twilight time

No, not the book, or the movie. Not even the twilight sleep that is used during some surgeries and procedures.

Twilight time is when it is too early to call in the call person because their shift hasn’t even started, it is too late not to.

When I was the working evening charge nurse this time would drive me crazy.

Scenario 1-Surgeon A is swearing up and down the patient will be out of the room by 1845. Surgeon B is putting pressure on you to approve the add-on because the patient is very sick and needs surgery like an hour ago when Surgeon B was still at the office. Funny how add-ons come AFTER the office is closed. The anesthesiologist is just wishing you’d stop taking add-ons. The charge CRNA is just wanting to be off the floor and back to their call room.

You’ve got a bad feeling about this. Okay, Solo, you still have to make a decision. You choose to allow the emergency.

You feel like this is a bad decision but you put into motion the add-on case because sick patient. The add-on gets started in a timely manner and you are the circulator here, with the evening scrub tech as you scrub tech. But wait! Surgeon A is not going to be done at 1845 after all, maybe yes, maybe no. (shocking that)

But you have to relieve the team from Surgeon A’s room.

Multiple choice time:

1. Do you throw yourself on the mercy of the team in Surgeon A’s room and ask them to pretty please stay late?
2. Do you want to roll back time and not accept the add-on?
3. Do you call in the night tech and beg for them to come in?
4. Do you call the evening tech and tell them to come in?
5. All of the above
6. None of the above
7. 1, 2, 5 only

What would you do? Oh, never mind, Surgeon A will be finished at 1855. Crisis averted. Yeah, except for your cortisol levels.

Scenario 2- The evening scrub tech gets ill very quickly and has to excuse themselves to go throw up. It is 2010. It is too late to call in the evening tech who would take the full thirty minutes to get to the hospital. It is too early to call in the night tech (who starts at 2100).

Multiple choice time:

Which one do you call?

1. the evening call tech who will surely yell at you and take their sweet time getting to the hospital
2. the night call tech who will surely yell at you and take their sweet time getting to the hospital
3. the surprise third choice, the night call nurse who lives the closest and will be glad to come in.
4. the even more of a surprise 4th choice, call for help from the ACU staff to see if they can spare someone who can be directed by you because you are scrubbed in until the called in tech can arrive.

What would you do?

Unsurprisingly, this is a dilemma that I faced weekly, if not daily, as the evening charge nurse.

Be kind to your charge nurse, there are forces and pressures that you cannot understand until you are in the role yourself.