I have had such a day....(Looooong)

  1. My patient today was detoxing from alcohol and had mucous secretions so thick he sounded like he was drowning in them. His skin was so thin it was tearing everywhere. He could hardly speak and he was agitated and confused.

    I started off by telling him my name and trying to get vitals..he started off my morning by throwing my thermometer at me and telling me to "get the h@ll out". Its ok though, that didn't bother me..I mean I just had to somehow get vitals...its just when something like that usually happens first thing in the morning you think "its going to be one of those days"

    Eventually he became more oriented and cooperative. Not to mention my nurse that was assigned to the patient never once came in and everytime I asked her a question she acted like I was bugging her.

    The day was getting better when my patients wife came in, I was so excited to have an opportunity to work with the family. We talked and she started crying and she thought her husband was going to die soon. It was soooo sad, I wanted to cry with her. I just told her I understood and that I was listening. She talked and I think she felt a little better.

    Then it was time for my pt. to go to xray..well the transporter came up and im not really sure what went on...all I know is that it took four of us and I dont think the transporter knew what she was doing..perhaps she was new...
    she had the stretcher up higher than the bed, his O2 tangled with his IV around his bed and his compression boots still attached trying to pull him onto the stretcher...before we could stop her! She had his head on the stretcher and we were at the feet..sigh...finally we got him on and she is wheeling him out when she knocks into the TV with the IV pole practically breaking it...OOPS! Then she left without any of his paperwork or his chart...

    Later my pt. needed augmenten and you know how large those pills are so we mashed it up in applesauce but after taking so many other pills he just was too weak to swallow it. I didnt know what to do..meanwhile the pts. brother and daughter had come in. The family insisted that I not try to give him the augmented P.O. they wanted it through his IV. They were soo upset, you could just hear the dx and wife choaking up as they talked to me. I explained that I could not just change it that the MD would have to. I also told them i'd have to talk to his actual nurse first too. They were ok with that. They were not pushy or rude at all. The dx came out and said, "im just not sure we will have tommorrow with my dad" and she started crying...i almost broke down in tears right there with her, while holding the mashed up augmentin/applesauce mixture. All I could do was tell her Id talk to the nurse and that I understood, I gave her a hug.

    What really made the rest of the day unpleasant was that after spending about 45 minutes holding the applesauce/augmenten mixture the nurse finally had time to talk to me, i know shes busy so i didnt mind waiting, but my mixture was starting to stink too! I didnt dare put it down though...

    So when I told the nurse the situation she sighed and rolled her eyes and said, "oh they will just have to get over it,". She then told me to put it back in his med drawer and she would give it to him with his food at lunch?
    Then she ordered me (not asked) to get the supplies for the dressing change. I told her i'd be happy to help her but either she or my instructor needed to be present when I did it...I brought back the supplies just like she asked and 10 minutes later she says "why havent you done that dressing change yet???" in a really nasty voice...I just apologized...im really not here to make waves..it was our last day anyway.

    Sooo....the moral of this long story is..I was sooo dissapointed how she handled the family situation. I later heard her with the family and basically told them this is how his meds are ordered and we arent changing them. How can you look at a family obviously grieving and have that attitude??? It tore my heart out and she was just like whatever, rolling her eyes and sighing..I was so put off by this. I NEVER want to be that nurse. EVER!
    On a lighter note, when the dx and wife hugged me, it all seemed worth it..I felt so good that I might have made them feel a tiny bit better. When things like that happen, those are the times I know that I am meant to be a nurse.

    Sorry for the vent...its just been one of those days!
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  2. 12 Comments

  3. by   shammy
    Just had to respond... Sorry about your day! And yes take it as learning experience. Now you know how you want to be in the real world of nursing.

    Sounds like you did a GREAT job of communicating with the family and trying to advocate for the patient.
  4. by   breaunna
    Wow, hearing stuff like that wouldnt want me to become a nurse, but I was wondering could i interview you its just for a high school class that im in, we have to interview someone thats in the job field that we want 2 do so can i please interview its onlly a couple of questions
  5. by   BabyRN2Be
    Wow, that was a long day. I really commend you on how you worked with the family. You demonstrated a lot of patience as well as empathy. It's really sad that the pt's nurse didn't feel the same way or didn't express the compassion that you did. I know that nurses get busy, it's the way of it these days, but a little compassion from the pt's nurse would go a long way.

    You done good.
  6. by   GrnHonu99
    Quote from BabyRN2Be
    Wow, that was a long day. I really commend you on how you worked with the family. You demonstrated a lot of patience as well as empathy. It's really sad that the pt's nurse didn't feel the same way or didn't express the compassion that you did. I know that nurses get busy, it's the way of it these days, but a little compassion from the pt's nurse would go a long way.

    You done good.

    Thanks and I thought the same thing...a little compassion goes a long way!
  7. by   Tweety
    Quote from ELKMNin06
    Thanks and I thought the same thing...a little compassion goes a long way!

    Yeah that.
  8. by   LoriAlabamaRN
    It's so sad that there are nurses who remain in the profession despite having lost all sympathy/empathy for what patients and family are going through. It doesn't sound like the family was being overbearing or PIAs, but that they were genuinely confused, scared, and heartbroken. Rest assured that your kindness made a huge difference.
    The nursing profession needs you, and more like you.
    Lori
  9. by   Thunderwolf
    Take away from the experience what you provided to the patient and family. Feel good about what stood you apart. You did good.
    Last edit by Thunderwolf on Nov 5, '05
  10. by   DusktilDawn
    Quote from ELKMNin06
    Thanks and I thought the same thing...a little compassion goes a long way!
    Absolutely. Sometimes all you can offer is to listen, provide compassion and empathy, although it may not seem like much, it is a lot to the patient and their family. It does bother me how the patient's nurse responded, it sounds like she has a lot to learn. When I was a student, those types of nurses were the examples I used when it came to the type of nurse I wasn't going to be.

