I am a fairly new nurse....I just hit the 6 month mark not too long ago. I work on a busy step-down unit. I arrived at work yesterday at 3PM to four monitored patients and a new admission. The new admit was a SBO who was vomiting all over. I tried to place three different sized NG tubes (with the help of another experienced nurse) with no success. I spent 45 minutes with this lady in all trying to get her (and the room) cleaned up. Right after leaving her room, I was given another admission (now I have six patients.) This patient had profuse diarrhea and a potassium level of 7.1. We don't have an nurse-aide after 6PM, so while giving insulin, D10, calcium gluconate, and kayexalate to this patient, I was cleaning up her as well.

My other four patients were busy too....I had families coming up to me in person demanding my immediate attention......so I was trying to do damage control and then run back to clean up the vomiting and pooping patients.

I was a crappy nurse yesterday, my charting was awful, I did not leave work last night until 1AM. It was one of those nights when you are just happy that all of your patients are breathing at the end of the shift.

You are NOT a crappy nurse. You did the best you could with what you had. Those two patients were your priority at the moment, not those family members. So don't let them get you down. I've been a nurse for over two years and I still feel that there are times where I am just inadequate. Like yesterday, I had a patient that was a hard blood draw. I was just trying to get repeat lytes after his magnesium was supplemented by the night shift. Mind you, I had to do it at 2pm instead of 12pm because I had to take my other patient to get a Chest CT which was more important. I also had to stick the patient 3 times because I wasn't having any luck so I had to get another nurse to draw the blood for me. I worked on a progressive care unit and we would never get over 4 patients, I can't believe you had 6.

there'll be days like that my momma said.......and you made it through and your patients were all alive when you left. not a bad days work!

just a few thoughts: did the doc try and place the ngt? did he d/c the order after you couldn't get it in?

does your facility have fecal incontinece pouches you could have placed on the patient with diarrhea? they are a god-send for both you and the patient. staff i work with would rather clean up poop all day long or worse yet, don't look for it instead of using a pouch. the patient's skin is kept intact and you have time to do other priorities.

That was what I was wondering. I was also wondering why they hadn't placed an NGT in the SBO patient in the ER. That's pretty standard procedure if docs suspect bowel obstruction.

:icon_hug:

i agree that your 2 admits were the priorities here.

as you get more comfortable, you will feel more secure in asserting yourself to demanding families.

that's a heavy assignment and hopefully is not the norm.

sounds like you did a great job.:icon_hug:

leslie

I'm sorry you had a bad shift. I hope the next one is better!

that gave you 6 patients on STEP DOWN, that is tooooo many, I am suprised that more people are not pointing that out, some how people seem to be suggesting that you just put up with it, my guess is that if this happens a few more times you will be one of the newbies that leave the profession early

When I worked on Med Surg, we usually had 6 pts, sometimes up to 8 and 8 Med Surgs pts is a LOT... but youwork on a STEP DOWN and got 6? What the ***?!

And no nursing assistants either, is ridiculous

Put your running shoes on and skeedaddle.

i'm not trying to be mean, but this is why new grads shouldn't be working on stepdown units. didn't any of your co-workers offer help? did you stop to take time to notify your supervisor what was going on? had i been the supervisor on duty i would have given the second admit to another nurse. it's very unfair to give two back-to-back admissions for a stepdown unit to the same nurse. i would talk to my manager about this.

when i worked on stepdown units we always decided at the beginning of the shift along with the assignments who was going to take the first, second, third admissions so their was fairness.

When I worked on Med Surg, we usually had 6 pts, sometimes up to 8 and 8 Med Surgs pts is a LOT... but youwork on a STEP DOWN and got 6? What the ***?!

And no nursing assistants either, is ridiculous

I worked several different step downs and we never got six unless there was nursing assistant to help out. If it was a big unit there would be more than one nursing assistant.

You are not a crappy nurse, you did the best you could with what was handed to you. That is all anyone can do.

I also agree that assignment was too heavy, for any nurse, much less a new nurse. So, don't beat yourself up. You did a good job, as you said, all patients where breathing and stable when you left!!

Someone said "why didn't you contact the nursing supervisor..." regarding the acuity of your assignment.

In the real world, that usually doesn't do any good what so ever - it should help, but usually just gets you the label of troublemaker or lazy - which is absolutely wrong.

You and I are warm bodies to fill a shift. It shouldn't be that way, and in a perfect world, it wouldn't be, but in too many cases that is the way it is.

We have 2 surpervisors that are great and will pitch in if you need a hand, and a 3rd who wouldn't get off her tush unless the building was on fire. And yes, administration is aware of that 3rd supervisor, but she is willing to work nights, and she too, is a warm body.

Do the best you can, try to get the other nurses you work with to work as a team, and don't be afraid to ask for help from your co-workers, because another night, they could end up in a similar situation as yourself.

Good luck dear, and welcome to the club.

God Bless