered. And it shouldn’t matter. The objective, the goal, was to save a life.
In contrast to my first day shift, my second day shift was not as chaotic, but it was still filled with learning, which made the hours pass quickly. However, this bright, bustling pace of the day would soon give way to the quiet shadows of the night – two different worlds, each demanding their own kind of strength.