Had 6 pts & was going nutty last night!!!!!

RaggedyRN · Mar 18, 2006

Hey Christy...

I feel like we have parallel lives, well I think I am behind you by 2 months. My name is Christine and I use that for work but family and friends call me Christy. I took the boards a few weeks after you. I read all of your posts about getting through the stress of the boards. I also started a job on a cardiac step down unit/telemetry. Your night sounds like many of my nights. I works straight night shifts. I work 7pm to 7am. I think I need 12 hour shifts to get everything done and many nights I still run out of time to finish everything I had hoped to.

I usually have 5 patients when I start my shift then pick up a 6th patient at 11:OO. Often the patient I pick up at 11 is from a different district and the nurse has been pulled from another unit for four hours so report is usually sketchy at best. The 7 - 11 part of my shift is usually so busy with late orders and many family questions and concerns. I went into nursing to be a liaison between the doctors and the patients families and I really do enjoy the time I spend with family but it does make it difficult to to get things done.

If I don't have a full district at the beginning of my shift it's guaranteed that it will be full by morning. Many times the patients they admit need an ICU bed but one isn't available so they admit the patient to step down because you know night shift isn't doing anything so they can take the high acuity patients. So what if it's three admissions in one evening with three very complex diagnosis and treatments, drips, unstable angina....

I totally know that overwhelming feeling that you are forgetting something because you get so bogged down in the busywork and don't have enough time for patient care. I wish I had some sage advice to give you but all I can do is commiserate and lend an ear when you need one.

Hang in there

TexasPediRN · Mar 18, 2006

christvs:

I think that you did an extremly great job handling yourself, and taking care of your patients at the same time. You were able to prioritize and multitask while still calling doctors and giving your patients the care they needed.

Although it was a busy (understatement?) night and you got out late, I think it sounds like you did a wonderful job.

Its very frustrating to be so overwhelmed, and then to have a patient on top of everything else who speaks no English, an NPO patient that requires more of your time to understand her needs, and everyone else you had.

I think you did a great job.

-Meghan

Daytonite, BSN, RN · Mar 18, 2006

This is one of the reasons I liked working in step down. Never a dull moment. Always felt I was needed and never wasting any time. Felt I was truly earning my paycheck.

There has to be some days like that to balance out the days when things seem a lot easier. That is the nature of the beast. It sounds very typical of what we went through on the stepdown I worked on. Can you imagine how you would have reacted to this 8 months ago? You've made a lot of progress.

Annor · Mar 18, 2006

Your post brought back all the reasons why ,i would never work in a hospital again!

I am exhausted just reading your post.....wow what a evening!! Sounds like you did a good job even if it was a "nutty night"

We need nurses working in hospitals.....just dont go looking for me there:sofahider ,no thanks!

