Meltdown moment...when was yours?

Ruby Vee, BSN · Apr 9, 2008

i've had too many to count, but the one that immediately springs to mind happened 5 or 6 years ago. i was in charge in the icu, and not only were we full to bursting, but we'd had a couple of sick calls. i spent hours and hours on the phone trying to line up staff, board out some of our more stable patients to other icus (specialized patient population) and deal with the patients we had who were going down the tubes. one of the cardiac surgeons and one of the cardiologists had a fight about their mutual patient -- right in the patient's room -- which ended with the cardiologist decking the cardiac surgeon. (usually it's the other way around!) and then one of surgeons tracked me down where i was trying to make an ice bag for the injured surgeon and said, "i just wanted to let you know that my patient is going to be a little delayed."

"which patient?"

"the one who's coming from moose dung community hospital. the balloon pump wouldn't fit into the helicopter, so they're trying to take it apart to see if they can fit it in."

this was the first i'd heard of any patient coming from mdch!

"oh, by the way," he said over his shoulder as he was walking away. "they called quite awhile ago, and i forgot to tell you. sorry."

oh yeah. they'd called quite awhile ago to say the patient was coming. they'd called again to tell him the balloom pump wouldn't fit on the helicopter. they'd called him a third time to tell him they were borrowing a travel pump console from goat spit general hospital a few towns over and they'd called a fourth time with their eta. somehow, all four of those calls had slipped his mind, because when i headed back for the nurse's station and my "brain sheet," i heard the unmistakable sound of a helicopter landing in our parking lot. did i say i had no beds? "no problem, we'll open a bed in pacu -- you'll just need to send a nurse since they don't do balloon pumps," said the every-helpful nursing supervisor.

did i mention i'd had sick calls? i ended up taking the fresh post-op (and retaining charge of a 22 bed icu!) while the nurse who was going to take the post-op went to the pacu to admit this balloon pump patient who couldn't go to any other icu because they don't do balloon pumps, either. and then i stayed four hours of overtime (making it a 20 hour day since i was doing a double to start with) to tend the patient in the pacu before he got whisked off to the or! during my last hour, the anesthesiologist wanted me to turn the patient for him so he could listen to breath sounds. (did i mention the patient was 120 kilograms?) (i'm told "imbecilic moron" is redundant).

at that point i'd had about 20 years of experience.

and then there was the time i was in charge of a 12 bed ccu full of eps patients, balloon pump patients, ventilated patients and one patient on dialysis. it was a sunday afternoon, and the maintenence staff felt it was the perfect time to change out the emergency generator for the new one they'd bought. it was a complicated procedure involving lifting out the old one with a crane, then slowly lowering the new generator into place and hooking it up. no electrical storms were predicted, the city grid was good and it looked like an auspicious day for such a task.

until the crane lowering the new emergency back-up generator into place slipped and dropped it on the main generator, thus destroying both of them. the good news is that the electricity only went out in part of the hospital. the bad news is that that part contrained the er, the or, the cath lab and both icus.

we had no lights, and no outside windows. the hospital didn't provide flashlights and the penlights each nurse carried to check pupils weren't very big, very bright and didn't last very long. ventilator batteries don't last very long, and balloon pump batteries last even less long, especially when someone had forgotten to plug in the balloon pump during a very long sojourn in the cath lab. we only had two portable monitors and 5 or 6 eps patients. one rt who had to decide which patients to bag, which to delegate bagging and which could (probably) survive an emergent extubation. the dialysis machine had no battery and we had to pump the blood back into the patient by hand. our phones didn't work, although there were three payphones in the lobby. one of the doctors took up a collection of quarters so that i could run the phone list from the payphone in the lobby to try to get some help.

did you know that the thing to do in that situation is to call 911? i didn't! turns out the fire department has a portable generator that they bring. we got through the crisis, power came back on, and i was congratulating myself and the staff for getting through without losing a patient and only losing one staff member (hit his head on a cupboard door in the dark and knocked himself out.) then my nurse manager came in and announced "this place looks like hell! couldn't you have at least cleaned up after yourselves?"

that was a meltdown moment! (12 or 13 years of experience)