    Side note ELKMNin06, augmentin is only available in pill or liquid suspension. However the nurse still could have consulted the MD regarding the patient's antibiotics. She certainly could have used some compassion and understanding while explaining this to the family and offered the alternative of the liquid suspension, which the patient may have tolerated better.
  11. by   GrnHonu99
    Quote from DusktilDawn
    Side note ELKMNin06, augmentin is only available in pill or liquid suspension. However the nurse still could have consulted the MD regarding the patient's antibiotics. She certainly could have used some compassion and understanding while explaining this to the family and offered the alternative of the liquid suspension, which the patient may have tolerated better.
    Is there another antibiotic comprable to augmentin that he could have taken through the IV? Just wondering The poor guy, those aumgentin pills are gigantic, and they taste just awful if you crush it up, even in applesauce!

    By the way, thanks for all the reasurrance and advice. I really appreciate it. I kinda want to go up there today and see how he is doing but I dont know if that would be appropriate...

    I like the hospital where I have been doing my clincials but some of the nurses haven't been quite so accomadating, some have been great though. We've been on a couple different floors, we got kicked off our first floow bc the hospital has its own nursing school in it and their students wanted to be on floor 12 (where the nurses were really nice!) so we went to floor 14 where the nurses arent so nice..the other group from my school is on 14 at the other end and our teacher is moving them bc she said she didnt like some of the nurses attitudes....It fumes me when I come across these nurses but atleast I learn how I don't want to be from them!
    Last edit by GrnHonu99 on Nov 4, '05
  12. by   tencat
    Jeez. Bad clinical karma must be going around this week. I had trouble with my precepting nurse, too. She's a great lady who is very thorough and she certainly knows what she's doing. I like to work with her because she keeps me on track and helps me to see how to prioritize. Anywho......We're supposed to sign off with the nurse at 2:00, and at 1:45 she asks me if I will do the paperwork for a discharge. I got everything ready, and at 2:00 she asks me to do the discharge. I said "I have to chart now because our instructor says we have to be done by 2:00 and chartring from 2:00-3:00." She tells me "No. You have to finish the discharge." I went with her because I wasn't sure how to get out of the situation without being rude or disrespectful. At 2:45 I finally said "I have to go chart. We're done at 3:30 and I have childcare issues and have to leave." She gives me a big lecture about how if I want to be a real nurse I have to work until the work is done, not just until I want to leave. I got a bit peeved because I know that you plan extra time at the end of a work shift to finish paperwork. But I'm a student now, and I had a 1 1/2 hour drive to get home by 5:00 to relieve the sitter who can't stay later than that. She said "No. You can't go until you show me your finished charting." I stood my ground and said "I don't really have a choice. I will finish my charting before I leave, but I might not have time to track you down to look it over, but my instructor will look it over." She finally let me leave after giving oral report, which was fine with me. Sheesh. It's times like these that make me wonder why I gave up being a respected professional so I could be patronized as a 'know-nothing' student. Don't get me wrong: I know I have A LOT to learn and that it will take time to become proficient and knowledgeable, most of which will happen on the job. I know that the nurses have a lot to teach, and I am ready to learn all that I can from them. It's just hard to go from being respected to merely being tolerated. Thanks, just a vent from an old student!
  13. by   DusktilDawn
    Quote from ELKMNin06
    Is there another antibiotic comprable to augmentin that he could have taken through the IV? Just wondering The poor guy, those aumgentin pills are gigantic, and they taste just awful if you crush it up, even in applesauce!

    By the way, thanks for all the reasurrance and advice. I really appreciate it. I kinda want to go up there today and see how he is doing but I dont know if that would be appropriate...

    I like the hospital where I have been doing my clincials but some of the nurses haven't been quite so accomadating, some have been great though. We've been on a couple different floors, we got kicked off our first floow bc the hospital has its own nursing school in it and their students wanted to be on floor 12 (where the nurses were really nice!) so we went to floor 14 where the nurses arent so nice..the other group from my school is on 14 at the other end and our teacher is moving them bc she said she didnt like some of the nurses attitudes....It fumes me when I come across these nurses but atleast I learn how I don't want to be from them!
    Well augmentin is a combination of amoxicillin and clavulanate (clavulanate increases the effectiveness of amoxicillin) and amoxicillin itself also does not come in IV form. Being a penicillin and knowing why (which I don't in this case) the antibiotic was prescribed I would have consulted the pharmacist where I work to inquire about alternatives in IV forms. I don't have a specific answer off-hand.

    Hopefully your next rotation will be on a more student friendly floor.
  14. by   GrnHonu99
    Quote from DusktilDawn
    Well augmentin is a combination of amoxicillin and clavulanate (clavulanate increases the effectiveness of amoxicillin) and amoxicillin itself also does not come in IV form. Being a penicillin and knowing why (which I don't in this case) the antibiotic was prescribed I would have consulted the pharmacist where I work to inquire about alternatives in IV forms. I don't have a specific answer off-hand.

    Hopefully your next rotation will be on a more student friendly floor.
    My next clinical rotation will be at Childrens hospital. I am not worried about the nurses there but I am worried about dealing with the families...

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