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I tried to explain to my family that being an ER nurse with 18 months of experience and working as a charge nurse isn’t a good thing, but what do they know? They aren’t medical. I am literally the rodeo clown hoping to not get speared by the bull while making sure the department doesn’t burn to the ground. As charge, I have just fallen into the position with absolutely no training, and I still am constantly looking for the adultier adult when the baby ER nurses look at me like I’m the adult. The night in question, I absolutely knew I was going to be charge before I walked onto the shift, and I still wasn’t prepared for the midnight 911 call and texting my boss that I fucked up.

My tiny ER has one psych room with a door that locks when it closes, but that doesn’t help you when you have 3 psych patients in the department and are woefully understaffed despite sending out texts asking for anyone to help. I was pulling double duty by working as charge and triage with 2 department nurses taking patient assignments, which isn’t highly unusual except there should have been a third nurse. Earlier in the night, a dayshifter asked if one of the psych patients needed a sitter, and I said that unfortunately, they didn’t meet the criteria for a sitter. Well, that statement came back to bite me in the ass. This patient had left their room multiple times and tried entering other patients’ rooms but was redirectable, so the idea that they would elope wasn’t on anyone’s radar. As the night wore on and staff was leaving and not being replaced, this patient seemed more agitated, and the nurse assigned was struggling to multitask with more than one patient at a time. How they have been an ER nurse for as long as they have and can’t seem to take care of more than one patient makes absolutely no sense to me. I digress.

Between triages, the CNA came to me and said I needed to medicate this patient or get help because they couldn’t do anything else but redirect the patient. The other staff nurse was taking care of essentially the entire department and couldn’t take on another patient. I went to the patient and offered medication to help them relax and possibly sleep if they were willing to take it (they had previously disagreed with medication), and to my relief, they said yes. Side note: this patient was being legally held and was not free to leave. I got the order, medicated the patient, tucked them into bed, and turned down the lights. Thinking I had a moment to breathe, I got a page for another triage and asked my CNA to fill an empty room. At the same time, the family next to the psych patient thought something was wrong and wanted the nurse’s attention. We all dispersed from the nursing station and were gone for less than 10 minutes. But that’s all it took. Quick and silent as a ninja mouse, the psych patient eloped while no one was watching.

At just after midnight, when I start to run the board with everyone, I look into the room to see the empty bed. Well, shitballs. The CNA went to the bathroom, empty. We spread out in the department to search and came up empty-handed. This is the only time working in a place the side of a shoebox helps; there’s just not a lot of places to look. Then I had the soul-crushing responsibility of notifying the House Supervisor, the doctor, and security to start a facility-wide search. Once that came up empty-handed, and I stood at the ambulance bay doors contemplating my life choices, I made the decision to have 911 called. Once I pulled that ripcord, I had no choice but to text my boss to let them know I had lost a patient. A patient I had medicated with a psych med known to cause sleepiness when it was below freezing outside, and the patient was without proper clothing for the weather. I’m not going to lie, I checked the bushes outside the bay more than once and hoped to be attacked by a rabid squirrel. Alas, no rabid animals to be found.

Thankfully just before 1 am, the cops returned the patient to us, and surprisingly the patient made it several blocks and had acquired money while on their journey and thought the whole situation was quite hilarious. The CNA found the situation less hilarious and used the disappointed parent voice on them while I had to fill out the incident reports. I tell patient’s all the time that falling and dying isn’t authorized because I don’t want to do the paperwork, and I’m not joking. I am sure this will somehow come back to haunt me, but if it means I don’t have to be in charge, it might be worth it. I pathologically avoid being in a position of responsibility even if my whole job is responsible for the lives of other humans. As my coworker says, we sustain lives, and I am perfectly happy doing just that but making sure people are taking breaks, going home on time, and not killing each other or patients is not my jam. I’m like that meme of the pangolin, insecure, hoping to not be a bossy asshole.

Later that day, on a completely different shift because that’s just how it goes for me, I was informed that this was just another scenario that made me a real ER nurse. Apparently, you aren’t one until you’ve had a psych patient peace out on you. If I had a dollar for everything that made me a real ER nurse…