Jelli_Belli · Apr 9, 2008

My meltdown moment came about 2 weeks after I got my license. I was working as a nurse on the same psychiatric unit that I had worked on as a tech through school. Actually I was still orienting (I had about 3 weeks to go). There was a really big snowstorm and the two other nurses I was supposed to work with called in. So I show up after fighting to get there through the storm and it is just me and the tech for the night. The day shift nurse tells me that the hospital is so short on nurses and the best they could do was send an LPN from the float pool to help with meds, but she has never worked our unit and never done psych before. Oh and guess what, I am charge nurse. :banghead:I start freaking out already saying I can't be charge, I'm still on orientation. I really considered quitting right then and there before I even took report, but I didn't because I really like my job and unit.

Okay so i psych myself up, saying "It's going to be okay, you can do this." And it probably would have fine if that night wouldn't have been sent straight from hell to test me. Turns out I am walking into the 7 patient we already have, plus I have 2 brand new admits one from 1820, and 1840, and there was an admit that came at 1400 that no one had even started on. So I have three admissions, 2 who are fairly stable and frequent fliers, and one who is crying so loud you can hear her through the glass partition in the nurses station and before I can even go out to talk to her to calm her down, I get a call from the ER saying that the police have brought in an Emergency Detention patient and that they are on there way up in the elevator and "Oh, by the way, he is in straps and you probably will need to keep him that way." :no:

So I hurry to get out there to meet him, grab the tech, and the police help us get this guy restrained in a seclusion room. So I am hurring back to the nurses station to call the doc to get Ativan for the sobber, Haldol for the restrained guy, and call my supervisor to get a tech to sit 1:1 for the restrained guy. Before I make it there a patient stops me and says she is having chest pain so I take her B\P and it is through the roof, like 180\100, or something. So I go in the nurses station, close the door, ask the secretary to page the psychiatrist, the CP ladies MD, and the supervisor, and then I start sobbing. I just felt so overwhelmed I couldn't stop crying. :bluecry1:

So of course this is the time the supervisor arrives, sees me crying and freaking out, and instead of staying and offering to help, she goes back to her office and calls my unit manager and tells her I can't handle it as charge nurse. :madface:

It all worked out in the end though, I got my extra tech. Thank God the tech I was working with was really good, she did so much to keep the milieu together and work on the admission paperwork.:bowingpur I got orders for everyone and CP lady got better with a little attention and Nitro. Everyone got medicated, and went to sleep.

We made through the night, nobody died and all the paperwork got done. Unfortunately, none of the patient got the attention they deserved but you can only do what you can do. It really was one of those nights that makes you question your career choice.

