WORST day at clinical- just need a shoulder

  1. I am in my final clinical rotation and we are on a regular M/S floor.

    Today I walk in and find out one of the pts I had yesterday that I stressed needed more aggressive care ..coded..and died. What a start to the day. Then I was getting report on my 3 pts when the night nurse told me she was " sorry" I had this one patient. I already knew then things would probably go badly but I held out hope ( sometimes they said it's bad but you find it's just fine!).

    Ok to start off I was told my patients DX was herpes zoster and then she proceeds to tell me the lady is covered head to toe in red circles. Well I know HZ only appears along a dermatome one 1 side so I was already confused. Then she tells me the lady isnt on contact precautions( what???)...she also has " herpes in her mouth" and a febrile sickness. My report basically STUNK. The lady's temp has been 103-104 and they have no idea why.

    So I go check the chart and find out that they basically have NO IDEA what is wrong w/ this lady. They have run every test they could so far and everything is neg. So they were sending her for CT Scan.

    They said she had to take oral CT contrast..but once I assessed her I could tell there was NO way this lady could take the oral contrast. She couldn't even swallow her spit basically. I was told she had 0630 motrin but when I looked in the MAR it wasn't signed off..and by then the night nurse was gone and when I told my instructor she said she was pretty sure it was given ( Uh, ok???)


    OK now I need to back up. When I walk into her room it looks as if WWII happened. There is stuff ALL OVER THE FLOOR....supplies ( Guaze, syringes, tegaderm, flushes, wrappers,you name it). I was like WTH happened in here and I know it wasn't the pt because she couldn't move. So since our instructor has us doing everything w/ no tech help, etc I had to clean all this up before my instructor walked in and saw this wreck. Then her IV had blown overnight and the IV therapy team had not put in a new line..so the night nurse just left everything hanging..even refrigerated meds....I mean you should have SEEN this room.

    So I go to assess her and every time I touched her she just SCREAMED out in pain. It was awful. Her temp was 103 auxillary- so DID she get that 0630 motrin? Who knows....I asked about giving another dose and my instructor said " it's Q6!". SO I was able to get her set up on a cooling blanket( that they had set up w/ her rectally but it wasn't connected..nice.. and some cold compresses.)


    I left the room to tell my instructor about my findings and she comes in assesses the lady herself and basically just said " good luck".

    Well things just got worse...the lady was incontinent consistently....she was NPO but they wanted her to take her am meds crushed up w/ water in 10CC syringes...she could barely take 1cc every 5 mins....it was god awful. I stressed the need to get these meds in IV form or substitutes but my words seemed to fall on deaf ears.

    MIND YOU I have not hardly even had time to see my other 2 pts. *sigh*

    Then my lady starts to choke and I had to suction her. Then she is incontinent again. Then she chokes again. This is a constant cycle.

    I am consistently updating my instructor and apologizing about why I am so late w. the other 2 but I CANNOT leave this lady's bedside and my instructor was adamant we do this w/ no help.

    FINALLY at 930 I was able to get a break to check on my other 2pts and give meds....IV therapy came and put in a new IV line on my lady so I go to see if her Doxycycline is up from pharm but it's not....so I go to the pyxis and pull her IV lasix and my instructor walks up and asks me if her doxy is up and I said no I just checked.....literally 5 MINUTES had passed since I checked..and the next thing I know my instructor is walking up and slamming the doxy down in front of me saying it was there ( NO IT WAS NOT- It's a REFIG med and in a dark bag- and there was NOTHING in the fridge when I checked)...so now I look like an idiot.

    So I do my checks and we go in to hang the Doxy and give the Lasix and her new IV that IVT had JUST put in is NO GOOD..and my instructor starts yelling at me that I didnt assess the site 1rst.....I was falling apart inside at this point. Then she is incontinent AGAIN..and chokes AGAIN...the cycle starts again

    I pulled my instructor aside and gave her the low down and how this lady is almost 1:1 and I have failed to be available for the other 2 pts and could she perhaps give me some guidance on how to better prioritize b/c to me this lady has been a full priority since we can't use any help.

    She was basically " She's tough...get used to it" and walks away.

    Anywho..the day got worse...they made me TRY to give her 600 mg Motrin in 30CC oral....even though I stressed over and over that she CANNOT take oral meds...and of course she choked and vomited them all up....I was giving her 1cc at a time because it was ALL she could take and my instructor tells me to push 3CC instead and when I do...she vomits... lovely.

    FINALLY they decided she was going to get IV contrast for CT and came and got her. I was FINALLY able to spend more time w/ my other pts ...thankfully I was able to give them their meds on time throughout the day.

    It was just an AWFUL day and I feel like an AWFUL failure.....4 weeks from graduation and I have NEVER felt so unprepared and helpless.