I've been an RN for 8 months now & feel that my med/surg/tele unit is usually a pretty nice unit to work on. Not last night on 3-11!!!!! Oh my GOD! I had 6 patients to myself, which is a lot for our unit, since 3 of my pts were on tele, and 3 others had non-cardiac issues (2 pneumonia, 1 gastroenteritis). At the beginning of my shift I got in & saw all my pts and assessed them all & got them done right away thank god. I had enough time to scribble notes on my clipboard, & I pulled all the tele strips, which were fine. But then it went downhill from there. Every single pt of mine had issues like all over the place, & I was on the phone all night long with docs. Pt #1 had CP (mostly on her left side and to her back) so I was with her for a good hour making sure I was doing everything I was supposed to-checking and rechecking VS, pulse ox, EKGs & I gave her 3 SL nitro under the tongue & her HR didn't drop too much at all during it. But it only helped her pain "a little bit" so I gave her 2 mg IV morphine and then IV Zofran for her nausea, but then her pulse ox dropped from 96 % on RA where it was all shift to 89% on RA, so I elevated the HOB and put her on 3 L O2 on the nasal cannula and she went up to 94 % finally -I told her doc all that who was very good and came down to see her. THen I gave her nitropaste, and all her other evening meds. Oh and she had 3 IV pumps going too! I started her on NS @ 5o ml/hr, heparin gtt at 24 ml/hr and integrillin drip at 11 ml/hr.Her VS were good too, and she said she felt a lot better, but still has some pain, so we were going to transfer her over to the CCU, which was a good thing cuz she needed a lot of watching over as you can see! But she was so nice she kept saying "I hate to bother you nice girls but...." Then pt. #2 was here with gastroenteritis and was confused, and almost fell when I helped her walk to the bathroom-she started to slump to the ground, I didn't know I was that physically strong cuz I literally picked her up in my arms as she started to fall and put her back to bed and said here's a bedpan! Her other issue was nausea-she threw up a little at the beginning of my shift, so I gave her zofran as ordered prn, that only helped for a little bit. Then later on she threw up again so I got on the phone & got an order for IV reglan-which I asked another nurse to give cuz I was SO BEHIND on everything! That helped her. Pt. #3 was here with pneumonia and had a stroke a few months ago so she had absolutely NO gag reflex and was hard to understand her speech-kinda frustrating for both of us I'm sure. Anyhow, she was not to have anything by mouth-but she kept asking for it. Then at the end of the night she coughed up some blood onto her tissue. I called her doc (another nurse thought she got that from coughing a lot and being dry in there)and at first he told me to give her po robitussin-but then I said, wait, she can't have anything by mouth cuz no gag reflex-I don't want her to choke, so then he said well, there's nothing else we can do then. Luckily she didn't cough up any more blood, but that freaked me out! And she was also semi-confused and kept trying to get out of bed. So I put tab/bed alarms on her too! Pt. #4 only spoke viatnamese, which I don't speak so I basically used my made up sign language to communicate with her until her family came at sporadic moments and translated for me to see if she had any pain (yep, in her legs-gave her a tylenol) and if she needed anything, etc. Her BP was scary low-in the 70s/40s, called her doc about that, he came and looked at her, said she might be going to the ICU but he must've changed his mind, cuz another doc came to look at her later and thought she looked fine. She had CHF, so she was on a fluid restriction, but her family kept trying to give her WAY more drinks, which I tried to explain no.........Pt. #5 had A fib, came in with CP, but was fine now, but just talked a lot and I had NO time for chit chat, so I had to keep cutting her off! Oh well, it was either that or ignore the active CP, blood coughing up, low BP ladies! Pt. #5 kept asking for all these things while I was trying to give her meds-oh, I ran out of ice, I need crackers, ....and of course the nursing assistant was no where to be found, so I kept fetching things for her, while trying to pass my meds! My lord! Then I finally got a working IV pump for her NS IVFs, cuz I had to just drip the IVF & count the drops by eye which I don't feel great about doing in case it is off. Then pt. #6 was here with pneumonia also, very nice pt and nice family, only he was so HOH I was literally screaming in there so he could hear me. He was a new pt (luckily my charge nurse helped me admit him cuz I was soooo drowning in everything as you can see...)so I assessed him, and he needed a Duoneb breathing treatment like RIGHT AWAY, so we must've paged the resp. therapist 4 times!!!! He kept saying oh, we're changing shifts right now. UMM
-Christine

christvs, DNP, RN, NP · Mar 19, 2006

Hey Christy...
I feel like we have parallel lives, well I think I am behind you by 2 months. My name is Christine and I use that for work but family and friends call me Christy. I took the boards a few weeks after you. I read all of your posts about getting through the stress of the boards. I also started a job on a cardiac step down unit/telemetry. Your night sounds like many of my nights. I works straight night shifts. I work 7pm to 7am. I think I need 12 hour shifts to get everything done and many nights I still run out of time to finish everything I had hoped to.
I usually have 5 patients when I start my shift then pick up a 6th patient at 11:OO. Often the patient I pick up at 11 is from a different district and the nurse has been pulled from another unit for four hours so report is usually sketchy at best. The 7 - 11 part of my shift is usually so busy with late orders and many family questions and concerns. I went into nursing to be a liaison between the doctors and the patients families and I really do enjoy the time I spend with family but it does make it difficult to to get things done.
If I don't have a full district at the beginning of my shift it's guaranteed that it will be full by morning. Many times the patients they admit need an ICU bed but one isn't available so they admit the patient to step down because you know night shift isn't doing anything so they can take the high acuity patients. So what if it's three admissions in one evening with three very complex diagnosis and treatments, drips, unstable angina....
I totally know that overwhelming feeling that you are forgetting something because you get so bogged down in the busywork and don't have enough time for patient care. I wish I had some sage advice to give you but all I can do is commiserate and lend an ear when you need one.
Hang in there

