I often tell myself, or others, in a (sort of ) joking manner, that "there are no emergencies in hospice." It helps me keep my perspective and maybe even stress levels under control. But that doesn't stop me from waking up in the middle of the night, with a sudden realization that I forgot to chart something. In the persistent, niggling way that only middle-of-the-night-lying-there-in-the-dark thoughts will do, this thought kept circling through my brain, kept me awake, and finally insisted that I get out of bed. I logged into my work laptop and sent the order: I had forgotten to change the patient's bath schedule from once weekly to twice weekly. Phew, now I could rest easily. No wait...since I'm right here in the front of the computer, I think I'll check on the status of the other patient I saw yesterday. Oh, that reminds me, I might as well submit that supply order request now so I don't forget later. Which leads us to here, with me typing a blog post at 0430 in the morning. While there might not be any "emergencies" in hospice, there's a different set of priorities that can take on the same significance. A bath is definitely never "STAT," but to the exhausted daughter at her father's bedside, knowing that someone is coming today to give her dad bath because he's now incontinent and needs much more frequent cleaning might be the only thing giving her a little relief or comfort. The added stress that I feel, while not emergency status, is that if I don't remember to change the bath schedule, it just won't get done. It doesn't just roll over onto the next shift like in the ICU, family member can't just put their call light on again or the computer doesn't pop up a little reminder to the next nurse. So that's what wakes me up at night.
Maybe my old night-shift schedule is too deeply ingrained in my brain. This used to be the time when I would toast some bread or get my yogurt out of the fridge, sit down in front of the computer, and finish up my charting or complete my nursing shift note, reviewing my shift and making sure I didn't forget anything.
So there you go...that's what goes on in the mind of a hospice nurse in the middle of the night.