Frustrated - irritated - something

[SunDazed, BSN, RN]

I am just posting because I am frustrated or irritated or both? This is a big vent or a lot of little ones. I work 16 hour shifts on-call, from 5pm to 9am. The pay is a formula that is meant to compensate me but also presumes I am not working the full 16 hours.

There are times where I work 12 or more hours of the shift, and last night was one of them. These nights have gotten more rare in the last 6 months, but when they come they come in sets of 2 or 3 nights in a row. Argh! 

This Summer, with a higher census than usual, and staff encouraged to take all the vacation they need for a happy life, so much more falls on to night shift. Of course day shift and management needs to stay a little delusional to avoid upsetting the apple cart. All have to believe that their caseload will be taken care of if they are off sick or on vacation. Even if all but a couple nurses are left after all the sick calls?!? Fridays in the Summer? Ack.

It doesn't help that patients are coming on when they are near death's door, it is a very intense teaching EOL and symptom management slope... and de Nile, de Nile. My 85 year old sister who is dying can't have morphine... people die after taking morphine.... but we will agree to Dilaudid. What?!?! So narcotic naive patient can go straight to Dilauid? 

So she can call out in pain and suffer for 6 plus hours with morphine on hand, but need to wait for Dilaudid. Cuz that will be better? And will hospice be to blame that it takes over 6 hours for the pharmacy benefit manager to process this order? Who knows. I am not there to do the daytime teaching/coaching.... so after being there for 90 minutes in the middle of the night and getting her comfortable and updating the POA, I am going to have to do it again tonight? Hells to the no. If I get a call again tonight at 3am, then I am going to call the POA before I drive 20 miles and ask if the goal of care if actually comfort. If not, no drive. If it is? Well, I guess I will drive it again. And do it all again. And then the sister will come in and blow it all up the next day. People with money and no sense annoy the crap out of me.

Okay

1 for frustrated

2 for irritated

3 for sleep deprived

 

 

 

 

[SunDazed, BSN, RN]

Okay, I have sense had a good night sleep. Meet them where they are. Hospice is messy. Sure wish fewer staff were sick or on vacation at the same time.

[FolksBtrippin, BSN, RN]

I hear you. I also work on call 5p to 830a and also have had stretches where the job felt near impossible. I get very angry at case managers who seem not to do their jobs. I recently went out to disimpact a patient who had no BM x12 days!! And the real kicker is that the RNCM was there earlier same day and did absolutely nothing for the patient. So yes, it can be extremely frustrating. Also, RNs doing admissions without putting in a local fill for pain meds. I get called in the middle of the night and the pharmacy is closed. It's extremely frustrating. Hang in there.

 

[SunDazed, BSN, RN]

@FolksBtrippin

Yes, you know too! I was out to replace a chronic foley last week. RNCM had been there that day. The family had ASKED her to change it. Lots of sediment. She declined. Totally obstructed by bedtime. He had 1000ml out on replacement. They talk to their friends and neighbors and know it had been 4.5 weeks and was in the range of being replaced during her visit. Geez!

If it is was only me knowing we could do better, and the patients and families being sort of grateful for anything and not being the wiser, well that is one thing. But when the patients suffer unnecessarily, that is so wrong. 

[FolksBtrippin, BSN, RN]

I agree, it's wrong. I wonder sometimes if I should tell the clinical manager when things like this happen. The 12 days of constipation is downright dangerous, and so is a blocked foley.