The Night Shift They Gave Me

The email came in at 6:42 on a Tuesday morning, while I was still in bed with my phone balanced on my chest. The subject line read: Night Float Coverage, Week of March 4. I had already worked three night shifts that week. The unit was short-staffed, and I had agreed to pick up extra because that was what you did when you were the newest nurse on the cardiac step-down floor and you still believed the system would remember your sacrifice. The email was from Dana Whitfield, the day shift charge nurse. She was not my supervisor. She was just the person who made the schedule and, more importantly, the person everyone liked. I opened it. The message was three lines long. Miriam, I know you are off tonight, but we are in a bind. Kayla has a family thing and no one else can cover. Can you take her night float? I owe you big time. I stared at the ceiling of my apartment, the one with the water stain shaped like a crooked smile. My apartment building was a beige box on the edge of a city called Cauldwell Harbor, a coastal town that had once been a fishing port and was now mostly biotech offices and expensive coffee shops. The rent was too high, but the hospital was close and the walk was short, and I had thought that mattered when I moved in two years ago. I typed back: I can cover. What time? The reply came instantly. 7 pm to 7 am. You are a lifesaver. I had a text message from my husband, Aaron, who was already at work. He ran a small landscaping company that had three trucks and a crew of eight. He had been up since five. Aaron: You are not actually going in tonight, are you? Me: It is just one shift. Aaron: You said that last week. Me: I know. I will make it up to you this weekend. He did not respond immediately. I put my phone down and got dressed in my scrubs, the navy ones with the faded logo of Cauldwell Regional Medical Center stitched over the left pocket. The logo had been updated three years ago, but the hospital still issued the old scrubs to new hires like me, because the supply budget was always the first thing to get cut. I walked to the hospital. The morning was windy and gray, and the harbor smell of salt and old diesel drifted up from the docks. The hospital was a ten-story building of pale brick that sat on a hill overlooking the water. It had been built in the 1960s and renovated twice, but the elevators still made a grinding noise between the fourth and fifth floors that everyone had learned to ignore. I swiped my badge at the employee entrance and took the stairs to the third floor. The cardiac step-down unit was quiet at this hour. The day shift was just arriving, and the night shift was giving report. I saw Dana at the nurse's station, her blonde hair pulled back in a neat ponytail, her scrubs perfectly pressed. She was talking to Dr. Marcus Feld, the hospitalist who covered the floor. Dana saw me and smiled. "Miriam. Thank you so much for tonight. I already put you in the system." "Who is the charge nurse tonight?" I asked. "Lisa Tran. She is on vacation, so it is just you and two aides. I know it is tight." I nodded. The floor had thirty-two beds. Two aides and one nurse was not tight. It was dangerous. I went home and tried to sleep, but I could not. I lay in bed and stared at the water stain and thought about the email that had come the week before, the one from Human Resources about the restructuring. The subject line had been: Important Update: Staffing Model Changes. I had read it twice. It said the hospital was implementing a new staffing model to improve efficiency. It said that some positions would be affected. It said that affected employees would be notified by the end of the month. I had not been notified. Not yet. But I had heard things. The night shift was being cut. The step-down unit was being merged with the telemetry floor. And the nurses with the least seniority were the first to go. I was the least senior nurse on the step-down unit. I had been there for two years. Kayla had been there for four. Dana had been there for eleven. I got up at four and made coffee. I did not drink it. I just held the warm mug and looked out the window at the gray water of the harbor. I thought about Aaron and the way he had looked at me when I told him I was going in again. I thought about the mortgage we had taken out on the apartment. I thought about the fact that I was thirty-one years old and I had done everything right and it still might not be enough. At 6:45 I walked back to the hospital. The night was clear and cold, and the lights of the hospital shone down on the parking lot like a beacon. I took the stairs to the third floor and found Lisa Tran at the nurse's station, her coat already on. "Miriam, right?" Lisa said. "I am so sorry to leave you like this. I have a flight at nine." "It is fine," I said. "I have got it." Lisa gave me report on the eighteen patients on the floor. Seven were post-op. Four were on telemetry. Two were waiting for placement in a rehab facility. One was a man named Harold Pines, seventy-six years old, who