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?