is it always going to be like this?

[MIA-RN1, RN]

OK, new nurse here. I work on a busy postpartum floor. But it has been outrageous. I have been off my 6 week orientation for about a month now. I have worked three months and two weeks all together.

Normally, we get four mother/baby pairs, eight patients in all. Ok so the census is HIGH and the babies just keep coming. So tonight I had one fresh Csection, still on hourly checks (hourly respirs, q4 assesments and vitals. Needed I's and O's, IV fluids, Foley, SCD's. And redhead which supposedly means more risk of bleeding.) I also got a C-section day three, who was okay but realy painful nursing issues, then two C-sect day twos, one of which was going home, and one who's baby was on abx for r/o hydronephritis (i luckly didn't have to give these). So NONE of my patients were on self-meds, meaning lots of calls for meds. ALL of them were breastfeeding and ALL of them had issues of some sort. The one going home was to be d/c'd @ 2100, which was impossible since at 2030 I realized she still had her staples in. (OMG I just realized I didn't take the baby's umbilical clamp off. Crap.) Anyway, They took out her staples, and realized that they needed to put them back in! And I found out at 1800 I was getting a new admit--you guessed it, a fresh C-section WITH TWINS. There were four other lady partsls on the board and they gave me my fifth Csection couplet. (one of the two babies went to special care nursery)

I ran my butt off all night. I KNOW I missed something (prolly that umbilical clamp) But what if I missed something else? I was almost in tears all night. I have never really done a d/c on my own and I couldn't find anyone to help me. I hope I got it all right.

It was awful. And I have to go back tomorrow. Even one of my patients commented on how busy it was when I was paged via the call system in her room toand told I was getting that admit in ten minutes. I didn't have the room ready, nothing. I couldn't!

I had to spend lots of time w/ the new admit, as she was vomiting and a new mother and needed lots of teaching to get breastfeeding going as well as all the normal teaching stuff such as spitting, gagging, etc etc. I was trying to get her phenergan and mix it in the 10cc saline, spilled the whole darned thing. Meanwhile she started vomiting again while I was gone.

So then I find out that one of my other patients tells me she feels weird and there is redness @ incicison. I call MD, they come. I check chart it says only "Repeat HCT" OK fine. No time given, no stat order nothing. So I mean to do it but got lost in the shuffle of the discharge, admit, and the others. So I get grief from MD at 2330 when I am trying to give report to a very ticked-off coworker who is inheriting all my patients.

I don't like this at all. I understand busy. But give the newest nurse the heaviest patient load? I mean there were sicker patients for sure, but to have ALL C-section patients is unreal. And my 2100 discharge left at 2300. Oh well.

[puggymae]

I have had days too numerous to count that were just like you described. Fair? No. Safe? Probably not. Going to happen again? Yes. Unfortunately the low man on the totem pole usually gets dumped on. And I know that it isn't rightm, but that is the way it is. Talk to your manager - that person is in a position to help you. Is there a charge nurse on your shift? Tell them what is going on. Is there a resource nurse or another nurse on your unit that can help you out when you are in a tight spot and then you can reciprocate some time? Could another staff member be called in to help out?

Have a plan for next time - maybe if everybody could have a pain pill as soon as you got on shift (go room to room and offer them), then in four hours you could make one round to medicate them again - wouldn't have to make 20 trips for that. Prioritize. Keep your cool. And most important of all remember that you are only one person and can only do so much.

[MIA-RN1, RN]

thank you puggy. I guess that it is totally overwhelming as a new nurse to try to prioritize everything when there is so much to do. THey all had been medicated on the previous shift but at different times.

I guess now the worry is if I got everything done I was supposed to, knowing that I did not get everything done. Hopefully I got the important stuff done. And hopefully tonight will be better. Its hard when its the first day of a four day in a row week to have it so hard.

[CHATSDALE]

i wish i could tell you that this won't happen again but this is the nitty-gritty advise from pudgy good..you know that post-op pts are probably going to need pain meds and they are more effective if you give them before pain gets bad

you are learning every day how to organize your day, sx that require immediate attention and sx that are to be expected..how to present your self to pts so that they don't even realize that you are getting ready to pull your hair out

smile retirement is only 30 years away [just kidding, even if the situation doesn't get better you will]

[colleennurse, ASN, RN]

Hey D. It's Colleen. Just thought it might make you feel better to know that one of your fellow grads has also had a few days that way myself. You know I work on a med surg unit, mostly back/thoracic surgeries and there is tele. Some days I get home and I worry that I made some mistake that I am unaware of, or I get in my car and think to myself that I was so busy trying to get everything done, did I even really look at my pt as a human being? Everyone keeps telling me that it will get better, but that even after years of experience we will still have days like this. I am sure you are doing a good job. All we can do is try our best :)

[MIA-RN1, RN]

I am happy to say that tonight was almost like a different hospital. Last night and for a few days prior, we had been full census and even doubled up a couple times (our rooms are all private). Last night was the worst its been, I guess, in some time.

They had something like 13 discharges to day, so when I came in we had a bunch of available beds, no inductions and no planned C-sects. It was freaking heaven. All four of my patients were vag births and they were all easy peasy. I left on time for the first time in I don't know how long, AND I got a dinner break! :)

[MIA-RN1, RN]

Hey D. It's Colleen. Just thought it might make you feel better to know that one of your fellow grads has also had a few days that way myself. You know I work on a med surg unit, mostly back/thoracic surgeries and there is tele. Some days I get home and I worry that I made some mistake that I am unaware of, or I get in my car and think to myself that I was so busy trying to get everything done, did I even really look at my pt as a human being? Everyone keeps telling me that it will get better, but that even after years of experience we will still have days like this. I am sure you are doing a good job. All we can do is try our best :)

I know what you mean about looking at patients as human beings. I tend to think of them by their room numbers (321 needs percocet, 329 needs to ambulate etc). I get home sometimes and realize that I don't know their names al the time, and I rarely know the babies' names.

I can' tbelieve back and thoracic surgeries--brave woman! :) Tele sounds interesting but I saw all I needed to in school. I wouldn't want that stress on top of what I deal with.