had been admitted for atrial fibrillation and was now stable but confused. "Watch him," Lisa said. "He keeps trying to get out of bed." I nodded. Lisa left. The floor went quiet. The aides, a woman named Rosa and a man named Darnell, were both on their phones. I did not blame them. The shift was long and the pay was bad and the hospital did not care about any of us. At 9:15, Harold Pines tried to get out of bed. I caught him just as his feet touched the floor. He looked at me with watery blue eyes and said, "I need to find my wife." "Your wife is not here, Mr. Pines," I said. "You are in the hospital. You need to rest." He did not believe me. He tried to push past me. I called for Darnell, and together we got him back into bed. Harold cried. He said his wife had been dead for six years, but he kept forgetting, and every time he remembered it was like losing her all over again. I sat with him for twenty minutes. I held his hand. I told him it was okay. When he finally fell asleep, I went back to the nurse's station and sat down. My feet ached. My back ached. I was thirty-one years old and I felt like I was sixty. At 10:30, I checked my phone. There was a text from Aaron. Aaron: How is it going? Me: Long. I will be home at eight. Aaron: I will make breakfast. I smiled. I put the phone away. And then I opened the charting system to log my notes for Harold Pines. That was when I saw it. At the top of the screen, in the patient banner, there was a note that had not been there when Lisa gave me report. It was a nursing communication, flagged as urgent. It said: Patient has a history of falls. Do not leave unattended. Notify Dr. Feld if patient becomes agitated. I had not written that note. I had not seen it before. And the timestamp on the note was 10:12 pm, which was after my shift had started, which meant that someone else had been in the system while I was in Harold's room. I scrolled down. There was another note, this one from Dr. Feld. It said: Family has requested a sitter. Please arrange. I looked at the nurse's station. There was no sitter. There was no one. There was just me and two aides and eighteen patients. I called Dr. Feld. It went to voicemail. I left a message. Then I called the nursing supervisor, a woman named Patricia Okafor who worked in an office on the fourth floor. She did not answer either. I sat back in my chair and looked at the screen. The note was still there. The timestamp was still 10:12 pm. And I had a feeling, the kind of feeling you get when you are a nurse and you know something is wrong but you cannot prove it, that someone was setting me up. I thought about the email from HR. I thought about the restructuring. I thought about the fact that I was the least senior nurse on the floor and that the hospital needed a reason to let me go, a reason that would hold up if I filed for unemployment or talked to a lawyer. I thought about the fact that Harold Pines had a history of falls, and that if he fell on my shift, and if there was a note in the system saying that I had been warned and had failed to act, then I would be the one who was blamed. I looked at the clock. It was 10:47 pm. I had eleven hours and thirteen minutes left in my shift. I stood up. I walked to Harold's room. He was asleep. I checked his vitals. They were stable. I wrote a note in the system, a real one this time, that said I had assessed the patient and that he was resting comfortably. I flagged it as urgent. Then I went back to the nurse's station and opened the audit log. The audit log showed every action taken in the charting system. It showed who had logged in and when. It showed who had written the note at 10:12 pm. The user ID was mine. I stared at the screen. My hands were shaking. I had not written that note. I had been in Harold's room at 10:12 pm. I had been holding his hand. I scrolled up. There was another note, timestamped 10:08 pm, that I had not written. It said: Patient is confused. Monitor closely. And another, at 10:04 pm: Patient attempted to get out of bed. Assist as needed. All of them were under my user ID. All of them were notes that I would have written if I had been doing my job. But I had not written them. Someone else had logged in as me and written them for me. I thought about the password I had been given when I was hired. It was the same password I had used for the past two years. I had never changed it. I had never thought I needed to. I sat there in the dark of the nurse's station, the only light coming from the computer screen, and I understood what was happening. They were building a case against me. They were creating a record that would show that I had been warned about Harold Pines and had failed to act. And when he fell, or when something else went wrong, they would have their reason to fire me. They would have their reason to cut the night shift. They would have their reason to do whatever they had planned to do all along. I looked at the clock. It was 11:02 pm. I had ten hours and fifty-eight minutes left in my shift. And I had a choice to make.