An Unbelievable Night

[RNSuzq1, RN]

Hi All,

I apologize ahead of time for the length.

I've been a Med/Surg Nurse for a year. Last night was the worst ever, I'm still stressed out about it and just had to "Vent". 1/2 hour into the shift one of my 6 pt's went into Resp. Distress (a first for me). I called RT and the Hospitalist - they both come up, RT suctions the pt, I get orders for Lasix, Morphine - ekg, chest x-ray, tons of labs, etc. The Hospitalist and RT decide ICU is the best place for the pt, we had to wait over an hour for a room, so another RT puts the pt on Bi-Pap until the pt can be moved.

The ICU Nurse calls me for report - I give her every detail I know about this pt I've had for all of an hour, along with transfer orders, etc. She starts asking me about the Bi-Pap and FI02 - there was nothing in the orders about it. I told her I've never had a pt on Bi-Pap (very rare on our floor) and I'd go get whatever info she wanted from RT. She started getting really rude, acting like I was a "Total Moron" for not knowing what the FI02 was set at, etc., then says, forget, I'll find out myself.

Just an FYI, my Husband's been an RT for 25 years - I've picked his brain for the last year about everything Respiratory to help with my job. Told him I felt stupid not knowing anything about Vents/Bi-paps, etc. He told me - I'm not stupid, said most Nurses don't know much about them, unless they're working in an ICU setting where they actually use Vents (which is the reason there is such a thing as Respiratory Therapists - this is their Specialty).

The CNA and I get my pt to the ICU, "Nurse Ratchet" listens to her for 5 seconds - screams, I don't hear any rales, is this what you call a pt in Resp. Distress? Look at her, she looks better than anybody in here - I transferred a much sicker pt to get "this one" - are you kidding me? Then she gets on the phone and chews out the "DR" about this. She did all this "in front of my patient" - the poor 89 year old lady looked horrified and scared to death and the CNA and I are standing there totally dumb-founded that this "Nut" is chewing out a Doctor. I told her how bad off the pt was on the floor and I was following Dr's Orders bringing her to ICU. She said - Well, ICU Nurses are much more aggressive advocates for their pt's, you should have told the Dr. she didn't need to come down here (just went on and on). I've been an RN for a year, this was my first Resp. Distress pt, I'm not about to argue with the MD - no way!!!!

While we're standing there in front of the pt - she has a loose stool. I said - don't worry, we'll clean her up before we leave - she yelled - You Better!!! Then, to make matters worse, she says (again in front of the pt) - I sure hope you're working tomorrow night because I'm getting her out of here and right back on your floor. The Most Unprofessional Nurse I've ever met - non-existent bedside manner, just a horrible person. I told my Charge (a Nurse with 30 years experience) what happened. told her that Nurse made me feel like a total failure as a Nurse. She was furious - she said - Susan, if you don't write her up, I will. Later that night - the ICU Charge Nurse came to our floor, I told him what happened, he said she's a Travel Nurse with a really bad attitude and she wouldn't last an hour on my floor taking care of 8 pt's like we do and to go ahead and write her up.

1/2 hour after I got back to my floor (while I'm still upset about the nut-job) and hours behind in my work, CNA tells me that one of my DNR pt's just stopped breathing. I fly in there and he's gone - ran a rhythm strip, he flat lined, so the Charge and I called the time of death and I proceed to call the Dr, Nursing Supervisor, his family, funeral home, etc. He was a terminal pt, his family was expecting it, but still it was very sad. My wonderful co-workers offered to clean his body so I could take care of the rest of my pts.

So, I'm just getting off the phone with the funeral home and heading to one of my pt's rooms to check on her when telemetry calls to say one of my DNR pt's just went into V-Tach (another first for me). I was at his bedside in less than a minute and "Unbelievably" he was gone, I couldn't even hear a few last heart beats, not taking his last breath, nothing, he went from V-Tach to dead in a minute, I almost fainted. Everybody runs in and sees me on the verge of tears trying to find a pulse somewhere on this poor old man - I think I was paler than him. The Charge said - Susan, stop, it's ok, it was his time.

The 2nd time in an hour, I'm on the phone to a pt's family to tell them their loved one had passed. After I called the Nursing Supervisor to tell him about the 2nd death, he came right up, gave me a hug and kept telling me there was nothing I could have done differently. My Charge said she'd never seen anyone have a night like mine in her 30's years of Nursing and was proud of me for not "falling apart". But I was falling apart inside, I was absolutely freaking out, I've never been so stressed out, upset in my life. I managed to keep it together for the rest of the shift, then cried a river when I got home.

