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.

[Limik]

I just wanted to say that i would have cried too! I think you held up remarkably well considering the circumstances! Hugs to you!!!! :hug:

[bearcat194]

Wow, just wow.....

[Dixielee, BSN, RN]

Welcome to the ED! We have all had those days, but yes, it sounds like not only did you do a great job, but you have an awesome group of co-workers who salvaged your day! That is why we have to have each others backs. ED patients can turn on a dime, and the chief complaint is often only the tip of the iceberg!

It sounds like you did all the right things, including asking for help and venting!! Never be afraid to ask for help when you feel like you are drowning or your patients are being neglected because you are involved with another bad patient. You will be in a position at times to return the favor. I never avoid hard work, and will work till I drop sometimes, but you can't be everywhere at once, no matter how hard you try. That's what the team is for. Good for your charge nurse for letting you get a breather. Many times we don't know a co-worker is drowning, so don't be afraid to speak up.

I have called out the phrase, "I need some help in here!" many times in my career, and expect there will be more to come.

Good luck, go drink some Tension Tamer tea by Celestial Seasonings, ahhhhhhhh

BTW, I love your screen name. It fits an ED nurse :)

[redhead_NURSE98!, ADN, BSN]

Are you serious? I cry about every other day at work. lol

[Patti_RN]

Wow! If I ever have to go to the ED, I want YOU to be my nurse!

[WildcatFanRN, BSN, RN]

Wow! If I ever have to go to the ED, I want YOU to be my nurse!

What she said :-) You sound more together than I would have been.

[Merlyn]

It will get better over time. Unfortunately you will have days like this throughout your career. Believe it or not you handled it well

[lisaannjamRN]

You did an amazing, fantastic job!! YOU are a great nurse!! Hoping the upcoming week is better :)

[Been there,done that, ASN, RN]

You have excellent assessment skills.

However... while not knowing the rest of your background... I personally do not feel ER is a place to start out.

Yes, it was a pretty bad shift... there's going to be many more that are worse.

It is NOT ok to cry in the middle of the unit. It indicates you are not ready and ...it is not acceptable for ER patients to see.

I would have sent you home, as you clearly lost it.

We are simply not allowed to, and when we do , it's a sign we need to make a change.

[kayern]

I agree with the previous poster, ERs are not for new grads fresh out of school! There is way too much to learn let alone navigating the ER nuances with residents, attending, etc.

I tell my staff "never let them see you cry". What I mean = come into my office cry your eyes out, but not out in the open in front of patients/families and ESPECIALLY not r/t physicians. Come find me and I'll defend you, help you do what ever I can to get you out of a situation as you described.

You don't state whether the other three patients you were caring for were admitted patients, but I thought there was state defined patient:RN ratios for ERs.

My advice to you..................find a M/S unit get some good solid experience then transfer to back to the ER

[anotherone, BSN, 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.