my awful crappy night (vent)

[EmilyUSFRN, RN]

i just have to vent and get it out of my system. i've been on my own off orientation for 2 weeks now. i stroll into work for 3-11 shift, since on holidays everyone does 4s and 8s. so i get report on my 4... which would have been my first night w 4, i've had 3 except for the night i floated... so anyway, it's myself and 3 other nurses on my side, 2 others on the adjacent wing. everyone has 4. i have a kid who had a C6 fx and a fusion with uncontrolled pain mgmt issues and severe anxiety and needy parents, a kid who had sx for pyloric stenosis and mom is not the brightest light in the harbor to put it nicely, a kid with bronchiolitis and mom doesn't have anywhere for her other 2 daughters to stay so they're also camping out in the hospital in the area designated for another family in the room (its a 4 crib unit) and pretty well behaved, but i got a little tired of tending to their needs and wants since they weren't patients, and a kid who has had heart transplant x 2, a trach, g tube, etc etc etc and is at the hospital for rehab and regaining his strength... its honestly a heavy load for the most part, and i spent so much of my night tending to the basic necessities, and our techs were tied up, and then my fx neck needy parents see me running, no, sprinting through the hall practically to get my crap done and *right now* he wants his aspen collar liner changed and *right now* pain meds. they were truly nice about it and offered me some food of theirs, which no thanks, but still. not even the best part. I got an admit. New kid on the block now has 5, seasoned nurses have 4. i never ate lunch, i clocked out an hour and a half late because as much charting as i did throughout my shift i just couldn't do it all. after all, i had labs to draw and send, trach care, g tube care, pain meds, getting food for the kids that aren't patients and tracking down some movies for them, convincing pyloric mom that her baby's diaper needs to be changed more often than every 9 hours, everything pertaining to the admit, entering my own orders because the UC checks out promptly when it's time, nevermind there's more to do, i can truly go on and on. i have good time management skills and i'm pretty good at prioritizing usually, but also if i don't write something down or do it reasonably soon i usually forget. unfortunately, when the call light was used tonight we ask "can she bring you anything" so that we aren't making a billion trips but the only answers from my kids tonight were just "i need her" and so i walk all the way down and its can i get some water. OMG. we've all had shifts like this.... also the charge nurse is very rude and a snot, always gives herself the easiest assignment, but i don't want to be "that nurse" that snitches and all, since nursing is such a vindictive profession.... ahhh.... my night made me totally crazy.

i know it was long, thanks for reading.

[RPNinTO]

what a bad shift

sounds like you did a wonderful job

hope things have gotten better!

[nurseby07]

Well I thought I would go on and post about my awful crappy night, but it seems that you already wrote it! I had my first night off orientation the other night and thought that I was going to have a nervous breakdown somewhere along the way. Honestly, if it weren't for my awesome, supportive co-workers I wouldn't have made it.

I had three patients-one was a confused elderly man on a vent, g-tube, feedings, abx, meds, and uncontrolled diarrhea. Ok, fine, I don't mind changing you every 3 minutes. Next, a younger man, 1 day post op for skin grafting, trached, g-tube, feedings, wound vacs, and millions of home-boys in his room, hallway, using the call light so I could get them things, you know what I mean. The pt had uncontrolled pain, the pca wasn't helping, etc etc etc. Third pt, an obese middle aged man who had broken 8 ribs, clavicle, and a spleen lac. UNCONTROLABLE pain. The worst part? His wife was an RN-Oh God. His epidural gave him little relief, he had diarrhea and was up to the commode every 15 minutes-fine-but, he is obese and in tons of pain so I had to spend a lot of time helping him up and down. He was also a "play with the equipment" guy, his chest tubes, his o2, his pulse ox. His wife was on the call light every 2 minutes for everything. His foley looked funny, his feet look edemetous, I need a blanket, PLUS he had an order for q FIVE MINUTE dilaudid & morphine. Then his iv leaked and I had to pull it. Abx were late. Wife=extreme anxiety. It was hell. Every time I sat for two seconds I couldn't even get logged on to the computer without my beeper going off. AAAHHHH!!!! Then the guy FINALLY falls asleep, the posse down the hall leaves, old man is watching tv contently, I am nervous about all of the pain meds I had given broken rib guy so made sure I checked on him every chance I could. I tip-toed into his room, watched his breathingm checked his pumps, and then BEEP BEEP BEEP, my flipping beeper goes off, wakes him up and alerts him to his pain, again!