I love being a Nurse and caring for people, it's been a lifelong dream. As unsually crazy as it was last night, we're always so busy and understaffed, we stay stressed out and it's really wearing me down. I'm just so tired of coming home every morning feeling so worn out and drained, it's affecting my health, my home life, etc. I'd hate to leave my co-workers, but I really need to find a Nursing job with a manageable pace. I want to come home feeling like I've made a difference in some lives, but not feeling like I've just been through WWIII. Anybody have any suggestions/advice, etc. - I'm all ears. Sorry this was so long - Thanks for listening.

[deeDawntee, RN]

Wow! You certainly survived a night that would have made any nurse, no matter how much experience, stress out, go home and want to find a new area of nursing! I am truly impressed by how you handled it. I hope you are giving yourself all the credit you are due. I am also impressed by the supportive staff that you work with! This is not only a testament to them, but mostly to you, that you are able to rally that much support. That tells me you are well liked and well respected at your work place. Med/surg is as demanding as any area of nursing. That you chose to take on the challenge as a new grad, also tells me what you are made of. Of course you need to decide for yourself, but I would recommend that you stick it out for about a year and then do something different, perhaps ICU nursing? You have what it takes, I would definitely say.

You did the best that you could. You did everything right. I hope you went ahead and wrote up that ICU nurse, she was being totally rude and unprofessional. I hope and pray she never travels to where I work! Two deaths in one shift is very unusual. But it is ok, they were DNR and their suffering is over! Do you have some difficulty dealing with death? That is an area that nurses must come to terms with quickly in order to tolerate the death around them. I think of it as normal and as wonderful as a birth...the person's journey is over and they are born to the next plane of existence. It is a good thing, not the enemy it is made out to be in the hospital and also in our culture. (Of course, sometimes death IS tragic.. I am not discounting those times...)

Again, I want you to know how impressed I truly am by who you clearly are. Stick it out if you can. Think of it as an extension of your education. In the meantime, look around to where you might want to work next.

:yeah: way to go!!

OOOps, I just noticed that you have been a medsurg nurse for a year... well go little one, find that next area of nursing where you will truly be fulfilled and happy!! (I still say ICU would be a great fit for you, it can be stressful, but you only have 2 patients, so at the very least you feel like you can keep your eye on both.)

[VivaLasViejas, ASN, RN]

Susan~

You are a trooper!! That was surely the shift from Hell---even the most experienced M/S nurse would've been a wreck after that one. Congratulate yourself for having gotten through it, and please give yourself the credit you deserve for taking such excellent care of your patients!

Shifts like this were what finally drove me out of M/S nursing two years ago. I didn't have anywhere near the support that you do---in fact, I had an assistant department manager who actively disliked me and worked at making life as hard as possible for me---so it was probably easier for me to make the decision to leave, although it certainly didn't seem easy at the time.

It sounds to me like you are on the edge of burnout, even though the sort of shift you've described is apparently a rare occurrence on your unit. M/S tends to do that to a person---it is without a doubt the worst-staffed AND least-appreciated unit in any hospital. (To me, ER would be the most stressful, but at least it gets some respect!) But only you can decide when enough is enough.......or whether to soldier on, knowing that conditions in M/S are tough all over and will have to get even worse before the people who run hospitals finally learn that nurses are NOT machines that never need to eat, drink, pee, sit down, or simply take a break from the insanity for a couple of minutes.

Good luck to you in whatever you decide. You are an awesome nurse who can take care of me anytime!

[luvBonjovi]

I think that you should be very proud of yourself for getting through the night. That does sounds like a shift from hell. Do you enjoy Med/Surg nursing? If so, you should stick it out and not let one horribly unprofessional nurse (who should not be in the profession if you ask me) ruin it for you. If Med/Surg is not for you then you should look at another area. Life is too short to be miserabe and work and at home.

[zooparade]

it sounds like you did a find job. having been a nurse for over 18 years, i know lots of seasoned nurses that could not have done any better. as you gain experience, you will learn how to deal with nurse ratchet. just remember that as a nurse you will see many people at their worst. more than likely, it is not personal, although it feels personal. they could just be having a bad day / night, or they could just be generally miserable people. either way, it is not your fault that she was hateful to you. let it roll off your back and consider yourself lucky you have such great co-workers and a great support team.

zooparade

[JulieRN07]

First of all- I honestly believe that being on a med/surg floor is one of the hardest that there is! I don't think the other specialty areas (unless they have worked there at some point in their career) have any idea what it's like. Yes, the patients may not be "critical", but they are certainly very sick and needy, and on top of that, you don't get 1 or 2 ,you get 5-8 patients of that nature to chart on.