    At post conference my instructor made me tell the group about the horrendous day and critize myself and then she just ripped me apart. I am normally very cool under fire but I couldn't help but just sit there and almost cry.

    I know.. I know...I was awful....but WOW ....T.G.I.F
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  2. 28 Comments

  3. by   Conrad283
    Nah, you weren't aweful. It sounds like you had a tough day. Hey, everyone is going to have a tough day once and a while. There are going to be days where you are stuck in one room for the majority of your day, and there are going to be times when you neglect your other patients. But you did take care of her as best you could and that's what counts. Being that that patient was in agony and you were trying to act in her best interest and that's what nursing is all about, patient advocacy.

    Keep up the good work

    This sounds like a case for Dr. House!!
  4. by   nicuRN2007
    Sounds to me like you handled yourself quite well. Sorry your instructor was so unhelpful. I hated clinicals!
  5. by   ginger58
    You did a fantastic job. You needed the support of your instructor, like going to the lead nurse or manager and discussing the way you received the room, drug not signed out, etc. You're going to do fine. Sounds like you were on top of things. Somethings instructors, managers, walk into a room at a most unopportune time and make snap judgements on what they see. They need to ask us what happened instead of blaming us.

    Keep going, head up, best wishes.
  6. by   Skrawberri
    Uhh were you in Med/Surg or ICU?? That lady sounds like she needed to be in ICU!!

    I'm sorry all that happened to you!! Sounds like a nightmare of a day... Hopefully it will get better!!
  7. by   Jules A
    I also think it sounds like you did a great job in a horrible situation! Just reading your post has my anxiety level through the roof. Hang in there.
  8. by   allthingsbright
    Quote from BoonersMom
    I am in my final clinical rotation and we are on a regular M/S floor.

    Today I walk in and find out one of the pts I had yesterday that I stressed needed more aggressive care ..coded..and died. What a start to the day. Then I was getting report on my 3 pts when the night nurse told me she was " sorry" I had this one patient. I already knew then things would probably go badly but I held out hope ( sometimes they said it's bad but you find it's just fine!).

    Ok to start off I was told my patients DX was herpes zoster and then she proceeds to tell me the lady is covered head to toe in red circles. Well I know HZ only appears along a dermatome one 1 side so I was already confused. Then she tells me the lady isnt on contact precautions( what???)...she also has " herpes in her mouth" and a febrile sickness. My report basically STUNK. The lady's temp has been 103-104 and they have no idea why.

    So I go check the chart and find out that they basically have NO IDEA what is wrong w/ this lady. They have run every test they could so far and everything is neg. So they were sending her for CT Scan.

    They said she had to take oral CT contrast..but once I assessed her I could tell there was NO way this lady could take the oral contrast. She couldn't even swallow her spit basically. I was told she had 0630 motrin but when I looked in the MAR it wasn't signed off..and by then the night nurse was gone and when I told my instructor she said she was pretty sure it was given ( Uh, ok???)


    OK now I need to back up. When I walk into her room it looks as if WWII happened. There is stuff ALL OVER THE FLOOR....supplies ( Guaze, syringes, tegaderm, flushes, wrappers,you name it). I was like WTH happened in here and I know it wasn't the pt because she couldn't move. So since our instructor has us doing everything w/ no tech help, etc I had to clean all this up before my instructor walked in and saw this wreck. Then her IV had blown overnight and the IV therapy team had not put in a new line..so the night nurse just left everything hanging..even refrigerated meds....I mean you should have SEEN this room.

    So I go to assess her and every time I touched her she just SCREAMED out in pain. It was awful. Her temp was 103 auxillary- so DID she get that 0630 motrin? Who knows....I asked about giving another dose and my instructor said " it's Q6!". SO I was able to get her set up on a cooling blanket( that they had set up w/ her rectally but it wasn't connected..nice.. and some cold compresses.)


    I left the room to tell my instructor about my findings and she comes in assesses the lady herself and basically just said " good luck".

    Well things just got worse...the lady was incontinent consistently....she was NPO but they wanted her to take her am meds crushed up w/ water in 10CC syringes...she could barely take 1cc every 5 mins....it was god awful. I stressed the need to get these meds in IV form or substitutes but my words seemed to fall on deaf ears.

    MIND YOU I have not hardly even had time to see my other 2 pts. *sigh*

    Then my lady starts to choke and I had to suction her. Then she is incontinent again. Then she chokes again. This is a constant cycle.

    I am consistently updating my instructor and apologizing about why I am so late w. the other 2 but I CANNOT leave this lady's bedside and my instructor was adamant we do this w/ no help.