Morettia2, BSN, RN · Apr 9, 2008

i've had too many to count, but the one that immediately springs to mind happened 5 or 6 years ago. i was in charge in the icu, and not only were we full to bursting, but we'd had a couple of sick calls. i spent hours and hours on the phone trying to line up staff, board out some of our more stable patients to other icus (specialized patient population) and deal with the patients we had who were going down the tubes. one of the cardiac surgeons and one of the cardiologists had a fight about their mutual patient -- right in the patient's room -- which ended with the cardiologist decking the cardiac surgeon. (usually it's the other way around!) and then one of surgeons tracked me down where i was trying to make an ice bag for the injured surgeon and said, "i just wanted to let you know that my patient is going to be a little delayed."
"which patient?"
"the one who's coming from moose dung community hospital. the balloon pump wouldn't fit into the helicopter, so they're trying to take it apart to see if they can fit it in."
this was the first i'd heard of any patient coming from mdch!
"oh, by the way," he said over his shoulder as he was walking away. "they called quite awhile ago, and i forgot to tell you. sorry."
oh yeah. they'd called quite awhile ago to say the patient was coming. they'd called again to tell him the balloom pump wouldn't fit on the helicopter. they'd called him a third time to tell him they were borrowing a travel pump console from goat spit general hospital a few towns over and they'd called a fourth time with their eta. somehow, all four of those calls had slipped his mind, because when i headed back for the nurse's station and my "brain sheet," i heard the unmistakable sound of a helicopter landing in our parking lot. did i say i had no beds? "no problem, we'll open a bed in pacu -- you'll just need to send a nurse since they don't do balloon pumps," said the every-helpful nursing supervisor.
did i mention i'd had sick calls? i ended up taking the fresh post-op (and retaining charge of a 22 bed icu!) while the nurse who was going to take the post-op went to the pacu to admit this balloon pump patient who couldn't go to any other icu because they don't do balloon pumps, either. and then i stayed four hours of overtime (making it a 20 hour day since i was doing a double to start with) to tend the patient in the pacu before he got whisked off to the or! during my last hour, the anesthesiologist wanted me to turn the patient for him so he could listen to breath sounds. (did i mention the patient was 120 kilograms?) (i'm told "imbecilic moron" is redundant).
at that point i'd had about 20 years of experience.
and then there was the time i was in charge of a 12 bed ccu full of eps patients, balloon pump patients, ventilated patients and one patient on dialysis. it was a sunday afternoon, and the maintenence staff felt it was the perfect time to change out the emergency generator for the new one they'd bought. it was a complicated procedure involving lifting out the old one with a crane, then slowly lowering the new generator into place and hooking it up. no electrical storms were predicted, the city grid was good and it looked like an auspicious day for such a task.
until the crane lowering the new emergency back-up generator into place slipped and dropped it on the main generator, thus destroying both of them. the good news is that the electricity only went out in part of the hospital. the bad news is that that part contrained the er, the or, the cath lab and both icus.
we had no lights, and no outside windows. the hospital didn't provide flashlights and the penlights each nurse carried to check pupils weren't very big, very bright and didn't last very long. ventilator batteries don't last very long, and balloon pump batteries last even less long, especially when someone had forgotten to plug in the balloon pump during a very long sojourn in the cath lab. we only had two portable monitors and 5 or 6 eps patients. one rt who had to decide which patients to bag, which to delegate bagging and which could (probably) survive an emergent extubation. the dialysis machine had no battery and we had to pump the blood back into the patient by hand. our phones didn't work, although there were three payphones in the lobby. one of the doctors took up a collection of quarters so that i could run the phone list from the payphone in the lobby to try to get some help.
did you know that the thing to do in that situation is to call 911? i didn't! turns out the fire department has a portable generator that they bring. we got through the crisis, power came back on, and i was congratulating myself and the staff for getting through without losing a patient and only losing one staff member (hit his head on a cupboard door in the dark and knocked himself out.) then my nurse manager came in and announced "this place looks like hell! couldn't you have at least cleaned up after yourselves?"
that was a meltdown moment! (12 or 13 years of experience)

note to self..call 911 if we have no power..i had a rough night tonight so i def. enjoyed your post. hope this never happens again!:bowingpur:banghead:

TazziRN, RN · Apr 9, 2008

Ruby............Moose Dung and Goat Spit General Hospitals.....??

:hhmth:

nurturer · Apr 9, 2008

Dear Jelli Belli....I am just starting with prerquisites. You have completley horrified me! As I read your post I was actually laughing out loud because of the insanity of your whole situation...but when I stopped laughing....I began shaking in my shoes.....please tell me this is NOT typical....

Penelope_Pitstop, BSN, RN · Apr 9, 2008

ruby............moose dung and goat spit general hospitals.....??
:hhmth:

i was hoping someone else laughed at that! i love you, ruby! can we just have a forum that is your stories? you tell them so well, in such detail - i feel like i'm there! and you make them always professional and funny!

jess

SteveNNP, MSN, NP · Apr 9, 2008

My meltdown moment happened a few weeks ago, when I was assigned to my unit's Transitional Nursery attached to L&D. (We have 70 babies on the main units, this one is where all in-house admissions are initially stabilized before moving downstairs as beds allow)

I was the only RN assigned to the unit, as it only had 4 monitors, (it's basically a 20'x20' room) and had 4 babies at the time. Normally you shouldn't have more than 2, in case you get admissions. We were currently above capacity at 78 babies, so there were no beds available.

