Going from Stepdown unit to Endoscopy

This was posted in April. Did you take the position after all? Send your letter? If you took the position, are you happy with it?

Oh boy, sorry to be so late replying to your post!

So I did get the position! This June will make 2 years in Endoscopy, and if I could go back in time I would tell myself I had no idea what I was getting myself into, both in a good and a bad way.

First of all, it confirmed something that I had suspected for a long time: that I personally prefer working in an intraoperative area compared to a bedside setting. While bedside nursing in incredibly rewarding in its own right, it is also incredibly exhausting both mentally and physically. The result was that after two years I had come dangerously close to burning out and desperately needed a change.

Compared to 12 hour shifts with the same patients and family members, my day is now filled with short periods with numerous patients. Our time together is limited by the specific goal of the procedure we're doing, be it a screening colonoscopy or an EGD with control of bleeding. On one hand, you don't get to develop the same relationship with patients that you would on the floor. On the other hand, if a patient or their family is, shall we say difficult, then your interactions are kept restricted to their procedures.

The procedures are the best thing about Endo. I'm a very hands on person and I've learned so much in the past two years working directly with the GI docs, pulmonologists, and general surgeons. A common misconception about Endo is that it's only "Butts and guts". Since we're a level 1 trauma center, I've gotten exposed to a variety of procedures and cases. In addition to standard colonoscopies, EGDs, and bronchoscopies, we also do numerous different specialty procedures.

The most common specialty procedures we do are ERCPs, which we use to treat obstructions of the common bile and (to a lesser extent) pancreatic ducts. At our facility, these are done under general anesthesia in a special cysto room in the OR. The type of patients undergoing ERCPs can range from relatively healthy young adults needing a simple stone extraction to a severely ill person who's gone septic from cholangitis.

Other specialty procedures include EUS, EBUS, and Navigational Bronchs. Of those three, different nurses in our department are trained to do them and become a sort of "team" for those procedures. I've been trained to do EBUS and Nav. Bronchs (both of which have to be done in the main OR) and have had some training with EUS (which is either done in the cysto room or the endo unit), which I hope to finish learning soon.

We do both outpatient and inpatient procedures. With outpatients, these tend to do routine screenings or interventions like esophageal dilatations and therapeutic bronchs. Inpatients are obviously sicker and include acute GI bleeds, cholangitis, respiratory exacerbations, and other issues. This is where I feel like we really get to flex our nursing muscles, considering their current illnesses and what we're going to do to fix it. Sometimes we place endoclips, sometimes we cauterize, and other time we do multiple treatments. Sometimes it works and we get to feel really good about helping someone, and other times I've had some scary situations with really sick people.

The way we do call is different from how it was done on the floor. My old unit did call for an entire 12 hour shift meaning I would be called in for call outs and short staffing (and occasionally for high patient volume to staff overflow areas in other areas of he Heart Center, such as during the height of cold and flu season).

For my call days in endo, I show up for my scheduled shift as normal and stay until all cases are done. Sometimes we finish early/on time, other times we get stuck pretty late. The latest I've ever had to stay was 2100 (usually I leave at 1600). After we leave, we're on call until 0700 the next day. If an emergency case comes in during the night, like a bleed or a foreign body, we have to come in and work the case. Then when report for our shift the next day and a different person takes over call. We also take weekend call from Friday to Monday morning, coming in if the Baylor team needs help or calls out. In addition to this, we have late stay days, where one of the room nurses stays on the unit with the call nurse until all cases are done, and then gets to go home. Unlike the call nurse, the late stay nurse does not have to come back overnight for emergent cases.

The good part of call: it's not based on staffing. I get called in when a patient urgently needs me. Also, once we finish our case, my tech and I get to leave and go back home. The average time I spend at the hospital when I get called in is about 2 hours.

The bad part of call: it SUCKS having to work a long shift all day, having to come in overnight, and then get up and come to work as normal. Also, while there is the potential for overtime, they are so serious about maintaining "productivity" that they usually send you home early on your regular days to avoid having to pay you for your extra work.

Instead of working 12 hrs shifts, my official schedule is 0730-1600 M-F. Most of us work 5 days a week, excluding 2 10hrs nurses and Baylor nurse and tech. The pros to this are getting my weekends back, since I was a Baylor on the floor. While a more regular schedule has been so nice, I REALLY miss having extra days off during the week. I've burned through so much more PTO in the past two years. Also, while at first my schedule looks more consistent, between call, late stay days, getting sent home early when I have overtime, and having to stay late for various reason on non-call days, the reality is that my schedule is all over the place. Also, because they aggressively send people home or call them off for OT, there are plenty of days the rest of us wind up being there late because the volume of patients requires more people.

While I love getting to directly work with the docs to help patients, especially the inpatients with acute issues, its hard to simply see them go after we're done. I do occasionally miss the follow up with them, and there are times that I find it difficult to only focus on the issue we're dealing with at the moment (ie the bleed or the cholangitis). Sometimes I miss getting to be apart of their overall care and thinking about the patient as a whole instead of a single body system at a time.

There are no perfect jobs in any professions, and there will pros and cons to any position taken as a nurse. On the floor, it was the every increasingly sick patient population and amount of time consuming charting.

In a peri-operative areas, there's the all important schedule and pressure to stay on time despite schedulers cramming as many cases in as they can even when the times are literally impossible. I've had them schedule cases in endo and downstairs in the main OR 15 minutes apart (or even at the same time) with the same doc. So while my tech, doctor, and I are working as hard and as fast as safely possible, we're often hounded by our charge nurse and the OR to hurry and rush. This creates a lot of friction and conflict from those of us working in the rooms and those that manage the flow of the units. Because while we understand the importance of staying on time, the reality is the case takes as long as it takes and it's our duty to make sure the patient and their safety comes first, not the schedule.

Overall, I've been happy with my decision to move to endo. Whenever I get frustrated with call or having to rotate through preop or recovery (something all the room nurses have to do), I remind myself how much more unhappy and stressed I was on the floor. Since we do both moderate sedation and cases with anesthesia, I've gotten the chance to spend a lot of time with the CRNAs. If I were to ever go back to school, that's what I definitely want to do. It would mean going to the ICU for a few years, which would also satisfy my wanting to be more involved with the overall care of the patient.

WHOOO! Now I'm tired from writing all this. Hope it was helpful, because I need to get in bed and get ready for my call day tomorrow.