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For Rob Lewis, it was one of those days.
Although one nurse is supposed to take care of only two patients at the critical care unit of Bartlett Regional Hospital, Lewis and another nurse - Sandra Gillim - started their shift with five.
One of the patients was an old man that Lewis had been looking after for 10 days. The man had been unconscious and was put on a ventilator. The patient's family finally came to terms with the fact that he was dying.
"Nursing is a very demanding job, both physically and emotionally," Lewis, 41, said. "Any minute, you have to prepare to let somebody go. It's hard because we are the ones that are with the patients all the time. You get attached to them."
The unit is normally quiet because its patients are weak and fragile. But this is one of the busiest units at Bartlett and one that is in the greatest need for more nurses. The unit has six beds and each shift has two nurses. If all six beds are filled, some nurses have to work overtime or nurses from other units are asked to help out. Eight shifts are covered by only one nurse in June.
Bartlett's nursing shortage in critical care reflects the nation's situation, though overall, the hospital's shortage is less pronounced.
According to a national survey released by the American Organization of Nurse Executives in 2002, the average registered nurse turnover rate is 21 percent. The average nurse vacancy rate was 10 percent, with the highest rates in critical care units, at 14.6 percent, and medical-surgical care, at 14.1 percent.
"As baby boomers grow older, people are living longer and need more medical services," said Sheryl Washburn, patient care administrator and nurse executive at Bartlett. "Thanks to the advances of technology and medical management, people who stay in the hospital are much sicker than they used to be. And there are fewer schools in nursing."
Bartlett has been aggressive in combating the nursing shortage and successful in keeping its nurse vacancy rate at 3 percent, Washburn said. About 30 percent of its 121 nurses have worked for Bartlett for more than five years.
"Many people still like the adventures of Alaska. We can sell the community," Washburn said. "Because this is a small facility, Bartlett attracts people who like working in a rural atmosphere. We are also able to attract people who like challenges because we provide a huge range of services."
The competitive benefits that Bartlett offers also draw many nurses. The average wage of a registered nurse in the Northwest is $27.82 an hour, while that of a registered nurse at Bartlett is $28.13 an hour.
To retain nurses, Bartlett has a promotion system called "the clinical nurse professional practice ladder." According to their performance and experience, nurses can get involved in the hospital's policy-making processes and community volunteer activities. "It allows nurses to advance their careers without leaving bedsides," Washburn said.
All of these reasons Washburn mentioned lured Lewis and Gillim to Bartlett.
"They put a great advertisement in the newspaper, saying Juneau is a good place for fishing and hiking," said Lewis, who came from Rhode Island and has worked at Bartlett for five years. "I didn't plan on staying here that long, but the quality of life here is really good."
Gillim, 45, said she came to Bartlett for the adventure and the benefits. "In the town I came from, the nurses had the worst health coverage," said Gillim, who moved from Kentucky in October of 2003.
Although both Gillim and Lewis enjoy working at Bartlett, they said they hope there are enough nurses in their unit to meet the demand.
"When things go really bad, you want as many hands in there as possible," Gillim said. "Although we have a 12-hour shift (from 7 a.m. to 7 p.m.), we actually work between 13 and 14 hours because we have been so busy that we don't have time to finish the paperwork and put it in the right order."
Most of the time, Gillim and Lewis don't get a lunch break. Even when they have time to sit down and have their lunch, they are closely monitoring patients.
During their shifts, nurses keep a close eye on patients. They constantly check patients' heart rhythm, heartbeat and blood pressure on a computer screen in the nurse's station. They watch patients' movements from their station, which is separated fromthe unit's beds by large glass windows. At the same time, they call the labs and report results to doctors, who normally give the nurses a four-page order for each patient.
"We try to fix what is broken while trying to maintain what is not broken," said Therese Thibodeau, assistant manager of the critical care unit. "A lot of our work is to monitor the problem and anticipate problems before they happen."
Although she loves her work, Gillim said nursing is stressful. Sometimes she cries in the car when she drives home.
"When I am working, I hold my emotions inside so I can do what I need to do," Gillim said. "A bad day is that you have done everything you can but nothing you did helps the patient."
And this day was exactly such a day for Lewis. Although he has been a nurse for 10 years, he still finds it hard to watch his patients die.
"It never gets easier," he said.
For the past 10 days, Lewis had taken care of a pale, elderly man. The patient was sedated and unconscious, but Lewis got to know his idiosyncrasies.
"I know when he is waking up, sleeping well, or in pain. When he feels uncomfortable, he might get a little restless in bed or knit his brows," Lewis said. "All I can do is keep him comfortable until he meets his god."