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.

[jeckrn, BSN, RN]

I cried at work, 'cuz my grandfather died and I was really sad and stressed out about it. I don't think it makes me unprofessional, it wasn't in front of a patient, it makes me human.

Of course not. This is not the same as the OP, no one will long down on you for crying when a family member dies.

[Morainey, BSN, RN]

That being said, reading the OP made me want to cry! Thank goodness I haven't ever had a day like that, yet. Usually it's just the sickening pit of despair in my stomach when I come in and they tell me you're getting the first admission and PACU is already calling to give report, with 4 other needy patients.

[Gold_SJ]

It sounds like you had a horrific shift and as a new grad you had a lot on your plate. I think you did a rather good job particulary advocating and seeking help for the high acuity. You'll find with more experience and time you'll be able to manage your shift even the nightmares with more ease and less emotion. Reflect on your shift and work out things you could change next time, whether seeking assistance earlier, time management maybe, communication, you've already pointed out things you'd like to do differently so I think that's quite proactive.

A part of human emotion is to cry, it's how we're made else it wouldn't happen. So to say it's wrong I think is off the mark, if occuring in private I would think that's more natural than keeping it all inside. My opinion anyway, I've seen grads occasionally can have overwhelming moments which have resulted in tears but during the few crisis/horrors they run into, then when more confident and experienced it's a thing of the past. If someone's breaking down constantly on every little thing you could consider this a coping situation but I think the OP did quite well considering. It's a big thing learning and taking everything in during your first two years out.

Hope your future shifts are better and keep your chin up, experience and time make a world of difference so don't be too harsh on yourself, reading your post I think you did rather well under such stressful circumstances. Every moment of chaos makes us stronger I think, as we learn new ways to look, evaluate and approach difficult situations. ^.~ As long as it's not a constant thing, no good for us to be ground into dust.