dunno where to start, dunno where to finish!

[hapeewendy]

I am really feeling it today, it being a gross generalization of terrible feelings one feels when work seems to get the better of them.

for the last 2 12 hour nightshifts we were short on the floor, four RN's for 36 patients may not seem all that bad , but as I mentioned to my incharge, 36 patients are 36 people with problems and needs and in this particular case we have extremely high acuity.

I called the unit admin on call on monday night to explain my feeling about it being unsafe working conditions especially since the patient I had mentioned in my previous post (super violent outburst man) did not have a sitter either. The U/A was very nice and basically said what I knew was going to be said "just do the best you can"

my own patient assignment consisted of 2 confused patients one of whom kept dashing for the elevators, 3 patients going for gastro's/colonoscopy in the AM - no consents or checklists done at all of course.....bowel prep to be done on my shift, 2 patients that I felt were going downhill,but with no "hardcore clinical evidence" I couldnt get them seen by an MD

pt #1 BP was 88/50, she was diaphoretic, other vitals stable complained of no pain , talking to me pretty much all night but I just had this feeling - u know the horrible gut feeling that something is gonna happen, well we muddled thru , I checked that patient every five minutes fearing a code, and I had 9 other patients to worry about too. Anyway I know that we all have these stories to tell and share . In the morning I expressed my concerns to our new unit administrator who seemed quite understanding and supportive...... until.....

I came back on tuesday evening to find that my patient did infact code at 0815hrs , the other patient I was worried about they made him DNR so he could finally be on that morphine and die comfortably, and the super violent outburst man got worse and worse. I came on tuesday night to find that yes we were still short and gonna be four on the floor again, and it was decided that we couldnt even keep the setup we had the night before where we just took the patients off the team missing the nurse, we instead divided the floor into two sides, two of us for 18 patients, however , because of the setup of the floor/teams ,the two teams were all jumbled up so it was like an all new assignment again! We tried to change it but the incharge said this was specific instruction from above(which turned out to be bull uhhhh bullchips)

this morning, after being run down tired we get questioned as to why we didnt call the dr about my patient who I had the feeling about - which infact I did call the MD about another patient and the response I got was basically unless its a code situation dont call me about your "Feelings, or concerns about confused patients, I'm in ER dealing with a crisis" after that response, having already worked my poor little butt off I did not have the energy to keep calling the dr ,so I chose the route of checking this patients vitals frequently, keeping her comfortable and basically trying to hold her at bay - which I managed to do successfully - a BP of 90/52 was obtained by my co worker at 0645

the point of this longwinded rant/tearful explanation is that I feel like no one cared about the horrible situation our night staff was left to contend with, management says muddle thru, your day shift co workers dont care what you had to deal with all the care about is that the glucometer hi/lo testing didnt get done, or that your charts are sitting on a desk instead of in the appropriate folders, the incharge RN was mad because we left 2 charts for clarification - one was a vancomycin IV orde with no route or frequency and the other was geriatric suggestions to be okayed with the attending MD - none of these could be handled by the on call on nights....I just cant believe the lack of compassion or just basic human understanding...

walk a mile in my tattered and half a size to small feeling white nikes and then you can pizz and moan all you like , but until then keep your mouth shut and tend to your patients.

I have no more tolerance for all these petty issues that keep facing me ....

doesnt matter that all the patients were alive,medicated and comfortable , or does it?

I'm sorry , I ramble.... Typing thru tears is tricky innit?

[Stargazer]

Oh, Wendy. Crap like this is exactly what drove me from bedside care.

Nothing useful to add but a big hug--

((((((((happeewendy)))))))))

I hope things get better.

[Nurse Ratched, RN]

Doncha just want to tell some people, "Bite me?"

First of all Wendy, I thik 9 patients sounds like a helluva huge load considering what they were dealing with. What would day shift say if they had to contend with that volume? (But of course, you night shift people have it easy - all your people SLEEP all night (when they aren't busy trying to die or crawl out of bed, that is) (HEAVY SARCASM here.)

As you say, folks can't possibly understand what you deal with until they've walked a mile in your shoes. If the empathy is getting too thin, I'd invite the worst offenders to come sample the night shift. They'd know the lousy hours aren't the only reason there's a shift differential.

((hugs)) from those of us who *do* understand. Wish we could be there to take some of the load from you.

[midwestRN]

I am appalled at what your facility expects you to do. I have never taken care of 10 people at once. I hope you can find another facility with realistic expectations. I don't think I could keep working in a place where I was so overwhelmed that I cried.

