bad med-surg day-wake-up call

  1. Just have to tell you my story: My last day of a 3 mo. orientation w/preceptor turned bad. I had 5 pts on an extremely busy med-surg floor-2 were pretty sick and had ng tubes to lis. The night nurse who gave me report on 1st pt had an order to clamp ng tube 10:00pm, but reconnect if n/v occurred. This pt had emesis and his dressing on abdomen was saturated w/blood-his ma who stayed the night told me on my shift that there had been blood everywhere (clothes, pillows, sheets...). anyway, the nurse gave him phenergan for nausea. When I came on he was still nauseous-too soon for me to give phenergan again. I saw his Doc (one of the pt's attending's) at nurse's station later on in a.m. and filled her in on pt's emesis/nausea. She did not visit this pt at that time but she had the chart and was writing progress notes in it,and told me she would not write order for anything else (for nausea)-I would have to call his surgeon. I then put a call to surgeon, and approximately 1hr 45 min later, the pt had emesis again. This time it was dark green w/blood in it and ngt was sucking up blood thru tube. My preceptor helped me clean up the pt and again I put out phone call to surgeon for orders. No one answered his phone-to make long story short-AOD was called, got ahold of surgeon and he called me back. He gave me orders but told me to get gastro dr. on board. I made that phone call and got another dr. covering for the gastro dr. He also gave me orders. In the meantime, pt's family was getting pretty upset. No doc had been in to see pt during my shift. Then pt #2 has temp 101.3F-I have orders to call doc for this, which I did. He asked me questions, thank god I had chart in front of me so I could answer knowledgeably (preceptor standing right beside me making sure everything went smoothly as this doc is a @$&*. He had new orders also, and they included calling another doc, d/c'n a picc, starting a new iv while awaiting placement on another picc (they think temp due to infected picc-want blood cx's drawn and whole nine yards). Then another doc calls regarding a 3rd pt's d/c and wants this pt out of hospital asap! gives me orders to call 2 other doc's on case to o.k. this. In the meantime, pt. #4 (who has been off floor all day for peg-tube placement, swallow study, and dialysis returns. He's not had any meds at all that day due to the dialysis. This all takes place w/in last 2 hrs of my shift-it turned into a nightmare and I stayed another hr and 40 minutes past my shift. Thank god for my preceptor. I start on my own next week and I'm questioning myself over everything. The #1 thing that I question is whether I assessed ngt in proper placement on #1? I thought it was in proper place-but obviously not, he still complained of nausea/feeling bad when I left. More drainage did come out-we inserted ngt 4" further. As for the other pts - I did my best. I felt like I left so many things unfinished. It was just enough to get all new orders written on the mars. Help!!
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  2. 7 Comments

  3. by   Tweety
    Welcome to med-surg nursing. Sounds like you did an awesome job. There will be days like this. It will be especially hard the first few months/year maybe. I still have many busy crazy days and have to stay late.

    I wonder why after days like this we get down on ourselves instead of having a sense of accomplishment for all we did do.
  4. by   lesrn2005
    Thanks tweety- I knew you would respond!! Appreciate it!
  5. by   sjrn85
    Wow...now see, I read that and throught "What a good job she's doing for being new!"

    (Look at that! Two experienced nurses who didn't eat a newbie! :chuckle )
  6. by   DutchgirlRN
    After 30 years I still have days like that. It used to be much easier. Believe it or not I used to have 10-15 patients. But the meds were very few, many of the pts didn't have IV's. The acuity of the patients on med/surg now is so high. The patients we have now are the ones who used to be in the unit. I do ok with 4 patients but 5-6 is really pushing it. You did really great!
  7. by   VivaLasViejas
    I think you did a FANTASTIC job of handling all of that:kiss These are the kind of shifts that give M/S nursing a bad name........yet that's what we have to deal with, day in and day out. It's definitely not a job for the faint of heart........if I were your manager, I'd give you a raise and a promotion just for getting through that shift!:wink2:

    Just remember: hospitals are 24/7 facilities, and what you don't get done, the next shift has to pick up. Everybody complains about it, but it's the nature of the beast, and it's not going to change. All any nurse can do is his or her best.....there are always going to be days when you can't get it all finished no matter how long you stay after your shift. (And believe me, you don't want to get in the habit of staying over---management will NOT thank you for your dedication, they've got a budget to worry about.)

    Kudos to you for a job well done!!
  8. by   lesrn2005
    thank you-appreciate it!!
  9. by   AtlantaRN
    you did well in a bad situation...

    when there are 3 md's on board, and a patient isn't doing well, if it's a surgeon I can talk to, I tell him/her; you 'Need to get in here"....Call them in the OR, or wherever they are. a post op patient would make decisions before a gastro or IMS doc...they will always defer to the surgeon...

    you did well under tough circumstances...

    as for family, if they KNOW you are doing your best for the patient, it's OK to tell them WHO you have called and what YOU are doing...As long as they know that you are on THEIR side, they are usually pleased (even if the patient is having a hard time)...

    linda

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