We have all had nights like that. It sounds like you handled things to the best of your ability, and that is all you can do. Just let what that nurse in the ICU said and did slide right off your back because it is much better to be safe than sorry!

[military girl]

Susan,

HERE'S A BIG BEAR HUG!!!!!!!

I am proud and amazed that you kept it together. I don't what I would personally have done if it was me. But the thing that I am most proud of is that your charge nurse was there to back you up as well as the nursing supervisor.

Treat yourself if you are able to to a nice spa or go for a run or something that will help to return the world to it's normal place. I've been a nurse for 6 years, and when I have bad days, it does drain you, but remember, just get back on the horse again. Somedays, there are beautiful and nice rides(meaning a really good, low stress day).

[leslie :-D]

susan, your post totally amazed me.

you handled these hurdles with finesse, competence and class.

ANYONE would have had a meltdown, after that shift.

i would not make any decisions when feeling so vulnerable.

but it may be time to move on...

something to think about, for sure.

i agree with dee's post (actually, everything she said):

that you would shine in icu.

just do your homework by asking about orientation, turnover, support, etc.

as for the icu nurse, i would write her up in a heartbeat!!

i personally could handle someone like that.

and if a pt wasn't present, i would have shared a thing or two and deal w/it myself.

but, because a pt was there, and she chose to demonstrate such unprofessionalism and insensitivity, she needs to be reported.

whatever you do, or wherever you go, you will always amaze me.

wishing you only the very best.

leslie

[RNSuzq1, RN]

Hi,

Original Poster here. I was really upset when I wrote that post - just had to get it off my chest and looking for suggestions about other areas I might go into. I was definitely not looking for a pat on the back, but was so touched by the responses I got. So I want to Thank Each and Everyone of you for the great posts and kind words, can't tell you how much it means.

The night crew gave me a card when I went back to work the other night - said they loved me and didn't want me to leave the floor. I can't believe they did that because I felt like the biggest failure in the world. One of them said - a night like that will "toughen up your nipples", ha, ha - must be a Southern term.

So, who do I get back as a patient my first night back - YES, the lady I took to ICU. I heard, they sent her back to our floor the next morning, then back to her nursing home - 2 days later she's septic and right back on our floor. My Charge Nurse said - she's dying and looks like they'll just keep bouncing the poor thing back and forth until she passes (but her family insists she be a full-code) - Ahhhh!!!!! All night long I was praying - please, please don't die on me - oh the stress!!!!

Last night, I was floated to the PCU - part of the ICU, scared to death I'd run into that Nurse. Luckily, she wasn't there, but honestly, they aren't a friendly group. I know ICU Nurses from other hospitals, just guessing the creepy attitude is just this place. My entire floor hates being floated there because they make us feel very stupid. ICU Nurses get 3-6 months orientation - we are not ICU Nurses, never been trained for that job, never oriented to the floor - we're floated down there on a moments notice when they need help and are expected to know everything they do - but we don't. We're also floated to the ER - no orientation, nobody tells us what to do or where supplies are, we're just expected to walk into this environment that couldn't be more different from our floor and get to work, it's ridiculous. When we get slammed with pt's on med/surg - they never, ever send an ICU or ER Nurse to our floor to help out - apparently it's beneath them.

I'm 45, but I've only been a Nurse for a little over a year. I'm guessing because of my age, people assume I've been Nursing for 20 years and should know everything, but I definitely don't. Some of you suggested that I consider working in an ICU, that's quite a compliment, but like I said, I already feel like a total idiot when I'm there for a shift, can't imagine how humiliating it would be full-time. The ICU Charge told me I could shadow someone to get more experience, so hopefully my Mgr will let me do that. I'd really like to get some Vent experience - take the mystery out of it.

I ran into the RT that was involved in the whole fiasco last week. She told me that the ICU travel Nurse not only wrote up the Dr and RT, but also my entire floor (according to her, we all have poor assessment skills) and chewed out the Nursing Supervisor - she really gets around. The RT told me this Nurse told someone in Admin that the RT Dept was a waste of money and should be done away with because ICU Nurses were capable of running the VENTS - all other Resp. tx on the floors could be done by the Nurses.. Like we don't already have enough to do!!!

Thanks again for the Very Kind Words - Truly a Great Bunch of people here at AllNurses, Sue