Christy, thanks for making me feel like it's not just me! :) It's nice to hear that other new nurses are going through what I'm going through too. That's funny how we took our boards around the same time, have the same name, etc. You're my twin. :) And thanks Daytonite for your nice comments. I do feel like I made a lot of progress. I feel like I know I can be a safe, capable nurse and feel confident in my nursing abilities. But it's always nice to hear a more experienced nurse telling me I did well. :)

-Christine

firstaiddave907 · Mar 19, 2006

Maby it was a full moon

grinnurse, RN · Mar 19, 2006

Hey Christy-

Sounds like you did an excellent job under tough circumstances!! I hate it when my days are like that but that happens and as long as it doesn't happen everyday we will all be ok right?

Indy, LPN, LVN · Mar 19, 2006

Actually, yes, it was a full moon thursday and friday night. Both my nights were heck on wheels as well. Full moons are NOT the time to be short staffed!

RainDreamer, BSN, RN · Mar 23, 2006

(((((Christine))))) Wow, what a day! I can't imagine how awful that would be! You did great though! I always dream all night long after I have a night from hell .... which isn't what you need after a night like that, you need a good night's sleep! And maybe a big ole margarita!

Really sorry to hear about your sister's m/c too I'll keep her and her hubby in my prayers.

WV_heart_RN · Mar 24, 2006

Christine, I work on a tele step-down unit 3-11p.m shift also. I normally have four patients from 3-7 then I pick up three more patients from 7-11. I can understand your evening. Mine tend to alway be like that.

Just a word of caution to you... you said you have been on the floor for eight months.. Do you realize how upset you got with the new nurse you were giving report to?? Yes, it was late and you had a horrible day and night.

Please, don't ever forget how you felt as a new nurse having to deal with a new situation. I know I would have felt sudden panic when I was told I had a patient who was to go to ICU.

It was simple to you because you have had time on the floor and you have learned what to do. Don't give the phrase "eating our young" any more fuel.

Stop, grab your breath, and explain yourself again. Just remember what it was like when you " just didn't know....."

RainDreamer, BSN, RN · Mar 24, 2006

Just a word of caution to you... you said you have been on the floor for eight months.. Do you realize how upset you got with the new nurse you were giving report to?? Yes, it was late and you had a horrible day and night.
Please, don't ever forget how you felt as a new nurse having to deal with a new situation. I know I would have felt sudden panic when I was told I had a patient who was to go to ICU.
It was simple to you because you have had time on the floor and you have learned what to do. Don't give the phrase "eating our young" any more fuel.
Stop, grab your breath, and explain yourself again. Just remember what it was like when you " just didn't know....."

Look at this from both perspectives though. From Chrstine's perspective .... she had a night from hell, BUSY as can be, already late getting out, she's tired and wants to go home. BUT, she didn't just give report and leave that new nurse on her own .... she explained the whole story to her twice, she spoke slowly and clearly and asked if she had any questions. Then when the new nurse asked what she should do, she suggested that she go assess the patient. She was patient with her and told her exactly what to do. How does that come across as a "nurse eating their young"?????

It didn't sound like Christine made her feel like she was stupid or anything. She was just venting about it here, taking it out that way, which has to be done ...... it's a lot better venting it out here than to vent it out there at the hospital on the new nurse.