Bad Day at Work (rant, sorry)

[MarcusKspn]

Hello everyone,

I just need to let of some steam. I had a terrible day at work yesterday (sunday). I work in a LTC facility. We had a patient who started throwing up friday evening. Called the doctor, recieved orders for Phenergan, the usual. Saturday she was still feeling sick, could not eat or drink. Called the doctor back, recieved orders to double the dose of phenergan, clear liquid diet. I wasn't the charge nurse on the wing those days. Sunday I was charging on the wing that the patient was on. Started my shift at 6, patient was stable. She drank 2 glasses of fluids for breakfast, started to throw up. I gave her phenergan 50mg IM. Took vitals, Temp ok, Pulse 100, Resp 24, BP 102/50. Skin turgor poor, musous membranes dry, obvious s/s of dehydration. Called Doctor at about 0900 in the morning, recieved orders to transfer patient to SNF status. Keep all meds the same, start IV and hang LR at 60cc/hr, draw a CBC and BMP. We worked the patient up, waited on the Pharmacy to deliver our IV supplies. The lab came back, BUN is 80'something, creat's are 2.something. Potassion high, WBC 15.2, and she is anemic. I, another LPN, and our RN tried a total of 10 times to start an IV, but she was so dehydrated that nobody could get a line started. Now the time is noon, I call the doctor back. He is at our local emergency room, I tell him that we are unable to start a line, tell him again all about the status of the patient, tell him all the lab values. He told me to leave the patient alone, and send her to his office in the morning :confused: . I'm thinking there is a pretty good change the lady will be dead before the morning. Ask him again if he wanted us to repeat any labs, call him about any changes, tell him she has thrown up again since I last called him, despite the Phenergan 50. Finally he said he will come out and see her, and start the IV for us. Get off the phone with him, start all the paperwork to send her to the hospital. I'm thinking that maybe when he gets here and actually sees her he will say "SHe looks like crap, send her now!!!" And I'm also hoping that having all the paperwork ready will make it happen. 2 hours later he still is not here, I've been checking my patient every 15. at 1400 her BP was 80/30, SaO2 86% on RA, she war breathing very schallow, with periods of apnea. (Looked alot like she was starting to Cheyne-Stokes on me). Took very loud verbal stimuly to get her to respond. I called him again at the hospital (He is sitting in the lounge, instead of comming here and taking care of her). Tell him all the clinical findings, that I am very very concerned about here health status. And he tells me "YOU HAVE VERY BAD JUDGEMENT. THIS IS NORMAL EFFECTS OF AGING. YOUR JUDGEMENT IS VERY POOR ON THIS CASE!" :( WTF. He finaly agreed to let me send her to the hospital so he can look at her. I talked to my DON (She was here for our thanksgiving lunch with the families and residents), she said he is a jerk, don't let it bother me. He called back about 2 hours later to give me report. Said he started IV, everything was ok, she is fine, there was nothing wrong with her, said "YOU NEED TO CALM DOWN, SHE IS A DNR, WHATEVER IS GOING TO HAPPEN IS GOING TO HAPPEN" Now I'm the very first person that is going to say: Hey, she is a DNR. or Hey, she has a living will, but not for Dehydration that can be fixed with an IV in her arm. The ambulance brought her back from the ER, the crew gave me report, said that she was in Trendelenburg when she was in the ER. (now the doc said she was fine, how fine can you be when your head is pointing at the floor and your feet at the ceiling) Within 60 minutes of fluids she started responding. Within 2 hours all her VS were WNL. She was her normal self. Aging my a$$, she was dehydrated and I had bad judgement for not letting her die. He also ordered some Rocephin, but she was allergic to PCN. He said to go ahead and give it IV. So I spend the last hour of my shift infusing it over 60 minutes. Not leaving her bedside (I had another LPN to cover the floor for me) and taking her VS every 15 minutes to make sure she was not having an allergic reaction. Everything was fine, it is now 2200, I have been here 16 hours (I pull two doubles on the weekend while going to RN school during the week). My relief has not shown up, I call my DON at home, she said I'm just gonna have to stay another shift. I tell her that in 15 minutes I am leaving, and she better get somebody else or herself up here to cover the floor. She threatens me with F***ing abandonment and tells me I'm gonna loose my license if I leave. Now I know that the BON in Oklahoma has released an abandonment statement, and it says in there failure to work beyond my scheduled shift is not considered abandonment, and leaving my area with apropriate notification of appropriate personel is not considered abandonment is neither. And I told her that if she EVER, EVER tries to threaten me with my license again, that will be the last time that I will work for her. The nerve of that *****, I spend the day recieving Verbal abuse from the doctor for not letting my patient die from dehydration, and then she threatens my license. I don't care that she has no basis for the threat, and could never carry it out. I wont stand for that. I'm looking for a new job today.

Sorry for a long rant, I just really needed to let of some steam.

[sharann, BSN, RN]

I'm floored. I can only say that you did all the right things (although I might have called 911, lol). Doc was a jerk and so was DON. Sorry you had such a lousy day, but you should be so proud of yourself.

