As we who have reached our middle years know, there are few things more satisfying than the realization that we have finally come into our own. It's not that we know everything, but we are wise enough to understand that we don't know everything......and to admit it. Every now and again, however, a situation comes along that shakes up our consciousness and blows our self-image right out of the water, and by the time the dust settles we realize---again---that we're not as 'together' as we thought.
Being an RN with almost a decade's experience under my belt, I like to think of myself as knowledgeable and mature, compassionate and competent. The other night, though, I was none of those things.........and a patient suffered because of it.
It was the 3 PM shift change, and in addition to my three stable pts, I was given a fresh post-op plus a very fragile patient at the end of one hall. That particular area tends to be a challenge, not only because those are the rooms which are the most physically removed from the nurse's station, but they are reserved for the sickest, neediest, most confused, and/or VIP patients. Everyone complains about this---after two or three shifts at that end, even the nurses who are in shape and very, very tolerant start to look a little ragged around the edges---but of course nothing ever changes, so we deal with it and then pray to be assigned elsewhere on our next shift.
As luck would have it, the very fragile patient had a husband who made Svengali look like a total wimp, and he'd alienated most of the staff already by being gruff, demanding, hypercritical, and just an all-around PITA. Sure enough, he started in on me right after the pt. got back from her CT scan; the radiology tech had just left her there in the room without hooking up the O2 or even plugging in the bed so the call light would work, and the husband was furious. I couldn't blame him, so I set about calming him down and going about the room straightening everything and hooking things back up. The pt. had a heparin drip, Procalamine, and lipids all going through a 22-gauge IV, and he wanted me to draw her PTTs through that because "they've already poked her too many times". He refused to consider allowing the doctors to put in a central line or PICC "because they're dangerous". He wouldn't even let me put in an additional 20-gauge saline lock!:angryfire
Then it REALLY hit the fan: the pt. started to retch, then vomited about 100 ml of blackish fluid which I knew was heme-positive even before the smell hit me. I'd heard nothing at all about this in report, so I assumed it was new and gave the MD a call. In the meantime, I was explaining everything I was doing to this man while I ran around giving medications to try to stop it, clean up the mess, and tell him once again why I was not going to draw the stat CBC from her IV line (of course, I'd stopped the heparin the instant she vomited).
While all this was going on, my TKR patient was crying and demanding a private room because her roommate had a visitor and they were being 'too noisy' (I could barely hear them on the other side of the curtain, but, well, you know). "I came to the hospital to sleep and rest(emphasis hers), and I have to listen to those women gab, gab, gab.......what sort of place IS this?!":uhoh3: Thank God my other three pts. were stable, because these two were a handful all by themselves (although to her credit, the Queen of the Total Knee calmed right down just as soon as her tantrum got her her way).
Unfortunately, the poor lady at the end of the hall continued to vomit that awful black stuff, and now her O2 sats were dropping and her BP was headed south as well. Meanwhile, I had call lights going off, phone calls from families wanting to know how their loved ones were doing, the pharmacy was wanting to know the entire med history of one patient I'd only had for an hour........and this bear of a man was griping to everyone within earshot about the 'incompetence' of every single staff member he'd encountered, how no one was taking proper care of his wife, yada yada yada. I tried to involve the department manager, who referred me to the nursing supervisor, who only told me to call the department manager, who finally said "We've already been in there, the man is an @zz****". No help there at all.
I went back into the room, and the patient was fading out........I called the MD again, only to be told her H&H were still OK and that we weren't going to move her to the ICU at this point. She still was vomiting, and now the husband was going nuclear at the idea of her not having 1:1 RN care: "What if she sucks that stuff into her lungs? She's got to have a nurse looking after her, I can't stay here all night, she HAS to be watched all the time", etc.
This is where I went wrong. I have never taken anything like this personally, but I'd had enough of this man's nastiness. I was doing everything I could, and nothing was good enough.........I sure as heck couldn't stand there and watch her, I had four other patients to care for, but he was having none of it. I was drowning, and so was my patient---yes, she aspirated, and two hours after I left for the day she was in the ICU on a ventilator.
Dammit, I made it personal, and I couldn't get anyone to listen because all that came out was "This patient's husband is driving me CRAZY!!" Yes, I told the doctor and the supervisor and the manager that she had an active GI bleed, but I wasn't focusing on the right person. Then on top of it, I failed to document anything but the calls to the physician---not the time I spent in the room, not the interventions with the spouse, only the calls and what I did with the orders. The one time in my career that I didn't document my hind end off.........oh, why did it have to be THIS patient?
So the next day I got called into the office for a dressing-down I won't forget anytime soon......and I have NO proof that I did anything more than give meds and call the physician. The man, not at all surprisingly, LIED---said that no one did more than "stick their head in once in a while" to check on her, and I can't prove that I spent probably 80% of those four hours in there.:uhoh21: :angryfire
I'm not going to spend the rest of my life beating myself up over this, but I do realize I should have handled this differently. I'm usually a very patient woman, but I let that pt's husband get under my skin, and as a result I didn't do all I should have to advocate for my patient and make sure she received the care she needed. As my manager pointed out, I should have gotten in the doctor's face, even the supervisor's face, and DEMANDED that she be moved to the ICU when I knew that was the place for her. When you get right down to where the cheese binds, all the excuses don't mean a hill of beans........that patient deserved better, and because I allowed myself to be distracted by her spouse's meanness rather than focusing on what SHE needed, she wound up in even direr straits than before.
This is why I'm beginning to really hate med/surg.....the patients are so sick now, the loads are just too much for me anymore. I can't keep up!! It isn't that I can't handle critical patients; just yesterday I worked ICU and had two extremely busy ones---both of whom were on insulin drips plus ETOH withdrawal protocol, and one was also on a Cardizem drip---and I managed just fine. Not many med/surg nurses where I work will even touch the drips, while I just plunge in there and work with them (and ASK when I don't know what to do!!).
But I'm still faced with the knowledge that I let that patient down........and it's not the fact that I may wind up as a co-defendant in a lawsuit down the road that really bothers me. It's realizing that I behaved in a most unprofessional manner, when I've always prided myself on my ability to read people well and handle the most difficult of them with grace. It's also knowing that I am fast reaching the end of my med/surg career and being far too young to retire; I won't give up nursing, but I do know that I'm unwilling to go back to LTC, and I don't want to do management again either. In fact, if I could just get a shot at it, I'd change to ICU in a New York minute......but where I work, they want only nurses who are already trained, or brand-new grads.
So yes, I'm feeling rather humbled these days, and I'm not sure yet what to do with this confusion, this unsettled-ness if you will. All I know is that no matter how long one remains in this profession, we never have it all down.......and that I still have a hell of a lot to learn.
