I just finished one of those night shifts where I ran the entire shift and did not sit down until after giving report. One of my patients was CIWA and required hourly scores/rechecks and was becoming increasingly difficult to manage. My other patients were OK for the most part, but busy. At 3:30 AM, we got a transfer from another floor on contact precautions due to MRSA.
Immediately after taking report by phone, I told my charge that the patient needed an iso cart. In our hospital in pre-covid days, we could just go to the basement and grab one from where they were stored. This was no longer the case, and the iso carts were locked up. I did not know the procedure for getting a cart, because needing to get a cart on nights on this particular floor is rare. I don't think I was ever told the procedure in any meeting or email, but generally charge will call house supervisor and they will bring in a cart. Charge called house sup right away, but there wasn't a cart brought before the patient arrived. There was another iso patient two doors down, so I made sure everyone on the floor was aware and we used that cart for both patients.
Here's my mistake: I didn't get signage on the new patient's door. Call it running my tail off. Call it inexperience. Call it dead tired. Call it sheer stupidity. That is my fault and my mistake. Yes, this should have been done the second the patient arrived and I messed up.
At 6:30, I realized that we still didin't have an iso cart for that patient. I told my charge and she called house sup again. Cart hadn't arrived by shift change. I butted into to huddle to speak up about the issue so that everyone would know. Oncoming charge said she already knew and was on it. Day CNA was late to work, but I made sure she knew too.
I was finishing up charting when the assistant manager over our unit and another unit came by and asked if there were any safety issues. I immediately told her about the difficulty getting an iso cart. She asked if there was a sign on the door, and I told her that I had not put a sign on the door. She tracked down a cart in short order and got signage up.
What happened next has me questioning everything about being a nurse. At the nurse's station, in front of anyone who might have been there, my assistant manager (I'll abbreviate AM) asked me what the breakdown was in getting a cart, and I started telling how we started trying to get one when I took report and I was having difficulty with my CIWA patient during that time. She didn't let me continue. She told me that it took her two minutes to get a cart and there no excuse for not having one. She said it was solely my responsibility, not charge, or anyone else.
My charge was about to leave and walking by. She reiterated that we had tried to get a cart. The AM then told us a process that I have never before heard involving going to a different place and using a door code to get an iso cart. Charge had also never heard this.
The AM is not wrong. I screwed up by not having a door sign, even if was photocopied from the other cart. I left that day feeling humiliated and wondering if I should just get out of nursing. I work tonight and I don't see how I'm going to sleep. I don't know what I'm asking by posting this, just please don't eat me alive. I'm already doing that.
