The night shift

When the sun goes down, adren aline levels go up at Kalispell Regional Medical Center

When the sun goes down, LaFaivre Williamson's eyes open.

It's the beginning of another 12-hour day of six in a row running Kalispell Regional Medical Center after dark.

"It's an enormous responsibility," said Fran Laukaitis, chief nursing officer. "It's a fully autonomous position."

As A manager of house supervisors, Williamson knows the buck stops at her feet. With the ever expanding hospital campus, those feet never stop moving from 7 p.m. to 7:30 a.m. the next day.

But Williamson has no complaints except to say that she deserves no more credit than the others.

"I'm not the only night supervisor. The others do the same thing," she said. "I get very few calls when I'm at home and they're working."

Laukaitis added that, as Williamson's supervisor, she gets very few calls at night. It was quite an adjustment from another position in which her night supervisor called for backup nearly every night.

Williamson said she and the other supervisors have the confidence to exercise critical thinking and make decisions because Laukaitis and other administrators back them up 100 percent.

"That's because they're so good," Laukaitis said. "They make great decisions."

Williamson and the other house supervisors use policy and procedures on-line for guidance. Some of their decisions about accepting patients or moving patients to other facilities come under the purview of federal law.

For situations defined by law or not defined, they use a basic tenant.

"We do what's best for the patient," she said.

Williamson works with a special fraternity of nocturnal people that makes her job easier. These include emergency room physicians and a nurse care coordinator, sometimes called the "Stat" or "SWAT" nurse.

On any given night, an awesome range of problems might confront Williamson and her staff. She said all units must pull together to keep the high tech medical complex caring for the acutely ill while ready to tackle any emergency.

If the power fails, Williamson figures out what to do. If a traumatic accident floods the emergency room with people, she either jumps in to help herself or rearranges staffing from other areas to get the patients handled.

Williamson keeps her cool, even thriving on the challenge.

"I think it's the best job in the hospital," she said.

During her shifts, Williamson draws on years experience that began when she was a child living on the grounds of a Veterans Administration hospital where both her parents worked.

"I spent summers volunteering, mostly in O.T. (occupational therapy), she said.

Williamson started her educational career with 2 1/2 years aimed at becoming an occupational therapist. But marriage and children interrupted that process.

When her youngest child started school, Williamson followed suit.

"I went to big-people school," she said with a smile.

She earned a nursing degree from Northwestern State University in Louisiana. While working as a night nursing supervisor in Louisiana, Williamson noticed an advertisement in a nursing-management journal for a similar position at Kalispell Region Medical Center.

A woman of few words, Williamson summed up her motivation to move north.

"Louisiana is very hot and humid," she said. "Montana is not."

Since getting hired 17 years ago, Williamson has not missed one day to sickness. She shrugged off praise of her work ethic, attributing her health to an immune system exposed to all manner of virus and every biological bug.

Armed with a pager and a cell phone, Williamson begins each shift by surveying her potential resources, ranging from maintenance workers to emergency room doctors.

"I make the rounds on every unit," William said. "If you need to do three things at once, you know who to call."

Laukaitis said the public has a misperception that the hospital is a quiet place at night with all the patients asleep. Williamson agreed that Kalispell has become a different place with its rapid growth.

"We have traumas nearly every night," she said.

With so much happening, Williamson struggles to think of a uniquely exciting experience.

"I remember going to a nursing conference once where a speaker said we see more things and different things in one night than most people see in a lifetime," Williamson said.

It isn't unusual to have more patients admitted at night than during the day. Williamson finds a way to serve patient and staff needs even if it means putting on an apron to make meals.

Williamson and Laukaitis laughed as they recalled soup and sandwiches cooked up for the night shift not long ago.

"We do that for patients too," Laukaitis said.

Williamson fetches supplies and sometimes taps the maintenance crew to help move patients if necessary.

Even when her pager, telephone and cell phone all ring at once, Williamson maintains her unflappable exterior.

"It doesn't do any good to get overwhelmed," she said. "It's all about setting priorities."

By the end of 12 hours, Williamson said she had no problem going home and going right to sleep. Then she gets up and starts the process all over again.

"I don't really do anything else," she said. "That's what you have to do."

It worked out well with her husband, now deceased, who worked the same schedule as a truck driver. Now she often uses her eight days off in a row to travel to visit her children in other states.

Laukaitis said she queried many of her nurses, now older than 40, about returning to eight-hour shifts. Williamson and many others wanted to stay with 12 hours in spite of their advancing years.

The house supervisor sees advantages beyond staff satisfaction.

"The patient has two sets of caregivers instead of three," she said.

Occasionally they see a third in the person of Williamson, called in to give a hand for something like inserting a tough IV. Those are the calls she looks forward to.

"That's why I stay on night shift," she said. "I can have patient contact."

Williamson quickly adds that the shift crew also keeps her working happily in the dark year after year. They become like a family that works and plays together, sometimes visiting Glacier National Park or taking float trips on their days off.

But they resume their business relationships when they return to the hospital. Williamson said she prides herself on maintaining fairness in her management decisions.

Laukaitis said Williamson does that well, along with the rest of her duties.

"In 31 years, she is the best house supervisor I have ever worked with," she said.

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com.