Falling short

[RisaRN]

I'm a pediatric nurse at a pretty large hospital on a general medical floor. However, our population isn't very general. We see patients who have had dozens of surgeries, have CVL's, GT's, JT's, ostomies - lots of "total care" patients and patients with very complex needs, and a lack of family support many times.

Not that simply being a pediatric patient isn't complex enough. Doing vitals on a two and a half year old can take half an hour. "No I want to do!" - putting blood pressure cuff on stuffed animal... "No I want to do!" - cleaning own PICC line with an alcohol wipe. "No I want to do!" - pushing normal saline into PICC line, etc. Everything we do needs to take more time.

Today I had a two year old patient with an infected double lumen PICC line with triple antibiotics alternating lumens q8h, TPN and lipids, a GT to gravity and JT feeds running. This didn't slow her down, however. She was running all over the unit, GT bag full of gastric contents dragging behind her. "Nana run!" (I'm Nana). All she wanted to do was play and I had to keep saying "I'll be right back, I have to see the other kids!" and left her in a tantrum because I couldn't spend time with her. My other patient was a ten month old infant who required NP suctioning at least every two hours, needed to be fed about every three, with respiratory treatments every four hours - and no parents. I don't know how many times I walked by her room today and heard her crying and crying - and had to keep walking because a patient was febrile or in pain or needed stat labs. I had an adult patient whose medical history was so complex he couldn't transfer to adult care yet. He was wheelchair bound, in pain and nauseous all the time. When I finally sat down to lunch I handed my pager to the charge nurse, and upon returning 20 minutes later she said no one had called. When I went to check on my adult patient he said "oh thank goodness, I've had to go for half an hour and called but no one came. I just can't hold it that long!" I can't imagine having to sit there, unable to use my own arms and legs to get up and relieve myself, and having my calls go unanswered. My fourth patient was a three year old with a GT and PICC line who was alone with no parents most of the day. She was the most medically stable and therefore, seen less often. She tried to follow my out of her room every time I left, but she was in isolation and not allowed in the halls. Every time I closed the door on her she stared at me with her huge brown eyes as I walked away.

On days like today I feel like I can barely keep my head above water. I feel like I've failed my patients because I can't keep up with their needs. I feel like a bad nurse. I spend the day walking away and neglecting their cries because I'm needed more urgently in my 3 other patients rooms. I do what I can to make funny faces and play and take my time with cares, but I can barely squeeze in time to rock the baby to sleep and order the toddler lunch and help her cut food into bites. I wish I could duplicate myself so my patients could get the time and care they deserve. How do I walk away from a day like today and feel good about myself and what I do?

[diva rn, BSN, RN]

Oh Risa,

I fancy myself a pretty "tough cookie" but your post brought tears to my eyes.

I could have written that about 15 years ago. I worked peds for several years then PICU for 8 years-ended in 2004 and I can so relate.

You are NOT falling short. I can tell by your words that you are warm, caring and compassionate. It is a testament to you that your little pt calls you nana (that really got me). That you take the time to play "me do it" and chase him around the room. This is helping to heal him as much as those antibiotics you are giving. It is BECAUSE you are so compentant that you feel that you are inadequate...if you didn't care this wouldn't bother you so much.

Please, maybe take some time for yourself to decompress, but just know what a valuable assesst you are to this hospital and above all to these little Kiddos...do not doubt yourself for a moment. Please, please don't change. I have worked with some mediocre nurses who were going thru the motions and some good ones but I have seldom worked with the GREAT ones like you..the ones that go that extra mile..they are few and far between.

Take a deep breath, and realize that each time your kiss that "boo boo" or tuck in the "teddy" for the 20th time your DO make a difference!

God Bless you:redbeathe

The diva

[annabeap, MSN, APRN, NP]

Please don't beat yourself up over this too much. We are all only human. We can do only so much in one shift. You are doing your best, which is over and above as it is. You're not falling short.

[TeleMeMore]

Sounds like you are a fabulous nurse to me.

God Bless You!!

[carluvscats]

I got angry when I read your post. Not at you, Risa, but at the system....time and time again I read posts like yours...nurses who put heart and soul into their jobs, day in and day out, and still walk away feeling like they haven't done enough. I'm angered by this system that can chew up and spit out nurses like you in just a short period of time. It's not fair.

I also get upset at all the suffering in the world, which your corner seems to have more than a fair share of. No answers for that, either.

I IMPLORE you to flush those feelings of inadequacy right this minute. You DO NOT deserve them. You deserve to be hugged and admired and compensated for what you do. Most people could not, would not, DARE NOT do what you do, day in and day out. To say that it is heroic does not even touch it. You are a hero every day to those little ones. They cannot thank you. Their parents might not even thank you. But I'm glad you came here and shared your story, because it gives me an opportunity to say THANK YOU.

I just want you to know that what you do makes a big difference.

[KristeyK]

I'm still a student, and WANT to work in Peds, but as a parent who has a child who spent quite a bit of time in the hospital thanks to a birth defect, *I* thank you!!! Not all nurses show the level of caring that you do, and for those of us parents who were there 20+ hours a day with our kidlets, we DEARLY appreciate nurses who want to be there for their patients. More importantly, you are twice as important for the ones who DIDN'T have parents there for them, and for that I give you an even bigger THANK YOU.

Plus, as was already mentioned, you did what you could do. This is something I don't look forward to struggling with when I get to be a nurse. Five patients? No. There is something inherently wrong with ONE person trying to care for five people. As a student nurse, I see how hard it is on a regular med/surg unit, much less a pediatric unit where trying to get vitals or dispense a pain med can take at least twice as much time. (When ARE you supposed to find the time to chart, much less use the facilities or grab a drink of water?)

Kudos to all of you who do this on a daily basis and care so much for your patients!

[diva rn, BSN, RN]

KristeyK---as a former PICU and PEDS nurse, I thank you too, we seldom hear that from the parents.

Good luck in your career!:redpinkhe

diva

[cjcsoon2bnp, MSN, RN, NP]

I think you sound like a great nurse to me.

!Chris

[rexy]

I work as a nurse tech in peds, and I can't tell you how refreshing it is to hear a nurse sound as compassionate, caring, and concerned as you do! So often I see nurses displaying anything but urgency in getting their patients pain meds, or allowing a baby to cry until the aide is available. It sounds like you need some good CNAs/NTs/whatever! Keep your chin up...you are doing a great job and we all appreciate hard-working nurses like you!

[RosesrReder, BSN, MSN, RN]

Oh, I hear ya. I just got home from a hefty shift and assignment myself in the PICU. 6 yr old with end stage renal and the works including dialysis.

A 4 yr old total care CP trached, on a home vent, tube feeds etc.

A 2 yr old with ALL, TPN/IL,BMA today etcetera

No aide, no help, no parents, wrong diets sent up......................ugh, I'm too exhausted to finish typing this!

Oh yeah, im the floater

[Persephone001]

Your post made me want to cry! You sound like such a compassionate and beautiful person, hang in there and don't give up and you need to get on that duplication issue stat cause the world needs more people like you!

[canoehead, BSN, RN]

Every one of your little patients that didn't have a parent would ideally have someone with them nearly 1-1. So you started the shift without being able to meet all their needs. You got the nursing care done and spent a few minutes trying to make things easier with each visit- you are an excellent nurse.

If your hospital has a volunteer program give them a call. If the parents allow a volunteer can make the day so much easier for patients and nurses.