Yesterday my assignment included two tracheostomies. There are no hard and fast “rules” on our unit about assignment limitations. Mostly we just divvy up the isolations, the total cares, the trachs, the chest tubes and the needy as fairly as possible among the nurses. Usually a nurse will only have one trach. 3 isolations at the most. A couple of chest tubes is no big deal. One total care is plenty. Usually it works out, sometimes you get screwed.
Some nurses complain more than others about their assignments. Some nurses don’t even bother to put their things down when they come in to work in the morning but rather head straight over the the assignment sheet with their purse/bag, lunch, coffee and phone in hand to make sure they didn’t get an unsavory assignment that day. Some nurses bitch and grumble if their assignment isn’t perfect, like with 5 walkie-talkies. I tend to figure, eh, what goes around, comes around.
Yesterday was a “come around” day for me. Two tracheostomies, one with a deep oral flap that required frequent checking but that I could barely see because she couldn’t open her mouth farther than a finger’s width. A total care with diarrhea (jackpot!) and an 80 pounder with a stage III. If given the choice between that assignment and a root canal yesterday, I would have strongly considered the latter.
My second one wasn’t a technically difficult trach. His secretions were thin and manageable and he didn’t need frequent deep suctioning like my other one did Which is probably why I got the two and everybody else only got one. Nurses are like the opposite of greedy kids at Christmas. “How come I got two and Johnny only got one!?…I only want one!”.
The Easy Trach, we’ll call him, was progressing nicely towards decannulation (taking the trach out and taping up the hole in their neck and letting them breathe through their upper airways again). Yesterday was time for cuff deflation and speech trials. Without getting into the anatomy & physiology of your airways and vocal folds just remember the following easy equation. Cuff up = no talk. Cuff down + Passey Muir speaking valve = talk.
I had been having difficulty with Easy Trach that morning while his cuff was up because in addition to being the worst lip speak enunciator, he had horrendous handwriting/spelling/grammar. He lip spoke too fast and when I couldn’t decipher I asked him to write down what he was trying to say. So he’d write down one word (“medasin”) and then continue to rapid fire lip speak the rest while pointing a the clock. After about 5 minutes I finally was able to figure out that he wanted his pain medicine precisely at 8am and not a second later. The morning went on like this with him lip speaking too fast, me asking him to write it down, him writing one or two “words” down and then lip speaking the rest. I was desperate to deflate his cuff so we could communicate better.
When it finally did happen, everything made sense to me. He was a talker. A fast talker. And he wouldn’t shut up. I wanted to immediately re-inflate his cuff. “Let’s just put this cuff back up, shall we hmm?”