What was your worst shift ever?

[Isakolistic]

I had one of *those* shifts last night.

I work night shifts on a moderate med/surg floor; 5 patients max for night shift. Four patients most of the shift, one that could have been in geri-psych if not for some wonky ammonia levels (which admittedly did not help things). We ended up having to give IM ativan and zyprexa to calm her down. While this was going on, also trying to monitor blood glucose levels on a brittle diabetic who on the day shift had been down to 26 and now was >300 due to D5 and IV methylprednisone; it's so fun contacting sleepy docs on the night shift! I get word through all of this that I'm getting an unorthodox admission from a different hospitals ER, so I contact that ER for report and hear that they're having trouble stabilizing her so they are unsure when she will be transferred. Okay, I guess I've got enough to deal with, I thought. Sure enough, in waltzed the pt with EMS at 0630, right before shift change! And now, I hear from the charge nurse that the nurse taking that patient was going to be half an hour late from the recent winter storm. Had to stay after quitting time a while to finish up on charting anyways, so what the heck.

All-in-all, I can't complain too much; nobody died and my patients were mostly pleasant (minus geri-psych lady). Just one of those shifts that you let out a big sigh and press on. But it did get me thinking about some of my "shifts from hell" as a nurse. There aren't too many recent threads on this topic, so lets hear some stories! Reply with a summary of your worst shift ever!

[BSN16]

we had two call ins that night. and 2 1:1's. I was in a 1:1 CRRT had to end up taking another patient (VERY UNSAFE). every other nurse was tripled. Had a patient come up to the unit from the floor and kept coding all night long. Less than 6 years experience that entire night between all the nurses

[LibraSunCNM, BSN, MSN, CNM]

Brand new nurse on a very heavy surgical floor. We had 28 floor beds and then 8 additional step-down beds, split between two different step-down units. For some weird architectural reason due to the way the unit was renovated back in the Dark Ages, one step-down unit was absolutely enormous, and one was barely bigger than a normal 2-bedded patient room. And when I was new, for whatever reason, I was in the tiny unit literally almost every shift. It was always full, and often mostly contained sundowning elderly patients, freshly post-op from any number of different types of surgeries we cared for, whose mental status was no doubt worsened by the ridiculous size of the room and the inevitable unending noise of 4 cardiac monitors, other patients, visitors, and the staff trying to maneuver around in the small amount of space.

I had been off of orientation only a few shifts. I was having an extremely hard time adjusting to the night shift, and was doing my best every shift to stay awake while keeping a group of very sick patients alive. The unit was full, and I don't even remember all of the details of the shift now, because I've blocked it from memory, but by far the worst part was a male ortho patient who was relatively young (as in, 40s), who started sundowning for unknown reasons (adverse med reactions? Looking back, I also wonder if he was a heavy drinker and never told us, so was withdrawing a bit. Who knows), and kept ripping out his IV and trying to climb out of bed, a few hours post-op. His family kept calling the desk, angrily demanding "Why does he sound crazy?? What's wrong with him? What are you doing to him?" I was completely overwhelmed and exhausted and couldn't figure out how to manage everything. I called the resident to ask him come take a look at the guy and of course, when he arrived, the patient was COMPLETELY sane and ordinary. The resident was very nice and actually helped me put in a new IV, but I felt absolutely incompetent. I ended up bursting into tears at the end of the shift onto the shoulder of a very kind coworker. The icing on the cake was that it was the night of "fall back" time change, so I got to work 13 hours instead of 12.

Takeaways: night shift in that unit will inevitably suck, learn when to ask for help, and never EVER work on "fall back" night again!

[Oh'Ello, BSN, RN]

Minnesota tube, 27 units in and 30 LITERS out. I think that pretty much sums it all up.

[UrbanHealthRN, BSN, RN]

Night shift, pedi med/surg, my first year of nursing. One of my patients was a very recent transfer from the ICU- a 200 lb preteen girl who had significant head trauma after being hit by a car, was temporarily blind from the accident, and had a fractured clavicle. She had a sitter in her room due to her mood instability...um, understatement! Went completely "frontal" on me two hours into my shift, the sitter was blaming me for it while also asking me to get her a recliner chair in the same breath for her "bad back", and none of the meds I had ordered for this girl seemed to touch her.

By end of shift, I think there were three or four of us in the room at any given moment, mom and grandmother had just returned to hear the pt swearing like a sailor and screaming we had tried to rape her, and grandmother was a diabetic with a rapidly falling blood sugar who almost passed out. Happy ending, though- the pt had a full recovery and the family was actually very satisfied with the hospital's care by time of discharge. Neuro cases are just tough.

[Wander1023]

Worst shift ever: New Grad RN, Night shift on Renal Intermediate Care in full effect, I already had a full load of 4 busy patients , and in comes a TURP that suddenly has some kind of abnormal clotting issue. The order was continuous NS irrigation (4L bags) and because he kept clotting off the catheter I had to keep it running pretty fast. Every 15 minutes the patient would yell out "I think it's clotting again! I'm getting that painful pressure feeling again! Ahhhh!" Sure enough, a foot long spaghetti clot came out of the flush. After hours of this, and the provider not offering any solutions, but "keep irrigating," this patient ended up using ALL the NS 4L bags in the hospital's supply room! Mind you, this was a 575 bed hospital, so no small feat. I must have used over 95 bags that shift, and we had to start stealing bags from other floors. I had to beg an aid to keep the NS from running out so I could take care of my other patients. It was ridiculous. And charting all that...Lol. Not fun either. I heard the next day that he had to go back in to surgery.

