Terrible Day!

  1. Well, it was bound to happen sooner or later. I officially had a terrible shift yesterday. The day before wasn't much better either. I went in to work with the uplifting thought that "today will be better than yesterday, and it is a Saturday so it may be a little slower." Boy did I jinx myself. All started out well enough, as two of my patients were at dialysis until 10:30. Dialysis called report for one of my patients and that transporter would take them shortly. Well, my other dialysis pt arrived to the unit before I had gotten report or my other pt. ????***???? So I called dialysis to get report. I had been in another pt's room but had my light on so they could have called over the intercom if they had called. Got report, and they said they called but "Nobody could find me." No message that they called or anything. Fishy.

    Anyways, pt hx post-op day 4 from exp. abd surgery and tumor debulking, failed central line attempt, failed av fistula declotting. Report that she had 1L of fluid removed and slight temp. Might want the bedpan. Pt assessed, pain level 10/10 for some time. Needed to get up to the commode, voided 30 ml of what looked like prbcs. OK, what to do? Got dilaudid 1 mg ivp for pain, o.5 mg ativan sl for nausea...Somehow her iv had infiltrated while she was up there. Talk about a bad day. Her heart rate was 135 in a fib, stat orders written for 0.25 div ivp. Hard to do with no iv. So got the md, explained the situation, orders for percocet and po dig stat received. Gave that. Freaking out with no iv access, notified charge nurse of situation and uncontrolled heart rate. She said if we had to, we could use the dialysis permacath (the red and blue clamped tubes) as a line. Didn't know nurses did that, but peace of mind if she did go into vt/vfib.

    In the middle of this chaos, my other pt came back. I did the world's fastest assessment, got baseline vs, and told him I was in the middle of a situation but would come back ASAP. He was to be discharged and wanted to go home. My fourth pt had dyspnea (PNA, sepsis, fve). Fast forward to me running around like a chicken with it's head cut off. Orders left and right for bladderscans, straight caths, albumin and lasix now (gives me an hour) with time sensitive rp and mg labs and call md with results....my box was overflowing with orders for 3 of my 4 pts (yes I only had 4 but probably only should have had the 2 (urinary retention and voiding blood).

    45 minutes later, pt to be dcd and his wife come to station and say they are going to leave, and it is unacceptable to have to wait for instruction. I asked another nurse to do the dc. Thankfully he was able (I had printed out info earlier that day so it wasn't a total dump). Pt wife out to say he was "taking too long and that if it took any longer, they would stay until monday for there outpt surgery." I told her it was the best we could do, and unfortunately my priority was with my pt who couldn't breathe. And that they were welcome to stay until monday (they had wanted to go and come back, md wanted them to stay). Well, that got her angry. She didn't want to stay. I politely asked her to wait in the room and the other nurse would be back asap (he was calling in the rx for crying out loud).

    Well, I did go to lunch at 1530, and the day progressed as such from there. CCU tx at 1700, in the middle of accuchecks, insulin, nausea, pain, and bladder problems. Got him situated, assessed, and went over the transfer orders. Taped report. Did a final once around to ensure nausea/pain/dyspnea/new pt were ok. Then went back to urinary retention to teach her and her husband how to straight cath for home purposes per new order. She was to be bladder scanned after every void, or every 4 hours, and then straight cathed. I called md to clarify (straight cath after every void?) Md stated if residual >40, yes. Well, pt had urinary retention for years, so straight cath p q void. Half an hour in room teaching pt and husband (went really well considering everything). 1930, time to go home but I had to chart. One of my taped reports was bad (chipmunk voice), so I gave a verbal. Pm RN questioned cath orders, so we discussed for 10 minutes. Finally, told him he could call the md if he felt it was unacceptable. It was a lot of work for sure.

    So I was charting like a madwoman, when the pm charge came up to me and asked why the new transfer (1700) wasn't on telemetry. I hadn't put him on, usually our cna's do with the vitals. Well, I heard about it. I honestly didn't know he wasn't on the monitor (I never did my pm shift tele strips as I was running). I told her that, and she wasn't happy. Three hours later and I am probably going to get written up for it. Pt was fine. So I went in the room (2030) to put him on. I don't know why nobody else could (I have done it for other nurses), but it was probably best that I did so I know he was at least put on the box.

    Anyways, I had to stay way late to document everything and am totally stressed. After all that I had been through, I am probably in trouble for not ensuring the pt was monitored. I cried all the way home. My pt's were fine, nobody was hurt, but I am upset. And then I was reminded that I "only had 4 pts". I told the charge that the nightshift nurse "only had 4 pts" but that the one would keep him busy all night. I am just so frustrated. The acuity was so high that I don't think anyone could have handled more than those 4 (thank god the transfer was stable!).

