Let me tell you about my evening shift I did yesterday. I offerred to work an extra 4 hrs on my day off (3p-7p). Wound up staying until 11:00 to help out.
Anyway, I was psyched when I saw I had only 4 pts instead of the usual 6! Then I met my 1st pt. Dx neuroleptic syndrome, new CVA, only responsive to painful stimuli. He's literally drowning on his own secretions and here I am suctioning the hell out of him all the time so he doesn't drown (of course traumatizing the hell out of his esophagus and casing more secretions in the process).
This guy's a DNR, but there I am w/ blood in one port of his IJ, fats/TPN in the other and numerous IV meds in the other (you're right, the doc is offended when I suggest that given his respiratory status and code status, should we be doing all this ****?) BTW, this guy is swollen like a ballon all over w/fluid. Just slow the stuff down and give him Lasix, is the answer.
Then I call the doc (who told me to hang the blood even though his T-max is 102) to tell her that the CXR says his NGT is in his esophagus and no one, not even another doc, can advance it. I also mentioned that the thing looks scabbed all to hell and I don't want to pull it b/c of possible esophageal varisces and I don't wan't a bloodbath on my hands (not in those words of course). The doc couldn't convince anyone to pull it and put the NGT meds on hold until the am. She was mad as hell, esp. when I pointed out that his H&H of 8 and 25 had to be from somewhere, and he had no hematuria and his stool was neg for OB.
I coudn't get this guy transferred to the unit. The doc said she wasn't going to do ABGs or tube him. I told her that wasn't what I wanted, I just wanted him somewhere where a nurse could care for him and NOT ignore her other pts, which is what I had to do (thank God they were all alright).
What I'd like to ask my fellow nurses is this, I've only been a nurse for 6 yrs, so a lot of you could give me some advice, I bet. What do you do when you have a pt like this and you have another one that goes bad and all of the other nurses also have a heavy assignment? And why the hell do we give DNRs on their death bed all this stuff when all it does is torture them.. One of these times I'm going to tell a doc, "You go torture that old lady w/a NGT, foley and IV, I'm not-I have morals."
I have 29 yrs until retirement, I don't know if I can keep doing this and if I do, am I going to hell?
P.S. You can be sure my lengthly nurse's note said, "MD made aware" many, many times.