[Cathy Wilson, RN]

Bless your heart, Wendy! I certainly hope that you documented (incident report would be good) the response you got to your call about the lady who eventually coded.

I think that if 4 people are left doing the work of 5 or 6, then they should be able to divide the teams in a way that is mutually acceptable to all of you. It doesn't matter how many people you will have to give report to in the a.m. You will have been able to manage the patients in your care in the safest way possible.

Keep doing all you can to get yourself heard and your ideas for managing the mess you are left accepted. Document EVERYTHING of consequence, even if you have to stamp an extra nurse's note to take home and chart (as an addendum, of course!).

Don't anybody jump on me for this suggestion to Wendy-you all know I play things really straight, but if these folks are being steamrolled, things MUST be documented, and they may not have time to do it all while they are on the clock. This is certainly NOT a best practice, but until things improve, these nurses must be able to protect themselves and their patients.

[Furball]

Did anyone c/o 4x4 wrappers or IV caps on the floor? Or in the pts bed? Sorry....couldn't resist.....were your pt's left spic and span in the am? huh? huh? huh?

Sorry but some other thread irked me.

sorry you had such a horrendous night.....and no support from above as usual. I got tired just reading your post. Don't apologise for expressing your frustration...you'll just get sick pushing it all down constantly. Really am feeling and praying for ya....take care....

Furby

[hapeewendy]

I love you all

(as usual)

I'm notorious for being a nicey nicey type person ,aka getting walked all over

thats changing, and at first I thought I was getting meaner and hardened from the workplace but now I think its that I'm getting smarter .....

I wrote 3 incident reports up that night, I didnt write up the MD because she was responding to our call for the confused patient, her response about not calling her unless it was an emergency and that she was stuck in ER just applied to every patient....since the patient I was worried about was technically still okay I guess I did what I could do in that case, I just felt bad that I was stretched in every which direction and then our every move was questioned.

I dont need to justify things until management is ready to justify leaving us in unsafe working conditions

but the point of this post was - I love you all-

my poor mom is worried about me so were gonna go have some dinner and chill in the good old A/C

forra while

I'm still nice, just learning

[shygirl]

Gee, I dunno what to say

[maizey]

Is this a routine happening at your facility. I know where I used to work it was. But, I worked day shift and we worked short staffed lots of time but of course the DON was always there to fill in if we needed her, NOT!!!! My problem was always that the poor night shift would be so dang short staffed that I would end up staying to help on too many occasions. Some of them I would pull 20 to 24 hours depending on if things simmered down any.

I'm sorry you are going through this and believe me I do understand your frustration. What is the answer. My answer was to finally quit after 15 years. I stuck around because I was only 5 minutes from work and kept hoping it would get better LOL.

It's even worse now from what some of my old coworkers are telling me and they are losing more nurses. Not only would we be expected to take care of 35 or 36 patients with 4 nurses but we would have to cover ER and OB. If an active OB came in one of the nurses patients had to be divided up among the rest of us so she could go do the OB. Did any body care, heck no. Just do the best you can. I heard that until I wanted to puke. Don't miss it. I miss the people but no miss the crap. Sorry for my ramble.

[flowerchild]

happeewendy, OMG! TEN HIGH ACUITY PATIENTS! Ditto what stargazer said, why I'm gone from the bedside too. Glad people like you are there though! Big HUGS to you!

When is your vacation????

Can you take some time off??? Seems to me, you need it, and deserve it!

Furball: LOL, you are so right to mention that on a thread like this.

Fitting point.

[BadBird, BSN, RN]

Wendee,

I feel your pain, hugs to you. Floor nursing is one of the hardest to deal with,no wonder the burn out is so severe. I will stay in ICU , thank God for you MedSurg nurses.

[Stargazer]

Originally posted by Cathy Wilson, RN

I think that if 4 people are left doing the work of 5 or 6, then they should be able to divide the teams in a way that is mutually acceptable to all of you. It doesn't matter how many people you will have to give report to in the a.m. You will have been able to manage the patients in your care in the safest way possible.

You know, Cathy, that is an excellent point. What friggin' unbelievable nerve to first give you insanely short staffing for this many pts, and then try to tell you how to divide up the work?

At the very least, if this happens again, you need to quote Nurse Ratched and tell them (A)Bite me; and (B) the ONLY hope of keeping these people alive until morning is if you figure out your own patient assignments, thanks so very much anyway.

Glad you're documenting. Make copies, distribute generously, and keep one for yourself.