I Cried At Work

[Guest 360983]

I had a super miserable shift yesterday. I'm a new grad, barely off orientation, in a crazy busy ER with a difficult population. I have 6 patients, who ought to range in severity from "You came to the ER for THAT?!?" to IMU. I should never have an ICU patient.

In a 2 hour period, I got 3 new patients. No problem, that's busy but I can do that. The problem is that these were the patients:

1) Came in for knee pain. Hx of liver disease that the patient said he saw an outside doctor for, but he had enough ascites to look pregnant, his legs looked like CHF and he had crackles. Oh, and he had an episode of angina last night, but "I'm here for my knee. My chest pain got better when I sat down for awhile and took some Tums. Why yes, it was in the middle of my chest and now that you ask, it did feel like pressure instead of pain." Ok, the monitor looks ok so I'll keep you and just run an EKG, enzymes & a chem 8. Oh, the EKG says possible current ischemia? Wait, the troponin is elevated? And his hematocrit is 6???? Let's talk to the patient again--oh, a history of melena, awesome. Hey, residents, this guy needs someone to look at him now. Can I move him to a resus room? No, not until the ICU consult is done? But he's got ischemia and a GI bleed and terrible liver issues and he's threatening to AMA because I won't let him eat!Sure, I'll just hang the blood and the protonix and octerotide, which means multiple calls to the pharmacy since we don't have that on the floor. Oh, hi ICU consult. No, those 2 20s are the best you'll get without an EJ or a central line, and you'd better be happy we got those in. I know you want larger bores, but I can't make veins magically appear. No, I will not take your 20 verbal orders, we don't do that and do you not see me pushing this guy to the resus rooms now that you've agreed to take him? I literally told the doctor "I think we should bring this guy over to the resus rooms. I am not the nurse you want taking care of this patient right now."

2) Dialysis patient sent to me from the resus rooms because she was "stable." Her K was OMG HIGH even for a dialysis patient. She was Spanish only, but why isn't she responding to most of my questions? My Spanish sucks but I can at least assess a dialysis patient. And why is she saying she had dialysis 1 week ago at this hospital when our records show it's been more than 2 wks. Hey, Spanish speaking coworker, can you ask this patient if she'll take her Kayexalate? Why is the patient just staring at me instead of taking it or protesting? Hi renal fellow! Wait, why are you calling the ICU right now? Usually our resident does that. Oh, we're trying to get her a bed RIGHTNOW and not 5 minutes ago? Hi, charge nurse? Come pick up the dialysis patient. Report? She refused the PO Kayexalate and she's unchanged from when you dropped her on me 2 hours ago despite me protesting an insane K and AMS together indicated she wasn't an IMU patient.

3) Guy comes in with vague chest pain x forever. Oh, and I fell at home a few weeks ago and it's been hard to breath since then. Fine, let's do some enzymes and a chest xray per protocol. Look, negative enzymes but the chem 8 indicates new onset renal failure. His potassium is WHAT? Awesome, let's push the cocktail. Oh, you need to take him to the resus rooms for a chest tube because his entire R lung is white on the xray? Here's the lab on the line with critical values for half his chem 8.

My other 3 patients were pretty low key and very stable, which was good because they were all getting ignored for HOURS. Like, one guy came in with a family member and I just glanced at him every so often to make sure he was still breathing. I figured the family member would tell me if he started doing something weird. Safe? Not by a long shot, though I didn't realize how unsafe it was until I was talking to my old preceptor this morning.

My charge nurse came by when she realized how bad my patients were and sent me to lunch. I was so frustrated and exhausted I started crying in the middle of the floor! I gave report to a few of my coworkers and they had almost everything done by the time I came back. The charge nurse put holds on some of my beds so I wouldn't get new patients. The other new grad took lunch with me (at 4 pm) and we ******* about life and I came back and charted like mad until the end of the shift.

I just needed to vent to some people who would understand. Thanks for listening.

[sapphire18]

That sure sounds like a craptastic shift, but you handled it well. Hope you have a couple of days off! I've also cried at work before- especially as a new grad- it's not the best thing but it happens. Hugs!

[Been there,done that, ASN, RN]

wow sounds terrible. to all the er is not for new grads I mostly agree but...- i gather from the op that the op is not supposed to be even getting these types of pts either due to beign anew grad or where she works in the er. .......I work and started out in med surg and had similar days. pts up from the er/or like the op's pts who should be in the ICU or at least step down but are not. I have them with my other 5. if you get more than one like this you are screwed for the shift. and guess what most times your co workers have the same types and can not help. i have seen a few nurses cry at work and I can not say I blame them. THe sress is unbelievable. We would get critical care fellows/residents assess pts on our floor, nto transfer them, write 1324234 orders, half most med surg nurses have no clue about and expect us to carry them all out within minutes, keep in mind we have 5 other pts, yes not as critical but we should never have ANY critical pts in med surg, now all those pts are mad that you have been ignoring them. they do not care that 1 pt is getting an ID at bedside and gen surg wants you in there for 45 mins, and your other pt is septic and should be in the ICU , why aren't you advocating now, oh and your one walkie talkie is in a insulin drip and needs it changed now, you have no clue what his blood sugar even is, and can only hope if it was bad the aide what tell you, you do not have time to look for the aide as the dr is looking for the idiot med surg nurse who is not able to do pressors. @@. ahhhhhh different types of stress but it happens in all of nursing. I never cry in front of any one esp not at work but sometimes i can def understand being overwhelmed enough to want to do it.