My one kid with questionable perf decided to puke blood clots all over his bed while his horrified parents watched....Meanwhile my other two on CPAP were desatting and bradying like crazy, and the one remaining baby who was supposed to be the good one decided to blow up his belly like a bullfrog after his feed. So now it's 2 hours into my shift, and parents are everywhere, and it's just me and the PA trying to make sense of all of this. Suddenly the L&D charge runs in and tells me that they are emergently delivering 24 and 29 week sets of twins. I literally have nowhere to put these kids. I call the fellow and charge nurse to get some help, and of course NO ONE is answering. I call my backup nurse, and she's on break. I'm frantically throwing radiant warmers in every inch of space, breaking open CPAP and intubation setups, shooing parents out, etc. Finally everyone comes running in at once, and starts carting my babies downstairs (funny how they can always find a bed when stuff like this happens). We finish setting up as the NNPs and MDs come in with the 24 weeker twins who need aggressinve resuscitation, intubation, surfactant, umbilical lines (which of course are in the liver and have to be replaced) IV, arterial line fluids hung, antibiotics given, labs sent, parents brought in, etc. Then they run in with the 29 weekers, who only need minimal stim and nasal CPAP. They also need peripheral IV lines, fluids, beds, bili lights, labs, parental teaching, etc. It's now 1am, and we're just sitting down to chart when they run in with a blue, limp term kid. We place him in a corner on our last remaining warmer, and barely escape intubating him too. He also gets CPAP, lines, meds and labs. So now I have piles of crap lying all over the unit, as the trash cans filled up long ago, and the housekeeper is on her 'break". I have wall to wall warmers, vents, CPAP setups, IV poles, etc. Every suction outlet, O2 outlet and power plug is in use.

We finally sit down at 3am to chart. We're all halfway through our admit assessments when the computer charting system crashes. It is down for 26 hours that day. So now we have to paper chart everything. I chart 9 assessments (we normally only have 1-3 babies in NICU) 4 on the kids I sent down (report must still be called 7 hour later) and on the 5 I have up there now. Then the lab calls and says that the labs I sent never arrived, as the tube system is down. I hunt them down and resend. It's now 7am, and they're calling us for another set of twins in a half hour. Who cares? I'm outta there. There are now 83 babies in our 58 bed NICU. The piles of trash have been picked up, the cabinets restocked, the babies are all stable, and all is well with the world.

We all laugh as we leave that morning. You have to, when everything that could go wrong....did.

Just a day in the life of NICU.

barefootlady, ADN, RN · Apr 9, 2008

Thanks to every poster for their story.

I live by these rules most days:

1. Even on the best of days, things tend to screw-up.

2. Take a deep breath, count to ten, and do what you can to fix the problem.

3. Ask for help.

4. Be kind.

5. While driving home I can have my own breakdown, meltdown, and screaming

fit.

6. God loves me.

Blessings to all.

santhony44, MSN, RN, NP · Apr 9, 2008

one of the cardiac surgeons and one of the cardiologists had a fight about their mutual patient -- right in the patient's room -- which ended with the cardiologist decking the cardiac surgeon. (usually it's the other way around!)
i'd have paid to have seen it, no matter who decked whom.
then my nurse manager came in and announced "this place looks like hell! couldn't you have at least cleaned up after yourselves?"
that was a meltdown moment! (12 or 13 years of experience)
that would probably have ended my nursing career, right there. just as soon as they pried my hands from around the nurse manager's neck.
you're a better woman than i am, ruby!

grace90, LPN, LVN · Apr 9, 2008

Brand new nurse

more to come later

Medic/Nurse, BSN, RN · Apr 9, 2008

Ruby............Moose Dung and Goat Spit General Hospitals.....??

Yep, I was thinking the same thing there Tazzi -

But, then I remembered that I've BEEN to some of those hospitals (often) ---

I do love the INTERfacility RESCUE! (Meaning the patient is so ^#(&@% that recovery may not be possible - what about that doing no harm thing??? - wonder if some folks ever heard of it???)

The doc was real focused on "You fly away now!" Big surprise there!

As for the MELTDOWN MOMENT -

I'm way overdue! I've been so good at maintaining CONTROL that it sometimes works against me! Woo!Hoo! It's coming and it's gonna be BAD!