Sorry, don't often dump here but I have had two days from HE$% or two days that make one wonder why nursing, and not flipping burgers? I work on a CC "step down" (yeah right) unit. Because we are classified as "step down" we have unit protocols for the type of patient we can accept on our unit, the ICU nursing co-odinator had our protocols rewritten by an MD to meet her needs to empty ICU beds. Our staffing is also set by our classification of "step down" Well yesterday and today I had 4 pts., we do not do team nursing, we do primary nursing. Pt. one was from the ICU, trach, vent, PEG, MERSA, PICC, obese, PO2 in the upper 70's on 50% trach colar with RR of 37-42 who in her spare time tachys to the low 150's. Pt. two also from ICU, RCW Port-A-Cath (dual), PEG, ileostomy, NG, IV's running: NSS @ 80, hydromorph PCA, TPN, lipids, vanco, fortaz, Zofran, AND 1/2 NSS @ 20 of K set at - "Doc to RN Note": "caluclate and set infusion rate to replace 1/2 of shift GI loss at a rate of 100-125 cc/hr not to run into next shift", GI loss my shift 2100 cc via NG, ostomy and emesis: don't think that ANY way I do the math I can replace 1000 cc at 100/hr and NOT run over the next shift. Oh, by the way, in the time left over, pt's wife may be a canditate for Munchounsen Synd. (sp) by proxy- Gomco's stop working, lines become disconnected, IV's flow faster or slower than set, NG drainage changes from billious green to pale yellow even though pt is NPO and wife swears she is NOT giving him water, ostemy bags are disconnected, and meds some how wind up running into the TPN line This patient also tachys into the mid 150's and has a PRN lopressor IV for "HR over 120". Wife is VERY demanding and nasty. Patient three is a very plesant gentelman COPD with new dx of abd. mass- he is VERY emotionally needy but won't ask for help so he disconnects his O2 and tele monitor to walk into the bathroom, he'll hook them back up right away so I know HIS sats are in the low 80's with a HR of 124 and a RR of 28-32. Pt. four is a 83 yo man with a dx of IDDM, SOB, COPD, CP, MI, previous CVA AND Alzhimers dementia. Mr. Room 5 has tried to climb from bed 5 times, has pooped on the floor, bed, chair, and in the hall when he got free from his bed and pulled all his lines including his PICC. Oh buy the way, I have had student nurses for both days. Past two days, no lunch, no potty break, not sure I got everything done. I know I did not do right by my patients or the students I worked with. I HATE days like this. It's one thing to be too busy for lunch when you get done what you have to and you know your patients got the best possible care from you, and it's another to be too busy for lunch or bathoorm, be an hour late getting out of work, fail the students you are supposed to be helping AND know your patients suffered with substandard care. Bottom line, being a nurse really bites some days and today was one of them. To all the students here, sorry, don't read all of this-it was just a REALLY bad day and you have them no matter what your job, even flipping burgers. Thanks for letting me dump on all of you.
This is why I maintain PCU's are the hardest units to work on.
I honestly felt ICU was easier ...when I wasn't in charge anywho... (at least when I had set visiting hours and could get the demanding family out of my hair for awhile..LOL!!)
:chair: Connie I hope it gets better.some times it helps to vent and on avarage there are at least 34 pairs of shoulders on this board at any given time Hang in there
I think the first two patients alone was more than enough. Definitely more than I could have coped with. That was terrible.
I sure do agree with that. Either one of them sounds like they were close to needing 1-1 care. I agree that you need to document, too. An assignment under protest seems to be in order.
As for you, take care of yourself, Connie. Do whatever you need to do for yourself to dump the stress, tension, frustation, and guilty feelings of those two days. :kiss :balloons:
You almost want to stick the student in the room with the interfering wife... since you probably can't get mgmt to back you up on getting her out of the room.
so sorry to hear about your awful shifts. unfortunately, most nurses can relate. just one question...did they give you a heavier load because you were with students? i have seen this done. well there are two of you so you should be fine. yes, 2 people but not 2 nurses...there is a huge difference. i agree with cactuswren...find that bubble bath with your favorite beverage in hand and prune away!!
Been there many times when i worked in a level one trauma ER , many times times we were totally overwhelmed. The solution for me after 3 years of that was to find an ICU with 2pt. to one nurse ratio and good staffing. I now work in much better conditions and can't image going back to the other job. hang in there and good luck!
Thanks for all the kind words of encouragement, I needed to hear them. In response to some of the comments here:
Yes, my nurse manager is not only aware of the staffing problems but is fighting the system as hard as we are to try to get the staffing guidelines changed, but you know how it is with the suits, they only see $ and not costs without $ signs.
My notes reflect EVERY task, intervention, assessment, and just about every-time I stepped into the room, esp. with the pt/wife pair. I have documented EVERY time I stepped into the room, what I saw, what I did, how I did it, and who was the nurse witness- I have taken to having everything I do witnessed and documented by a fellow nurse to protect myself and my patient.
No, I was not given a higher acuity because I had a student, that is one thing that the suits haven't been able to change, the students are not there as far as the suits are concerned. I don't even think they know we have nursing students, med students yes because they get generous financial support for providing "educational opportunity" (read slave labor) to student doctors.
Our staffing numbers call for 4:1 on 7-3 with 5:1 acceptable; 5:1 with 6:1 acceptable on 3-11 (which I usually work); and anything goes on 11-7. My nurse manager calls in agency to fill any vacant slots but the problem is with the acceptable staffing levels she has to work with. This unit is not written to be staffed to ICU levels yet the acuity I described above is not at all unusual. Imagine having 4 pts. one vented, one psych, one on a dopa gtt, and one on a heparin gtt. Our patients are so compromised that the resp. "red box" is NEVER in the bottom drawer of the code cart, it's right on top we use it so often. All of our pts. are on 24 hour tele monitoring and docs can order q 15 min vitals x 2 hours then q 30 min x 2 hours and then q hour and still be within the parameters for the unit. This intensive monitoring is not possible with a 4:1 let alone a 6:1. I don't mean to sound like I need some cheese to go with this wine, I took this job for the opportunity to learn a lot in a little time, remember, I only graduated in May and this is my first hospital job, it's just that I am having a hard time knowing that I didn't do the best I could for my patients and the students following me. If I had seen this as a student nurse I would have run as fast as I could have away from nursing and all the students I worked with are in BSN programs, they finish the first 2 years this May and will be eligible to sit for the NCLEX then (if any of them stay after seeing this week). I just have to remember that I took this job to learn, get what I can from it, and then move on to something better suited to my way of providing care and thanks to all of you I am better focused, more aware of the issues, and feel ready to tackle Monday (of course it doesn't hurt that this is my weekend off and that I am doing the breast cancer walk with my 11 yo son either). Thanks to all the broad (and now tear soaked) shoulders on the board. THIS is what nursing is supposed to be about, not about what the suits force us into. Thanks again.
yes, 2 people but not 2 nurses...there is a huge difference. i agree with cactuswren...find that bubble bath with your favorite beverage in hand and prune away!! 
mattsmom81
4,516 Posts
This is why I maintain PCU's are the hardest units to work on.
I honestly felt ICU was easier ...when I wasn't in charge anywho... (at least when I had set visiting hours and could get the demanding family out of my hair for awhile..LOL!!)
Hang in there, Connie...I feel your pain.