    FINALLY at 930 I was able to get a break to check on my other 2pts and give meds....IV therapy came and put in a new IV line on my lady so I go to see if her Doxycycline is up from pharm but it's not....so I go to the pyxis and pull her IV lasix and my instructor walks up and asks me if her doxy is up and I said no I just checked.....literally 5 MINUTES had passed since I checked..and the next thing I know my instructor is walking up and slamming the doxy down in front of me saying it was there ( NO IT WAS NOT- It's a REFIG med and in a dark bag- and there was NOTHING in the fridge when I checked)...so now I look like an idiot.

    So I do my checks and we go in to hang the Doxy and give the Lasix and her new IV that IVT had JUST put in is NO GOOD..and my instructor starts yelling at me that I didnt assess the site 1rst.....I was falling apart inside at this point. Then she is incontinent AGAIN..and chokes AGAIN...the cycle starts again

    I pulled my instructor aside and gave her the low down and how this lady is almost 1:1 and I have failed to be available for the other 2 pts and could she perhaps give me some guidance on how to better prioritize b/c to me this lady has been a full priority since we can't use any help.

    She was basically " She's tough...get used to it" and walks away.

    Anywho..the day got worse...they made me TRY to give her 600 mg Motrin in 30CC oral....even though I stressed over and over that she CANNOT take oral meds...and of course she choked and vomited them all up....I was giving her 1cc at a time because it was ALL she could take and my instructor tells me to push 3CC instead and when I do...she vomits... lovely.

    FINALLY they decided she was going to get IV contrast for CT and came and got her. I was FINALLY able to spend more time w/ my other pts ...thankfully I was able to give them their meds on time throughout the day.

    It was just an AWFUL day and I feel like an AWFUL failure.....4 weeks from graduation and I have NEVER felt so unprepared and helpless.

    At post conference my instructor made me tell the group about the horrendous day and critize myself and then she just ripped me apart. I am normally very cool under fire but I couldn't help but just sit there and almost cry.

    I know.. I know...I was awful....but WOW ....T.G.I.F
    Wow, sounds like a hell-day to me--you have a right to be dissapointed. I felt like a failure often through my clinical rotations--but I learned a lot. Try to concentrate on what you learned from the experience and move on!!!!! You are a STUDENT--dont forget that! (((HUGS)))
  9. by   ktwlpn
    Quote from BoonersMom
    OK now I need to back up. When I walk into her room it looks as if WWII happened. There is stuff ALL OVER THE FLOOR....supplies ( Guaze, syringes, tegaderm, flushes, wrappers,you name it). I was like WTH happened in here and I know it wasn't the pt because she couldn't move. So since our instructor has us doing everything w/ no tech help, etc I had to clean all this up before my instructor walked in and saw this wreck. Then her IV had blown overnight and the IV therapy team had not put in a new line..so the night nurse just left everything hanging..even refrigerated meds....I mean you should have SEEN this room.
    NOW you know why you found the room such a mess. Imagine what her night shift nurse went through-she had a full patient load along with this....
  10. by   Oz2
    It doesn't sound like you did bad...you did the very best you could...what could you possibly have done differently?

    Can anyone answer this question, because I don't understand something. If you were a licensed nurse already, and you knew this patient could not tolerate oral meds, wouldn't it be within your power to call the doctor or whoever it is who has the authority to change the order?

    Was it because you are a student that your superiors were ignoring your assessment of the situation?
  11. by   juli44
    I am going to be in the hospital starting next month for my LPN clinical. I have no other medical experience and the last time I even set foot into a hospital I was like 12. You just scared and prepared me. But I'm mostly scared.
  12. by   captron74
    Sounds like your instructor was pulling the drill sargent routine on you. I am sure she fully knew that this pt would keep you busy, but you were being tested to see how you did under presure.

    I also agree with the other post about the NPO status.....why would they try to make you give meds orally to someone that could not tolerate ANYTHING going down their throat??? Almost sounds like you were being set up for the worst from the begining.

    Ron
  13. by   locolorenzo22
    "The ones who CARE know they did ALL they could do. The ones who FORGET what it means to be a nurse judge all by one look, usually the most superficial. A STUDENT is one who will NEVER forget what it means to be a nurse. It is a HONOR, a REQUEST, A CALLING. Don't forget that."
    You needed support. If I was in your group and you came to me, I'd help you. Could NO one help you from your group? If I need to give a hand, if I'm not behind, I will be right on your coat tails. YOU will be GREAT! YOU provided all the care you could, and the power will be there when you get out.....keep your head up, tough days will happen.
  14. by   canoehead
    Your instructor was a neglectful and spiteful battleaxe. If you go to her saying you can't get the lady to swallow, and she says just do it, I suggest you ask her to show you how....

    The RN or the instructor should have been on the phone to the MD in the first hour for pain meds, and DCing the po meds. I'm disgusted with that hospital.

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