[Ruby Vee, BSN]

I was a newish grad on a hematology floor. Since I had a license, I was in charge; my colleague was a new grad who had not yet received her license. (You were allowed to work as a "GN" in those days, before your licensing results were in. If you flunked, you were an NA.) Patient had luekemia, was pregnant, and there was concern about fetal demise. Obstetrics was consulted and the plan was to wait until Monday morning and transfer the patient to OB for fetal monitoring. This was Sunday night.

The GN (I'll call her Debbie) wanted to work in L & D, so she begged to take the pregnant patient. I had no interest in L & D, so I agreed. Over the course of the night, the patient complained of abdominal pain and Debbie talked to the medical resident, took an order, and turned up the morphine drip. And again. And again. At 4am, she came running to me shouting "She's crowning!" Even I knew what that meant. We called the resident, Oscar, only Oscar wasn't answering the phone. From where we were standing, we could hear the phone ringing and ringing in the call room just across the hall. In frustration, I knocked on the door and, when there was no answer, I opened the door and saw Oscar sitting on the bed with his head in his hands. "I don't know nothing about babies," he said. "Nothing. I can't go in there."

"You're the doctor, Oscar. You HAVE to go in there."

"No, no, no"

"You have to." And I grabbed his arm with the intention of dragging him into the room. Only Oscar had other ideas -- he picked that moment to have a seizure. I wasn't looking at him, I was trying to see into the patient's room across the hall. I still had a good grip on his arm when he went down.

So now we had a hematology patient delivering a baby and our only physician was having a full-blown seizure.

If that wasn't the worst night I've ever had, it was right up there. We called a code for Oscar and stat paged OB and the nursing supervisor. Both patients got care.

Come to think of it, the absolute worst night was the next night. I came to work and Oscar was in the first bed, as a patient. He was surrounded by the rest of his resident class and when he saw me, he turned and pointed at me and proclaimed to the entire resident class "There she is. There's the (bad word) who dislocated by shoulder!"

[NanaPoo]

I was a brand new nurse on a med/surg floor and all of 5'0" and 95 lbs. We took a lot of DT patients and I somehow always got the 6'3" guys weighing in at 300 lbs. This one in particular was a young man whose DTs kicked in about 9 a.m. just after I hung a unit of plasma. Minutes after I stepped out of the room, he decided it'd be a great idea to unspike that bag of plasma and go for a walk (skate?0 across the room. I walk in, he's sliding across the tiled room soaked in plasma. I reach for him as he begins to both lunge at me and throw a punch at my face. He grabs me on his way down and, weighing thrice my weight, takes me down with him. He in his hospital gown, me in all white. Both of us soaked in a stranger's donated plasma.

Ahh, the good old days...maybe not my worst day on that unit but very typical.

[prmenrs, RN]

The one I had last night, in my nightmare.

[llg, PhD, RN]

A long time ago ... on a holiday night shift ... NICU. As I was walking through the parking lot into the hospital, I saw that there was a woman delivery a baby in a car. People from the ED were there, so I didn't go help -- but I figured that was a bad sign. Fortunately, the baby didn't go to the NICU because things were crazy there and very short-staffed. I was the Charge Nurse and had 3 very sick babies to care for myself -- the most stable was a 27 weeker who was 2 hours old. His tubes and wires were already in place by the time I arrived.

We had 6 full codes on 3 different babies (2 codes per baby that shift).

We had one very stable baby we had no nurse for and no bed space for: he was there for a full exchange transfusion first thing in the morning. As we had no bed space for him (expecting one would open up when one of the coding babies died), his bed was in the middle of the unit where he could be seen by everyone -- as he was nobody's official assignment. We got a new admission who was about 28 weeks and routine for a baby of that gestation. We all thought there was something unusual about him, but nobody had time to investigate. (It was his flaccid legs. Someone finally turned him over on day shift and discovered a myelomenigocele.)

It was one heck of a night -- but all babies and staff survived the night -- and no s*** actually hit the fan. Success.

[Horseshoe, BSN, RN]

The one during which I was working in a cardiac stepdown and was assigned one chest pain patient and two GI bleeders. I discharged my cardiac patient early, and my next admission was...a GI bleeder. All I did for 12 solid hours was answer call bells from patients who had crapped the bed with gobs of bloody stool, or didn't get to the bedside commode quick enough. The CNA and I spent the entire day cleaning bloody, smelly poop. I'd sit down to chart, and DING. Code brown/red. Get that cleaned up, sit down to chart, and DING. Patient 2 had an accident. While cleaning that one, I hear my patient three hit his call bell. Yep, another accident.

