I just need to let of some steam. I had a terrible day at work yesterday (sunday). I work in a LTC facility. We had a patient who started throwing up friday evening. Called the doctor, recieved orders for Phenergan, the usual. Saturday she was still feeling sick, could not eat or drink. Called the doctor back, recieved orders to double the dose of phenergan, clear liquid diet. I wasn't the charge nurse on the wing those days. Sunday I was charging on the wing that the patient was on. Started my shift at 6, patient was stable. She drank 2 glasses of fluids for breakfast, started to throw up. I gave her phenergan 50mg IM. Took vitals, Temp ok, Pulse 100, Resp 24, BP 102/50. Skin turgor poor, musous membranes dry, obvious s/s of dehydration. Called Doctor at about 0900 in the morning, recieved orders to transfer patient to SNF status. Keep all meds the same, start IV and hang LR at 60cc/hr, draw a CBC and BMP. We worked the patient up, waited on the Pharmacy to deliver our IV supplies. The lab came back, BUN is 80'something, creat's are 2.something. Potassion high, WBC 15.2, and she is anemic. I, another LPN, and our RN tried a total of 10 times to start an IV, but she was so dehydrated that nobody could get a line started. Now the time is noon, I call the doctor back. He is at our local emergency room, I tell him that we are unable to start a line, tell him again all about the status of the patient, tell him all the lab values. He told me to leave the patient alone, and send her to his office in the morning :confused: . I'm thinking there is a pretty good change the lady will be dead before the morning. Ask him again if he wanted us to repeat any labs, call him about any changes, tell him she has thrown up again since I last called him, despite the Phenergan 50. Finally he said he will come out and see her, and start the IV for us. Get off the phone with him, start all the paperwork to send her to the hospital. I'm thinking that maybe when he gets here and actually sees her he will say "SHe looks like crap, send her now!!!" And I'm also hoping that having all the paperwork ready will make it happen. 2 hours later he still is not here, I've been checking my patient every 15. at 1400 her BP was 80/30, SaO2 86% on RA, she war breathing very schallow, with periods of apnea. (Looked alot like she was starting to Cheyne-Stokes on me). Took very loud verbal stimuly to get her to respond. I called him again at the hospital (He is sitting in the lounge, instead of comming here and taking care of her). Tell him all the clinical findings, that I am very very concerned about here health status. And he tells me "YOU HAVE VERY BAD JUDGEMENT. THIS IS NORMAL EFFECTS OF AGING. YOUR JUDGEMENT IS VERY POOR ON THIS CASE!" :( WTF. He finaly agreed to let me send her to the hospital so he can look at her. I talked to my DON (She was here for our thanksgiving lunch with the families and residents), she said he is a jerk, don't let it bother me. He called back about 2 hours later to give me report. Said he started IV, everything was ok, she is fine, there was nothing wrong with her, said "YOU NEED TO CALM DOWN, SHE IS A DNR, WHATEVER IS GOING TO HAPPEN IS GOING TO HAPPEN" Now I'm the very first person that is going to say: Hey, she is a DNR. or Hey, she has a living will, but not for Dehydration that can be fixed with an IV in her arm. The ambulance brought her back from the ER, the crew gave me report, said that she was in Trendelenburg when she was in the ER. (now the doc said she was fine, how fine can you be when your head is pointing at the floor and your feet at the ceiling) Within 60 minutes of fluids she started responding. Within 2 hours all her VS were WNL. She was her normal self. Aging my a$$, she was dehydrated and I had bad judgement for not letting her die. He also ordered some Rocephin, but she was allergic to PCN. He said to go ahead and give it IV. So I spend the last hour of my shift infusing it over 60 minutes. Not leaving her bedside (I had another LPN to cover the floor for me) and taking her VS every 15 minutes to make sure she was not having an allergic reaction. Everything was fine, it is now 2200, I have been here 16 hours (I pull two doubles on the weekend while going to RN school during the week). My relief has not shown up, I call my DON at home, she said I'm just gonna have to stay another shift. I tell her that in 15 minutes I am leaving, and she better get somebody else or herself up here to cover the floor. She threatens me with F***ing abandonment and tells me I'm gonna loose my license if I leave. Now I know that the BON in Oklahoma has released an abandonment statement, and it says in there failure to work beyond my scheduled shift is not considered abandonment, and leaving my area with apropriate notification of appropriate personel is not considered abandonment is neither. And I told her that if she EVER, EVER tries to threaten me with my license again, that will be the last time that I will work for her. The nerve of that *****, I spend the day recieving Verbal abuse from the doctor for not letting my patient die from dehydration, and then she threatens my license. I don't care that she has no basis for the threat, and could never carry it out. I wont stand for that. I'm looking for a new job today.
Sorry for a long rant, I just really needed to let of some steam.
:confused: 
:(