Bob Nedens' spinal cord was cut two weeks ago after he fell off his ATV in the Beartooth Mountains. Since then, nurses have taken over his bodily functions. They do everything from clearing his lungs to feeding him to making sure blood clots don't form in his limp legs.
The 52-year-old Billings electrician is not able to talk, but he can smile and mouth words, which is what he did when his nurse, Tuni Theonnes, stood next to his bed in the intensive care unit of Deaconess Billings Clinic Monday afternoon.
"She does a wonderful job," he mouthed.
Theonnes laughed and went to work clearing Nedens' breathing tubes. She started nursing 30 years ago, but has left the profession for brief stints as a cocktail waitress, body shop worker and bartender. Each time, she has felt the urge to return to a patient's bedside.
"This is where I'm supposed to be," Theonnes said.
Years of aggressive recruiting by Billings hospitals of once-lapsed nurses — such as Theonnes — and new graduates is seeming to pay off. Both hospitals are now reporting their lowest vacancy rates for nurses in more than a decade. St. Vincent Healthcare has only three open registered nurse positions, said Joan Holbrook, nurse recruiter. Last year, about 10 percent of St. Vincent's 400-some nursing positions were unfilled.
Billings remains something of an anomaly, Holbrook said. The national vacancy rate remains between 10 and 14 percent. It's even higher in rural areas, where dwindling Medicaid and Medicare payments have not allowed hospitals to offer competitive wages.
For the moment, at least, Billings hospitals are breathing a sigh of relief. But the
long-term forecast remains dark. The average St. Vincent nurse is 45 years old. Both hospitals are now developing programs to make it easier for students to bear the high cost of a nursing education.
Theonnes has mixed feelings about how to fix the nursing shortage. Nursing is a calling, she said, not unlike the priesthood. Pouring more money into wages might increase the number of applicants to nursing school, but high wages don't always lure the best candidates, she said, still attending to the needs of her newly quadriplegic patient, Nedens.
"If you traded places with Bob, you would want a nurse to be here because she wanted to be, not because of money," Theonnes said. "No amount of schooling can teach a rotten person to become a nurse."
ICU nurses confront life and death daily, but most of their focus is on subtleties, Theonnes said. Each life-support machine has a different beep, some have more than three tones for different levels of warning. Patients always have different attitudes and desires for healing. The nurse must also remember that each family member is dealing with the crisis differently. Some are willing to help with every aspect of patient care. Others break down and cry at the slightest change.
Nedens is now battling to be able to sit up again. His wife, Karen, hopes he will eventually be able to regain control of his breathing and possibly travel to a rehabilitation center in Denver.
Theonnes shares the family's hope, but she also admits to feeling sad over Nedens' case. "He's only two years older than me and they just moved into a new house," she said. "Sometimes this job just makes you sad. It's real sad to me. I hate it. I hate seeing it. But Bob doesn't want my pity. He only wants my skills."
On Monday afternoon, Theonnes and a team of therapists worked to move Nedens into a special chair. When he was elevated, however, his heart slowed, then stopped. A distinctive beep came from one of the machines, sending the ICU charge nurse rushing into the room. Nurses, doctors and therapists crowded around Nedens' bed and began work. Within moments, however, Nedens' heart had restarted.
Soon Nedens was again smiling and mouthing words to his wife, Karen.
After her shift, Theonnes will return to her car — she calls it her "decompression chamber," — and listen to music on the drive home. "Anything other than beep, beep, beep," she said.
Each day presents the opportunity for deep tragedy and profound miracles for ICU nurses, said Martha Wetstein, one of seven charge nurses on the unit. At the start of her shift running the 22-bed unit Monday, Wetstein oversaw the admission of five new patients in a half hour. Most were people clinging to life.
The 16 patients on the ICU floor Monday included numerous heart patients, people with head injuries and a woman who had attempted suicide. Some require the constant attention of a single nurse. This is nursing in its purest, most demanding form.
"In ICU you know everything that goes on with your patient," Wetstein said. "It's total responsibility."
Burnout can be high for ICU nurses, she said. And many of the tough cases can never be forgotten, like the Wyoming toddler who was hit by a car in 1997. The little boy spent seven weeks in the ICU. He beat the odds, brought delight to the nurses and returned home nicknamed "the miracle baby." A few months later, he died from a complication. Wetstein still tears up when she talks about him.
But there are other cases that keep nurses in nursing, she said. "God gives you what you need to keep going."
Just before Christmas, a 17-year-old Billings boy was severely injured in a car crash. Doctors said he would never recover and urged his family to find a bed for him at a nursing home, Wetstein said.
That's not how the story ends, though. The young man was recently back in the ICU. This time, he was walking and talking about his plans to graduate from high school next year.
Those are the moments that keep her in nursing and make the long shifts so very bearable, Wetstein said. "I don't think people have a clue how much it means to us when they come back for a visit."