On and on it went. I went home that night and basically sobbed myself to sleep. That's when I decided ENOUGH was enough. Put in my resignation a few days later. Took a very long sabbatical from nursing, and haven't returned to standard bedside hospital nursing since.

[Penelope_Pitstop, BSN, RN]

I've had worse shifts than this one but I think it was the most stressful...

- walked in at 1900, my patient who honestly should have been comfort care was being RRT'd (I was hopeful that she would be moved to a higher level of care but she self-corrected her hypotension)

- a few hours later, two techs were turning said patient and one of them experienced a grand mal seizure and had to be admitted

- I had to RRT said patient around midnight. While trying to figure out central access (that in itself is another story), pt coded. By the time she achieved ROSC and was ready to go to the ICU, it was after 0600. The room looked like a slaughterhouse when all was said and done

- Came back after assisting in transport to the ICU (hey, I wasn't doing that again while I waited for escort!) and discovered that the tech working with me had no idea any of this happened and thus none of her work was done with any of my other patients

- During report, there was a fire in one of the nurses' stations

Why are bars not opened at 8 AM??

[kalycat, BSN, RN]

I can't compete with some of these stories. Ruby and IIg, you two need to write books.

I have told part of thise story in another thread, but never the *whole* story.

I was new to cardiac, fresh from the OR. I decided to work some overtime on a holiday weekend. Bad plan.

My assignment consisted of a young cardiac transplant patient with multiple issues - renal failure, rejection, needed stents, EF of 20 in the new heart, an older (>3 years) LVAD patient waiting for a heart with a GI bleed, and an elderly patient who had experienced a VT storm and whose ICD kept firing.

We were in a staffing transition period were we were full of float nurses who could take telemetry patients but not VADs, transplants, or drips. So it was me and like 2 other core staff. Our float nurses are great, but it's always hard when you're on an unfamiliar unit. No aids.

Just about 2100 I hear a truly bizarre sound from the transplant pt's room. The significant other was at the bedside, so I suspected horseplay. What followed was the unmistakable sound of an obstructed airway, followed by a scream. I was in the room before the overhead rhythm alert was called.

Patient proceeds to code - badly. Immediately incontinent of stool, significant other screaming their face off. I call a code. As I'm slamming the bed down and starting compressions, I hear the overhead code blue page... to the wrong floor and room.

Myself and the other two core staff proceed to start running the code while the house supervisor tries to fix the page (she was on the unit at the time.) The patient had a fresh HD cath placed in the right chest. We are going to town on compressions, stool is flying, and the cath blows. Now we're doing CPR in a semi blood bath, in front of family.

The code team arrives and we have further complications -- a difficult intubation. The CRNA tubed the goose twice - and since it was an hour after dinner and we had been bagging forever, a literal vomit fountain ensued, and there wasn't enough suction in the world to fix it. Luckily at this point the chaplain had assisted the family member to our waiting area.

The code ended badly. It was also very spooky. After about 3 rounds of compressions on my part, the patient reached up and weakly grabbed my arm, making eye contact. I shouted that the patient was responsive and to check a pulse, but as soon as I stopped compressions, the patient was gone again. We never regained a pulse despite coding for nearly two hours. Postmortem care and clean up for the family was something I will never forget.

As I raced to the locker room to change, my vocera rings. My LVAD patient is feeling weak/ill. We were running everything but blood into this patient since they were at the top of the transplant list and had never been transfused. Despite a precipitously low H/H, the patient had been asymptomatic. That changed after ~400 ml of bright red blood and clots were passed in to the commode. As I am calling the mechanical heart attending, the patient's nose starts to bleed. This particular attending was known to be difficult - but I had circulated for him and we got on well. His answer? "Stick a *expletive* tampon up his nose... and maybe one up his ***" **CLICK** I stood there with the phone in my hand and decide to to do what I could. All the labs I could muster, nasal packing, pressure on other sites. Call the code captain and mechanical heart team lead. Got my guts up and called Dr. CrankyPants back in 20 minutes.

it ended up that the attending did come in (eventually) we transfused the patient, stopped the developing DIC (he was oozing from everywhere including his driveline site) and about a week later, the patient got his heart - antibodies and all. All the clean up didn't happen that night, of course.

I sat down to chart around 0400 at this point. Of course I'm leaving out the calls to family, chaplaincy, medical examiner etc etc. Thankfully I had a strong charge nurse and house supervisor who helped immensely.

Just as I can see the whites of day-shift's eyes, my VT storm patient has another round. This was complicated by a very muddy set of advanced directives that indicated he actually wanted the ICD de-activated after a set number of shocks. The code team responded after the third shock (we had intermittent normal sinus), and when the resident who was code lead that night saw my face again, he broke down in hysterics. His only description for my appearance was "you look utterly violated."

The patient came around after shock #6 and some meds. When he was responsive again, he just repeated over and over again "I want more time. Do everything." He was 98, and after further stabilization, discharged a week later... with ICD on and ready to rock.

I commute about an hour and usually use that time to decompress. After spending 3 hours charting I headed straight to the nearest brunch place with some friends and alcohol and ended up having to have a nap at my buddie's before returning home. I didn't know whether to laugh or cry. I've had some crazy since then, but that one set the pace.