As I was giving report I told day shift about the night from hell and one nurse said, "Good, now that you've had the night from hell, you'll never have it again!" We all laughed hard and I drove home to a huge glass of wine. Yuck.

[MrsGPR]

Wow! How exhausting!!

Is it required that nurses cater to family members/visitors as well as patients? I understand the "treat the patients and the family" philosophy and I agree with it - but is there a such thing as going too far?

[clee1]

Wow! How exhausting!!

Is it required that nurses cater to family members/visitors as well as patients? I understand the "treat the patients and the family" philosophy and I agree with it - but is there a such thing as going too far?

Yes, there IS such a thing as going too far.

On several occasions, I have had to say to demanding family members, with varying degrees of force, that "Listen, I have seven pts tonight, ALL of them sicker than YOU (the family of the pt) are. I don't have the time, or the responsibility to deal with your wants. Your pt is comfortable (asleep, content, whatever). My responsibility is to my PATIENTS, not their families/visitors. My name is XXXX if you'd like to file a complaint with the hospital administrator." I then leave the room, and do not respond to requests from needy family/visitors. Some are additionally told that "this is a hospital, not a resort hotel, visit your loved one - and stop calling me for coffee!"

People don't realize your work load - how can they if you don't tell them? Often, all that is needed is a gentle reminder that you have more important duties than a visitor's comfort.

Only one visitor (not a family member) complained about me to the administrator. That complaint went nowhere, as the administrator basically said that "our staff are here for the needs of their pts - they are not here to cater to the desires of anyone that happens to walk through the doors." Whoot!

[ebear, BSN, RN]

Hey,new one!

I'm so sorry to read about your truly horrendous night! Bless your heart! I've been in nursing for umm.. years and have been there way too many times! Looking back though, those times will be funny later (they really will) and you will be amazed at how they have developed your nursing skills. It's how you learn that you can do almost anything with nothing and still live to tell about it! You'll never forget these nights and they certainly are not in the nursing texts! Press on new one! You are developing skills that you never knew you had!

In full support and understanding,

ebear;)

[BlearnRN]

WOW!

Pt families tend to be the hardest to deal with. I can believe that the senior nurses didn't take the 1st admit...not cool....

[leslie :-D]

isn't the first yr of nsg, everything you imagined it to be?

kidding, kidding, kidding.

i do agree with ebear.

you guys are learning skills that you're not even aware of.

when you least expect it, you're going to find yourself telling a family member, "ma'am/sir, i would be happy to do a, b and c for you. but right now, i have 5 other pts who need my attn. if i have time, i will gladly help you out. now, if you'll excuse me...."

it's not only about prioritizing care, but it's learning how and when to assert yourself.

not only do you need to advocate for your pts, you need to advocate for yourself.

and if it's any consolation, these horrific shifts do not happen often.

they really don't.

just get through that 1st yr.

it's your time to shine. :balloons:

leslie

[november17, ASN, RN]

I feel you. I've been licensed for 4 weeks and just the other day I got 8 patients. 2 of those were on the call light constantly. Towards the end of the night one of them kicked me out of their room and requested a new nurse because I refused to dose them 4mg of dilaudid literally 30 minutes after giving them 4mg of dilaudid IV!!! This was "frequent flyer" patient with no diagnosis except lower back pain - All the CTs, Xrays, MRIs were perfectly negative. Coincidentally this same patient had been discharged the week before from the hospital down the street for the same problem. I understand the concept of dosing for pain, and I'm certainly not one to withhold pain meds, but 8mg of dilaudid in 1 hour is just TOO much- especially when your patient starts talking all sorts of nonsense out of the blue. She was refusing any oral meds because she stated she's "not a pill popper." The charge nurse and I ended up devising a plan to play "Good nurse, Bad nurse" so I could get through the night with that patient. Thank god for my coworkers!

The next night I came back, and the (seasoned and experienced) day shift nurse confided that she had locked herself in the bathroom and cried because that particular patient had given her such a hard time during the day.

It's not just you!

I feel you. Hang in there.