Bad shift, need a pick me up.

[RNcDreams]

I am in my 5th week off orientation, trying my hardest to stay positive.

Today was by far one of the most challenging, frightening, and stressful days I have had yet.

The dept was full to the brim with patients, and I just don't feel like my skills are up to par yet.

At 7a, I had a "hold" waiting for a bed, who needed about 15 am meds, had a blood sugar of 388, needed regular insulin, NPH insulin, fluids, 2 units of blood, a MgSulfate bolus, and hourly pedal pulse checks in addition to q3 hr H+H draws. (leg hematoma post ortho surg, low H+H)

-- I can't recall if I documented the pedal pulses hourly, I neglected to mix the two insulins because I was so focused on getting all the meds out that I overlooked that option (which the patient called me on... ugh), I'm reasonably sure I should have re-drawn the H+H and never got to it before he went up to the floor because....

my next patient at 7a was a Telemetry hold, who also had about 15 am meds, was kept NPO per orders, and the MD never wrote for the pt to have a stress test, had a sliding scale ordered for insulin but the doc never filled it out the sheet, and needed IVF @ 80cc/hr that I never hung because.....

my next pt was a psych hold waiting for crisis evaluation, who was never sectioned and never had security put with her per the NOC shift because she was not SI/HI and was compliant....

She ended up signing out AMA.

Shortly after patient #1 left the dept, around 11am, a second was placed in that room that ended up going to ICU, because he had a pericardial effusion, 10mm pulsus paradoxus (10 point drop in BP with inspiration?), and an INR of 3.8. He needed Vitamin K, 2 units of FFP, and had an 11 beat run of VT that I had to give 40 meQ of Kcl for.... while the first 10 meQs were infusing, he began to have burning at his one IV site.... so the float RN had to pick up my slack and start another...

Shortly after this pt left, I got another pt in my next room who had a HR of 160, mild CP, hx of NIDDM, lowish BPs..... needed IV Lopressor, IV Dilt, several EKG's, and the person who drew his blood in triage didn't draw a troponin.. so that was added on late (MD wasn't happy)

And while I am trying to manage him, I have another lady plopped in my room who ends up having an elevated troponin... along with her K being hemolyzed and her cbc being coagulated, both of which have to be redrawn.

The other older lady I have in my 4th room around 4 in the afternoon ends up having a PE. Fabulous.

I feel like all I did during this shift was put out fires that I created by being slow, unfocused, and frazzled.

I feel like I would be a better trashman than I am a nurse

[vamedic4, EMT-P]

On the contrary. By your recollection of the day it sounds as if you handled things well given the circumstances. Do you have resources you can call to help you in times when you feel overwhelmed?(*charge nurse)?? Sounds like she might have been an asset - even if all she had to do was give one med for you. It's over now, hopefully it won't happen to you again. Get some rest - you've earned it!!

vamedic4

[FireStarterRN, BSN, RN]

You did fine. Your patients all survived your shift, didn't they?

[Standup]

Hi. I am a RN student grad 05/09, hopefully. Tell me. Is this what I have to look forward to. J/K. I have to get back to studying. Keep up the good work. You are doing a wonderful job........Sincerely Your Friend Standup;0)

[LadyJRN1]

if you can make it through a shift with keepin' them off the floor and breathin' you have done a good job. It is your charge nurse's responsibility to pick up when you are drowning and you need to tell her/him when you are in trouble. They are getting paid extra for it.

[VivaLasViejas, ASN, RN]

What you did was survive a brutal shift that NO nurse (or patient, for that matter!) should be put through. Unfortunately, this happens every day in America because so many hospitals have sacrificed patient safety (to say nothing of NURSE safety) in order to satisfy the insurance industry's ever-growing burden of documentation and maximize their profits. It's why I left med/surg nursing.......I was a good, conscientious nurse, but I lived in constant fear that the insane pace and the heavy workloads would cause me to make a mistake that could cost me my career, or worse, kill a patient.

Honestly, I don't know how ANYONE does it anymore........I left the hospital a little over two years ago, and I've since bumped into a number of former co-workers who have also fled acute care for the same reasons I did. And from what I understand, working conditions have only gotten worse!

Please, don't be so hard on yourself. Acute care is one of the hardest jobs there is in nursing, and it sounds like you've barely gotten your feet wet.......you can't expect to be perfect EVER, but as a new nurse, you've got a lot of learning still ahead. You are also working in an environment that all too often sets nurses up for failure, chews them up, and spits them out.

I wish I could be more helpful, but I thought you should know that it's not you, but the job that stinks.

Good luck to you. You are going to need it.

[xviii-xxv]

dont be too hard on your self..well if u are not satisfied with what u did, then do better tomorrow... nurses are just people so its ok to be like that, especially if u r pretty new and u r overwhelmed with all those stuffs to do...but u know just try to collect things up, remember what u learned in school and have faith on urself and everything will be ok...just be careful next time and focus..pretty soon u will handle everything better.. just enjoy and learn :wink2: :flowersfo

xviii-xxv:nurse:

[ERNurse752, RN]

Shifts like that are why I left the ER.

Only advice is that you can only do what you can do. You can't be in more than one place at one time. The goal is just to keep them alive. It sucks!

[canoehead, BSN, RN]

I've got 20 years in nursing, I work the ER, and that was a hideous shift for anyone. If they all left your ER alive you did very well. If you are less than one year out of nursing school- well you are exceptional, definitely a hard working, observant nurse.

[GeminiTwinRN, BSN]

Yes, you need a pick-me-up. A shift like that would be hard for any seasoned nurse, much less someone just off orientation like you! From the sounds of things, you were surviving a hellish day, and did an awesome job handling things. You kept going, kept persevering, and basically kept your patients alive until transfers could be made.

You deserve a pat on the back and huge atta girl!!!

:w00t:

[Tweety, BSN, RN]

Yes, you need a pick-me-up. A shift like that would be hard for any seasoned nurse, much less someone just off orientation like you! From the sounds of things, you were surviving a hellish day, and did an awesome job handling things. You kept going, kept persevering, and basically kept your patients alive until transfers could be made.

You deserve a pat on the back and huge atta girl!!!

:w00t:

I couldn't say it better myself.

We all have days like that, sometimes a string of days, or even weeks...............

[Bugaloo]

:scrm:This is how I feel on days like this. Sadly, acute care nursing is usually all about putting out one fire after another. You seem like you had a handle on things. There are times that you have to get the most important things done (things that are considered lifesaving) and leave the others until last. If they don't get done on your shift, pass them on.

It would be very nice if we had time to do "lovey-dovey" nurse things for our patients, but some days, we just can't. Throw some meds at 'em, make sure they are breathing, and try to keep from drowning.

If you have a helpful Charge, it is great, but sometimes you don't have a free Charge or you have a very poor one.