Golly, I thought maybe I wrote that post in my sleep, because the OP sounds exactly like what I'm going through on my tele unit. I've been there for six weeks; I've had three weeks off orientation. We do have nursing assistants, but I can almost never find them, and it seems like almost every day the manager takes away one of their responsibilities and gives it back to us--because one or another of them screwed up. Gee, if I screw up, can I make someone else do my work for me? Now it's our responsibility to do the baths, too, because they aren't getting done. Exactly what is the CNA supposed to do?
The charge nurse makes rounds in the morning and basically lets them know they have an RN waitress to take care of their needs. I get to hear that so-and-so didn't get their bed changed yesterday, or so-and-so needs to have their light answered faster. Even though they know I spent the day running, didn't even take a bathroom break, much less lunch, and that I always answer lights as soon as I can--if I know about them. We're supposed to have cell phones so the patients can dial direct, but often there aren't enough phones to go around or the patients still buzz the desk and the message doesn't always get to me. Heaven forbid they could call the CNA, who always has a cell phone, to get the patient a cup of ice (I must do that 20 times a day, including for visitors who stop me while they're roaming the halls ), while I'm trying to admit my cath lab patient. The other day I was admitting a cath lab patient (alone, of course) and trying to page the doctor for pain med orders and my other patient (whom I admitted from ER a few hours earlier with no help, and had spent much time with) threatened to go AMA because nobody got him to the bathroom, and it was all my fault. I spent 45 minutes personally showering a third patient, and my CNA couldn't bring her BSC while I'm admitting another patient?
I walked into a situation on Saturday where my patient had a K+ of 2.6 and Mg of 1.7 and nobody had done anything about it, and found both her arms infiltrated. She had come two days earlier from ICU with one arm completely blown. But the night nurse decided that he wouldn't put the ordered 10 mg of Lidocaine into her potassium bolus "because it would affect her cardiac status" but chose to run IV fluids concurrently instead "to water it down" and destroyed the 22g and the remaining arm. But he stopped running boluses at 1 am, so she went all night with only one bolus for the 2.7 K+. And he didn't report the followup K+ of 2.6, despite protocol that we call for K+ less than 3, so I'm calling at 7:30 am for multiple boluses of K and Mg, and then begging pharmacy to mix my K and Mg together so we can replace simultaneously, while my charge nurse is desperately trying to get another line in somewhere, and find a doctor who can put in a central line. So I wasn't all over my other patient who had come from another floor with CP and a troponin of 20, who had a TO during the night for a cardiology consult but nights didn't ask who they wanted for the consult, and so they didn't do it; so it didn't happen until the attending came through in the morning and wrote for the consult; by then, the cardiologist had already come and gone at 8 am and had to be brought back to the hospital. I think the charge nurse wrote three incident reports just for my morning.
I walk in every day expecting the worst, and usually getting it. I always hear about the negative. I don't hear about the patient who hugs me and tells me I'm the only one who showed her any caring, or the one who was livid about the care she received from the previous shift but now feels confident that she's going to be taken care of as long as I'm there. The patients tell me, but they don't tell anyone else. I got torn apart on my second day of orientation by nights over something minor, and when I said it was my second day at the bedside after six years away, I got looked at like I had three heads. Nights is very hard on us, but I think they live in a glass house. I worked nights for a long time, so I have no illusions about what it's like on that shift.
I can't seem to get my organizational skills down, although I made myself a worksheet on the computer and that has helped a little bit. My background is mostly ICU and long-term care, both of which have a different organizational skillset. I go home exhausted and my head is spinning and I'm having delusions/hallucinations when I wake up in the night or in the morning (had one this morning and yesterday, too). The tape never stops running. I replay it over and over until the next shift and the tape is dubbed over. I now have "sparks" in my lower extremities and am losing the feeling in a couple of toes, similar to what I had when I went to survival school twenty-five years ago.
Oh, and I start school tomorrow. Not sure how I'm supposed to log in and do schoolwork when I'm putting in fourteen hours away from home and coming home a wreck, but hey. What am I thinking?