Advice from experienced travel RN's

[caringchic]

OK I want the dirt from other nurses who have traveled.. I have been traveling locally and contracted for the last 11/2. I recently took a day shift job on a busy PCU. High acuity pts typically 4 rarely three w/ one CNA for 15-18 rooms. Ward rooms are still there w/ 3-4 pts to a room. Got my 30 day eval and got 97% great comments and great feedback from assistant nurse manager and unit director.

Last week got my assignment and report. Report on pt #1 - cant tolerate dopamine gtt titration.

pt #2- new onset CHF given 60meq KCL no replacement protocol ordered. plz f/u.

pt #3- cant thermoregulate, cooling blanket/warming pad at bedside, tube feeds ordered pls f/u

pt 4- d/c when CE are negative this afternoon.

1445 my pt codes call team, by the time code crap was completed and ready to catch up on my other 3 pts it was 1630.

During report in the am nurse told me pt one who coded had not been able to tolerate titiration of dopamine gtt d/t hemodyamic instability. Doc rounds and writes to d/t gtt. Call doc update on BP's w/ titirations. Call doc and get new orders to d/c gtt regardless of pt's BP or response to titration. Again made sure MD was aware of current BP. I literally was at pt's bedside almost all day until code, between quickly running across curtain to check on CHFer and across hall to see vent pt. No charge RN around, CNA unavailable no other nurses around, so I admit my attitude is getting a little grumpy.

Catch up on meds that are now late for 1500-1700, d/c pt who has now waited all day and it is time for report.

Night nurse comes on and wants to know why a 1800 IVPB wasnt hung on my shift, and if I was going to sign off orders. I said I had some charting to catch up on and I was sorry that was going to have be taken care of on her shift.

NOC RN is visibly upset, yells at me about leaving her a mess. I apologized b/c it was a mess, however the entire day had been a mess. I am only one person.

Next day come back and RN wants to know about 60meq of KCL that "werent given" I stated what I had been told in report given at night. WEll KCL wass now 2.3 and it was my fault. I reviewed that hyperK was much more difficult to treat thhan hypoK and had I given it 120meq within 4 hrs could be much worse.

Have same pts that day except at 1700 direct admit arrives w/ 10/10 CP. Needs SL nito, line started for Nitro gtt and BP is 220/118 w/ N/V/E, LOC and increasing SOB. Who the hell direct admits that to a floor? anyways.. d/t guy isnt finished up until 1835, lines in meds given, CP resolving, CBG stable, again no CNA, no Charge RN, and my other pts. Give report to same NOC RN who is now mad that none of this guys admit stuff is charted. I explained that I had some of it done but the U.C had not put the chart together yet, no labels, or anything else.

Next day I get call from my agency that the contract has been terminated b/c I am difficult to work with. I feel horrible. I feel like I was trying to take care of my pts. I dont just want to leave the guy w/ 10/10 CP, to go sign off his admit orders that arent even input in the computer yet. What is more important the pt or the paperwork? I know 12hr chart checks are the norm, but sometimes it isnt possible, or should I have thought it was my responsibility?

I am so burned out on nsg always trying to do more w/ less and travellers seem to get screwed w/ no recourse. I am up for any feedback. Good, bad or ugly, what are other experiences?

[gonzo1, ASN, RN]

Difficult to comment on this since we weren't there. However, can tell you that travelers are always held to a much higher standard and one bad day like this can be bad.

As a traveler most of us live in daily fear of being canceled for anything. We usually get way less support and help at work. And a lot of the nurses can be jealous of our supposedly great salaries.

I'm sorry you lost your contract. Hopefully you can get something else soon.

There is a travel section on allnurses where you can read about all the travel adventures of nurses and you will see that being canceled is a common occurance.