I don't know who you are..where you've been...

but your opinion of the "lowly med-surg " nurse 'the idiot med surg nurse' will surely bite you in the AZZ and I hope sooner than later.

[jeckrn, BSN, RN]

I agree with the other posters who say new grads should not be in the ED. I also believe they should not be in any specialized area since they do not have the basic skills down. In the ED you should be able to take serious patients if not you do not belong there. Crying behind closed doors is ok, but as others have said not in front of patients if you are being overwhelmed. The poster who states that she cries frequently; it wears on your co-workers and when you truly have a issue will they believe it or just say thats what you always do.

[Tina, RN]

Listen, it happens! No, it is not ideal to lose it in the middle of the unit. But, nurses are human, afterall. We can only take so much. Your coworkers sound amazing. Next time you feel yourself starting to drown, ask for help sooner! Hopefully, you won't get to such a point. :) Keep your chin up!

Best wishes for more pleasant shifts in the future!!

[anotherone, BSN, RN]

I don't know who you are..where you've been...

but your opinion of the "lowly med-surg " nurse 'the idiot med surg nurse' will surely bite you in the AZZ and I hope sooner than later.

hahahahah I am a med surg nurse. relax, re read my post and the @@ ( eye roll) i meant it in a way that the dr assumed I / the other nurses on my floors were idiots for not being able to do pressures on our floor. I guess it came out wrong.

[tcvnurse, BSN, RN]

I think crying was ABSOLUTELY REASONABLE in that circumstance. Holy cow sister! That sounds terrible.

[fathertod]

I think you are right when you are saying that crying while delivering patient care to multiple patients during your shift is an example of selfishness which should not be tolerated on the unit. Also, I do agree with you that the OP should reconsider her nursing career in its entirity and possibly consider something less stressful until they gain the needed skin and skills to deliver patient care without breaking down. Delivering care to patients is something selfless and should not be selfish. Knowing your own limits and boundaries is important, because you will not be clouded with delusions regarding how "skillful" you are and that you being absorbed in your own problems is actually causing more risks and problems to develop amongst your patients and co-workers. Thus, this is an example of bad nursing habits that cloud the advancement of the profession and your peers.

[Tragically Hip]

anotherone, the absence of scare quotes led you to miss the sarcasm toward herself.

[CrufflerJJ, BSN, RN, EMT-P]

So....other than those minor life-threatening issues, how was your day?:yelclap:

[fathertod]

While I was crying, my patient died.

[midlife101]

This thread is scaring the daylights out of me. As a new pre-nursing student, I'm really wondering what I've gotten myself into. Being well aware of the fact that I'm going into a female dominated profession, I've read an awful lot of threads here lately referencing nursing staff breaking down and crying due to frustration, anger etc. Is there no expectation in this field that adults will have developed adult mechanisms for coping with their emotions? Is there no expectation that professionals will conduct themselves professionally?

Perhaps I'm over sensitive to the issue for some reason but c'mon! Crying in response to frustration, anger, stress etc., I expect out of a toddler but not from a professional adult...in any field.

I wonder if some folks don't need to get to a counselor and try to develop some more adult mechanisms for dealing with their emotions.

[fathertod]

You will be entering a field with people who have a mindset of serving and healing other individuals. People will judge their nursing practice by how they interact, heal, intervene, and eventually "save" their patients. Being a nurses is like being a missionary, we heal and deal, with the poor, disabled, naive, rich, and crack addicted. We will turn no soul away and will help in any way possible. In return, we get our essence and being drained out from us at times. People are dysfunctional, people with problems are dysfunctional, thus it means that you will adapt parts of the environment that you are forced to deal with at work on a daily basis.

Join us nursing missionaries, we will find a position that is good.

This thread is scaring the daylights out of me. As a new pre-nursing student, I'm really wondering what I've gotten myself into. Being well aware of the fact that I'm going into a female dominated profession, I've read an awful lot of threads here lately referencing nursing staff breaking down and crying due to frustration, anger etc. Is there no expectation in this field that adults will have developed adult mechanisms for coping with their emotions? Is there no expectation that professionals will conduct themselves professionally?

Perhaps I'm over sensitive to the issue for some reason but c'mon! Crying in response to frustration, anger, stress etc., I expect out of a toddler but not from a professional adult...in any field.

I wonder if some folks don't need to get to a counselor and try to develop some more adult mechanisms for dealing with their emotions.