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?
