VENT!

[Enthused RN, BSN, RN]

I am sooo over my first RN job. I work at a long term care facility and usually I like it, but when an emergency pops up, I am reminded of how few resources there are.

So I walk into a patient's room to give meds and my spidey-senses go off. She doesn't look right - she's breathing a little too hard and too fast. Sp02 is in the mid-80s. I run back to the nursing station to call the doctor ... alas it's in the middle of the night and the doctor is not available. I then run to the oxygen room, grab a tank and a nasal cannula while praying I get an order for the oxygen later. I slap it on and then telephone the after-hours telephone nurse. I connect with an awesome telephone nurse who ends up getting a couple orders for me from another doctor within 10 minutes. Then the fun begins. I fax these orders to the pharmacy. Thus begins a 3+ hour saga of faxing the same information again and again. All the while my poor patient is SOB and now feeling some pain (she's DNR, next of kin doesn't want hospitalization). I finish late on my last med pass and give report to the next shift. The next nurse ends up cussing out pharmacy over the phone (bless her heart, I need to take a page from her book) but the pharmacy issue still isn't resolved. I finished up a few odds and ends then go home ... and then I realize I never asked for an order for oxygen that probably saved the patient's life for the time being. UUGGGGHHHHHHH!!!!!!!!!

[heartsgal, ADN, RN]

I feel your pain and know what you're going through, believe me. The very few classmates that have landed hospital jobs are shocked when I relay to them some of the things we deal with in LTC, because supplies and emergency situations are not things that take forever like they do at LTC. You did what was best for you client and if she was de-sating in the 80's even as a DNR she needed O2 stat, so I doubt if not having an order for it is that big of deal for the Dr to sign off on that later. At LTC you can only be in one place at the same time, with the heavy pt load, so you do the best you can on any given night. I've only worked at mine for barely 3 months and dropped to prn 2 weeks ago, so I can take classes 2 days a week towards my BSN. In my area if you work LTC for 6 months and most of the time less than that, you can get a job in LTAC or Rehab, which around the Houston area is about 7-9 patients instead of 25-29 at my LTC, which is much more manageable. Good luck to you! :)

[Enthused RN, BSN, RN]

Thank you for your kind words! I've calmed down now. The next shift took care of the order so it's ok now but I'm still aghast at how the situation played out with pharmacy and how incredibly slow everything was.