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!

[Lunah, MSN, RN]

Bus blown up by a roadside bomb. Lots of severely injured patients, including children. Somehow nothing since even compares to it.

[Here.I.Stand, BSN, RN]

That's a toss-up.

5 patients in LTACH, four of whom were on contact precautions. I spent two hours changing the dressings of a woman whose pants had been set on fire...I want to say her burns were at least 20% TBSA. I had no help with this; my two measly hands had to hold up her leg, apply the ointment and rolls of Adaptic, apply trauma pads (basically a giant, elongated ABD), and wrap in Kerlix....then repeat on the other leg. I had given her fentanyl and Versed prior to starting, and had to run to the Omnicell for more about halfway through. That morning I had already changed a wound vac dressing. That pt had 4 stage IV pressure ulcers, all connected to the same vac. I had to take more time to troubleshoot when I was finished; after I connected the vac, lo and behold there was an air leak. Anyway, after finishing the burn dressing change, I got reamed by a wife because I was 30 minutes "late" with her husband's scheduled Dilaudid. I think I said something like "I can't stay and chat; your husband needs his pain meds," gave the dilaudid and left.

I used to work the subacute rehab floor of a SNF; rehab had two wings of the building, shared with standard LTC and memory care. The other wing had 8 occupied beds out of 20; my wing had 17 occupied beds out of 20. They counted the census as the total number of occupied rehab beds...so our census was considered low. Even though I had nearly a double assignment (17 pts vs the standard 10), I was the only nurse with a TMA. I didn't even see some of my patients until noon that day, because I had ALL of the treatments, prn meds, phone calls, documentation, weekly skin assessments due on 3 patients, IV meds, BGs and insulins, family issues... all the while knowing that the sole reason I was being worked like that was there were empty beds in a completely seperate area. Had that wing been full, MY wing would have two nurses. At one point I called our DON and said "this is not reasonable" to her voice mail. That Monday she came in stony faced, arms folded, and said "What's your problem? Talk."

I've had a few shifts in ICU where I see one of my patients only a couple of times all shift, because my other pt is such a mess. Fortunately my team is amazing and I know that my other pt isn't being completely neglected. The last time this happened, it was a floor pt who had been rapid responsed...they really should have called a code. He was in full respiratory arrest, being bagged as he was rolling into the room, and needed ACLS drugs pretty much immediately. I/we spent the next four hours trying to keep him alive, before they got ahold of a family member who says he wouldn't have wanted all of that. This family member arrives, and says they're waiting for a few more people and then we'd withdraw. Another family member arrives and proceeds to get in my face and demand to know why I was doing all of that to him -- he didn't want life support, didn't I know. Um...that's a unilateral decision I can't make without risking my lifelihood and freedom.

A lesser level of busy was as a new grad; I had 7 patients on nights, two of which had fresh trachs and two of which had lumbar drains. I don't see lumbar drains now hardly ever, so don't know what other facilities do, but on this unit there was no prescribed height for the drainage vessel. The RN adjusted the height q 1 hr to achieve a prescribed amount of CSF output. So if there were 60 ml of CSF, we raised the chamber. 10 ml, we lowered it. Lots of times we had to go and check on it in addition to that, just to make sure the drainage rate hadn't changed too drastically following a reposition of the vessel. Early in the shift, my charge nurse said "You have a very busy assignment, so let me know if you need help prioritizing." Uh..... I didn't necessarily need help prioritizing. I could really have used actual help with these frequent adustments and frequent suctioning that my fresh trach pts needed.

[Here.I.Stand, BSN, RN]

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"

[idialyze, BSN, RN]

Minnesota tube 27 units in and 30 LITERS out. I think that pretty much sums it all up.[/quote']

Have no idea what this means, but it sounds intriguing. Care to explain?

[WKShadowNP, DNP, APRN]

49 patients in an urgent care setting but with ESI of three, not the usual 4 and 5, with no tech, no secretary and no break. I went home crying and cranky, mad, dejected.

[Oh'Ello, BSN, RN]

Have no idea what this means, but it sounds intriguing. Care to explain?

A Minnesota tube is a device used for upper GI bleeds. It's a long tube with 2 balloons and 2 drains. The gastric balloon inflates in the stomach to tamponade the bleeding there, and the esophageal balloon can be inflated likewise. The drains connect to suction to remove the blood from the GI tract. And the tube is set up to traction to maintain it's position. That night we transfused 27 units of blood (amongst other fluids)....And the patient had 30 liters of blood/fluid loss. If you do the math on that, you get a fluid balance that's not consistent with life.

[NICUNurseEliz]

Walked into a 4 hour old premie who was born septic and went into DIC. They couldn't get access on the kid so I walked into our neo putting in an IJ, a single scalp PIV infusing 17mcg/kg/hr of dopamine, a whole new set of antibiotics and a volume bolus ordered, and the blood bank calling saying that my cryo, PRBCs, FFP and platelets were ready for my kid with

And the charge nurse asked if I could take another admission.