[CCU NRS]

that was definately a bad day and you sound like you were doing your best to manage things until unable to get a line. i don't know exactly where you are in ok but i live in okc and around here the ltc's can call emsa and have their difficult iv team come to the facility to start iv's if you could have done this you would have probably had a much better day!!!!!!!!

good luck in the job hunt ps we need good nurses at st anthony's if you are in this area we are hiring they have sign on bonus and referal bonus if you apply list me for your referal lol

pss i beleive they are actually having open interview tomorrow no kidding 9:00am to 4:00pm in the main lobby

pm me if is something you might be interested in i can give you particulars and address if you are from somewhere else.

[cannoli]

You sound like a good, caring nurse.

I can't believe they wanted you to work 24 hours (or I guess it would have been 40) without a break or be charged with abandonment, sounds like THEY need to be charged with something, is there someplace you can call and report them to?

[redshiloh]

I don't know if you want to do this, but I think you should report the DON to the labor board...it's illegal for her to insist you stay beyond 16 hours. You also took a hellava risk giving that patient the rocephin...THAT kind of jerk doc would NOT back you up if something happened.

[MarcusKspn]

Thanks for all the replies. I documented my butt of yesterday. Very extensive charting on all his reponses, on every time I tried to get a hold of him. Of me making him repeatedly aware of PCN allergies, of his insistance to give the Rocephin anyway, on my staying with her the entire time it took to infuse rocephin.

I almost felt like he wanted her to die on the rocephin so he could blame it on us. Anyway, thanks again.

[sabRN2b05, BSN, RN]

Hey Marcuskspn,

I thought I had a bad day at work yesterday! I am a first semester nursing student (ADN program) who works in an emergency room (2 - 12hr shifts on the weekends and 3-11:30 on Wednesday night). This past weekend, yesterday in particular was SO busy. I work the Admit desk, taking care of all the registration, paperwork, etc. We really have to be multi tasked. We answer the phone, wait on every Tom, Dick, and Harry that walks thru, register ER patients, anwer the phone, on weekends we register outpts for x-rays, labs, etc., we do the admits from the ER to the floor, answer the phone, put in labor/delivery pts whether it be for observation, labor, whatever, register ambulance patients, answer the phone, register direct admits, register patients going to our rehab center, answer the phone, did I mention answer the phone???? It can be very stressful and some days your people skills just go right out the window (especially after about 6-7 hours into your 12 hours shift!)

We have a LOT of people who come in for common cold, "back pain", runny noses, you name it. Not at all emergency stuff - most stuff could wait until Monday to see their pcp's. People are triaged in the order they arrive, registered in the order they are triaged, but don't necessarily go "to the back" to a room in the order they are registered. It is such a pain in the ass to try and explain to people who b*tch because a chest pain pt comes in and goes back to a room before them. Hmmmm........they're waiting to see the doc for "back pain" and the person who went back immediately might be having a heart attack!!! Here's your sign!!! You just want to knock the sh*t out these people and say sit down, shut up, and wait your turn or go back home and take a couple of Motrin. I don't mean to sound harsh, but it's just aggravating. It's also aggravating when there's an MVA and like 20 family members come up to the ER (I know they want to see their loved ones) and EVERYONE wants to go back to the room at once. HELLO, people - everyone can't fit in those little rooms at once. One visitor at a time - and I don't make that rule. The docs and nurses have to have room to do their job. I'll get the charge nurse if you want to complain about it. Anybody else work in an emergency room? I'd love to swap stories!

I have to go now and get ready for a test I have tonight. I'll be so glad when this first semester is over. I am taking A&P II on Mondays nights on top of my nursing program classes. Are Xmas holidays here yet?

P.S. Marcuskspn, you sound like a great nurse. I am glad you documented your a*s off! Always CYA!! My hat is off to you. LTC is not my cup of tea and you are a special person to work in that field. Our clinical rotations this semester are in LTC and I am ready for it to be over with. I prefer Peds. Look forward to hearing back from you.

[RN-PA, RN]

I was sitting here reading your story,

MarcusKspn, shaking my head and horrified at what you went through that day! I also wish you could report the DON AND the MD! SHAME ON THEM!!! Horible treatment of you AND that poor resident. Thank God that resident had you for her nurse! And all the best to you as you look for a new job. That place doesn't deserve you, and I pity the residents under that doctors "care".

[jnette, ASN, EMT-I]

Good Job !!!

I just hope and pray I have a nurse like you at my bedside, when some ol' jerk of a doctor decides I'm not worth his time or trouble.

And as for the DON... sheeeesh... I'd better not say !

As horrible a day it was for you, please take comfort in knowing that you were ONE HE** OF A NURSE that day !!! :kiss

[nursenoelle]

((HUGS)) That is one helluva day. I hope that you find a place that deserves you. You did a great job today, and we are proud of you:)

[Tweety, BSN, RN]

Hope the next day is better.

[CoffeeRTC, BSN, RN]

Your not the only one that has had days like that...I've been in the same situation last week. Sooooo mad at the doc on call (he knew the pt) that I called the main doc at home to get orders. Boy was he mad..not at me..but the doc on call... I've also been known to call the medical director to get orders...DNR or not I don't just let MY res die for little things that can be treated easily or without pain meds.

Good for you Marcus!