    Sorry to ramble, but I had to vent. I expected my job to have its ups and downs, but this was way too much for me to handle. I have a few days off and then I think I will have to talk to the clinical manager. I just hope I don't get written up. Anybody else have a day like this? I wanted to quit, and now I am seriously dreading going back.
    Last edit by nursingisworkRN on Sep 24, '06 : Reason: TRYING TO MAKE READING EASIER!
    •  
  2. 6 Comments

  3. by   Genista
    Sorry you had such a rough day. I can totally relate. I have had days like this. Yes, I even at one time was planning to quit nursing. Sometimes the acuities are so high & the patient load is unbelievable. It makes it even harder when families like your d/c patient get huffy and cranky. (I know waiting is a bummer people, but for pete's sakes!) You would think sometimes they forget it's a hospital and not the Ritz Carlton...we are actually caring for very sick people and can't always be there at the snap of a finger when more pressing issues arise.

    My advice is to utilize your support staff as much as possible on days like this...if your lead/charge can help you or if you have a float RN team to help with putting in an IV etc. It's so hard, and sometimes you have no idea how high acuity will be. But does your unit try to balance out assignments based on acuity? I would ask the charge nurse to split up heavy rooms with lighter loads to balance things out (not always possible as sometimes pts get sick and take turn for the worse without you anticipating it). Bring up consistent concerns with staffing at staff meetings, too. I'm sure if this is a repeat scenario that you are not the only one feeling fed up & burned out. Most of all, it's not safe.

    Pat yourself on the back for doing the best you could with a tough sitation. We all have days like this. Hopefully, there are good days in there too...
  4. by   Tweety
    Don't you just love it when the PM charge nurse comes in all fresh with judgements?

    I'm sure there won't be any repurcussions. We're only human and can only do so much and some days it's just too much to handle. I still have those days.

    Hang in there.
  5. by   Hooligan
    Umm....what type of floor do you work on? Is it a general m/s floor or a Telemetry floor? :uhoh21: Because quite frankly, as a new grad, your post terrifies the bejeezus out of me!
  6. by   CseMgr1
    Quote from Tweety
    Don't you just love it when the PM charge nurse comes in all fresh with judgements?
    Yep...The last time I got screamed at by the 3-11 House Supervisor (not yelled at, mind you), for not doing this and that was when my only LPN was pulled to OB, leaving me with no med nurse and a Tech to care for 40 seriously ill patients, two of which were getting TPN, and a critically ill 6-day old baby with bacterial meningitis (don't ask me why this child was not admitted to a hospital equipped with a neonatal ICU, instead!). By the time I finished my charting at 5:30 PM I was a basket case, just sobbing up my guts. One of the 3-11 nurses who witnessed the nasty scene between me and that Supervisor was livid, and she got into it with her. I turned in my resignation the following day. That was back in 1987, and I haven't worked in a hospital since.
  7. by   RGN1
    Quote from bean 76
    Umm....what type of floor do you work on? Is it a general m/s floor or a Telemetry floor? :uhoh21: Because quite frankly, as a new grad, your post terrifies the bejeezus out of me!
    It terrifies me & I'm experienced! The lack of support you seem to have had on this is dreadful! We all have difficult shifts but this was a beauty!

    What gets me is that people just want to lay blame instead of supporting their colleagues. If I'm less busy than other staff I'm on with, I don't wait to be asked!

    Keep your chin up, I doubt that you'll get a shift like that again & if you do - start hollering & screaming for some help early on!

    Good luck xxx
  8. by   nursingisworkRN
    Thanks guys! I am feeling better about it today. I can be hard on myself sometimes and have unrealistic expectations (like to never make a mistake). The new goal for me is to learn from it and move on. There is still so much I don't know and have never done that I can't expect to be perfect. But I can learn to prevent it from happening again. I am now going to put all of my pts on the monitors myself on admit. Better safe than sorry.

    I am glad (or sorry?!) to hear that I am not alone and that the supernurses have bad days too. Yes, those of you with years of experience and still in nursing and loving it are supernurses. It gives me hope, which is all I need to find my faith again and keep going back. I love my job, and love my patients and their families, but the days I don't love are the days when I am criticized unfairly. Sure, mistakes and learning are tough, but there is no need to be rude to a new nurse just because you can. The few who do are probably burnt out or forget that I look up to them. Note to self: be nice to new nurses. I try to be nice most of the time, but take extra care with my students when I have them (gotta love them, it was me 3 months ago!) Now, I will be extra nice to new nurses too. Gotta fight the stereotypical new nurse eating!

    Coincidentally, I do work on the telemetry unit in our hospital. The only real difference in being a nurse on the tele floor is being certified to read the rhythm strips, but many of the other floors are starting to require it as most pts have cardiac history now. We are still considered medsurg, and not a "step down" or cardiac unit. We are a bit of a catch-all. We push many iv meds that other floors can't because of the bedside monitoring. We also do critical drips. It is a great place to work because you can go just about anywhere with the experience, but like everywhere else the only way to get experience is to put in the time. I know I am becoming a better nurse everyday, but it is hard. My mother says it is "character building." I will stick with nursing is work, but like everything else in life, anything worth doing is worth doing well! Thanks for the cheering up!

close