I had a crappy shift last night on our medical surgical. My job at times is so stressful that I hate it. I always leave thinking, "They cannot pay me enough money to do what I did tonight".
Here is an inadequate description:
I started the shift with three patients (pretty good, but I had first admission). I had one patient that was itching to be discharged and the doc was there writing d/c instructions. He told the patient, while I was in the room that it would be only 15 minutes for him to be discharged. I HATE IT when they tell a patient that. I have to write out the instructions and the meds and time of last dose and blah blah blah.... So, I said, rather snottily: It will be longer than that, as I have three other patients to check and I have to write out the instructions. The doc said, "Oh". I thought, I am not letting you get away with that you *******. As it turns out, he was STILL writing out all the meds for d/c as an order 15 minutes later. Doctors are such asses. They have NO IDEA how much more difficult they make our jobs. I had two other patients one was in with a huge tunneling gaping groin and abdominal wounds (that started out as a boil). Go figure. She had a PICC line and was getting TPN Lipids and Heparin, and she was diabetic w/two accu checks on my shift. She was a very sick lady with chronic renal failure and recent history of multi-system organ failure. She was on continuous oximetry and the monitor kept wailing ALL NIGHT. She was pretty much total care and confused. The other patient that I started with was MRSA positive and diabetic (two accu checks on my shift). He had hand and upper arm wounds from cellulitis. His blood sugar was too high all night requiring lab sticks and rechecks and admin of insulin. He was a Hmong patient and spoke little English, but he just smiled and laughed sometimes. His PICC insertion site was draining, so I changed that dressing. That is just what he needed, the MRSA from his upper extremities to get into that insertion site, cuz the dressing was lose from drainage. I then got a surgical patient Perc Neph -- back. I had to set him all up and do all of his orders, do q30minute VS checks X 4 plus every hour times six hours vital sign monitoring because he weighed 350 pounds and had sleep apnea. I also got an ER admit that was admitted with hypothermia and hypoglycemia ___blood sugar of 18 when the EMT's got there____(who's temp I couldn't get up all night). He was very sick with history of chronic renal failure and diabetes. He required q2hour accu checks and a bair hugger and q1hour rectal temps to get temp up to an accepetable lever (93.1 rectally when I sat down to chart). All of these VERY sick patients were full code measures. I did not sit down to start charting on a discharge, a surgical, an admit, a patient with 400-600 blood sugars all night, and a chronic and acutely ill patient until 11:30 PM. I charted until 12:45 AM, and then left. They all required extensive DART Notes to cover my rather large ass. I was so tired that I was starting to have blurred vision. I rolled the windows down on the way home to stay awake. When I have shifts like that, I KNOW that I need to find something else to do in the nursing field. It was a very physically and emotionally draining night. My discharge's paper work was sent down to medical records before I could chart on him at 11:30PM, so I just went home. That could be a problem waiting to happen. I just did not have one ounce of strength left in me to go down to med recs and find his chart and make a d/c note. I pray that I did all the things that I was supposed to do. I hope I didn't forget anything. So, now I have a migraine and feel gross and disgusting today. My son woke me up at 7:30 AM My other son had his allergy shot at 9 AM. I have homework up the wazoo to do (I am working on my BSN). I came home last night so riled up and stressed out that I opened the fridge and went at it. I ate turkey and cheese and two bowls of cereal. Gee, wonder how I deal with frustration and stress........... I have to find another way to earn $25.00 / hour. I know that. What else can and should I do???????????????????????????????????????????????? ????????????????????????? Is it ANY better ANY place else? I guess I should just SHUT up and take it, huh?
Jun 5, '03
KitKat24-Ihave no way of telling how old you are or what your personal situation is like. But as a very empathetic fellow nurse also dealing with a huge amount of stress, I can honetly say that you do need to consider a job change ASAP! Work, Family and School are wearing you down. My last battle with an extremely stressful management position resulted in my having a coronary at the age of 47! Six months later I changed jobs. My health has improved along with my family life. You can not just "Shut up and take it"! Consider all of your options and make that change! Nurses are always in demand, you will be able to find a position that meets your needs. You may have to search abit but it's there waiting for you. You and those you love will benefit greatly.
Good Luck to you.
Jun 5, '03
No, you don't have to take anything. You are in charge of your own life. There is nothing to stop you from finding something better! What a horrible night you described! I have been there, too. I know exactly how it goes. My first two ideas are this: are there any other acute floors that are less acuity that you might transfer to (or floors that you like better/are better staffed), and can you afford to cut back on your hours? I was burned out too, from a typical shift like you described happening everyday, plus throw in no lunch break. It wears you down.
I took stock & really considered my options. I did three things: cut back by one shift/week, switched specialties to a "nicer" unit (we still get slammed, but I do have some good days from time to time), and enrolled back in school. I found my current unit by having been floated there a handful of times. It was always nicer there than my usual floor, so I applied for a transfer. You already have the school part going for you. It can be very stressful, but I am loving being back in school (non nursing program), and find it is a great motivator and distractor.Accolades to you for hanging in there!
My other thought is for you to look into alternative settings for nursing: clinic, hospice, home health, advice nurse, school nurse (depends where you live if you are qualified), outpatient surgery center, private duty, etc. Have you considered case management? All nursing jobs are stressful, but maybe one of them is better for you. I found a nice little niche where I actually have good shifts here & there. Hope you can find a happier home! Good luck.
Last edit by Genista on Jun 5, '03
Jun 5, '03
I hear you!!! That old saying that the grass isn't always greener on the other side is sooooooo true!! But if you want to take your career in a different direction.....something a little more laid back (ok if that's possible
) I am sorry you had a crappy night! I can say that my unit is not much better...
Hope you find a position that suits you and that you like....
Jun 5, '03
I know. I see outstanting nurses taking on new admits with sacks full of meds they are on, and I see the nurses with total care PTs, with lactulose, having BM clean ups on the half hour. Or the nurse who is contantly pestered for pain meds after they tell the PT they have to wait. Or the older confused PT's that cry out to the nurse for help because they are panicing. PT's who get angry at the food served to them. The challenge is always met. Hang in there, and hang on to yourself :-)
Jun 5, '03
Yes, there are good units out there, but you have to be very picky and careful. In MOST hospitals, medical-surgical units are the pits. Often have patients that should be in an ICU and just impossible stress levels. Will burn out even the best in 1 or 2 short years. I warn my students NOT to work in certain medical, surgical units upon graduation. The best units (IMHO) are the cardiac step down units. Postpartum units (mother-baby) are often lower stress, even pleasant places. Other suggestions--endoscopy units, cardiac catheterization labs, dialysis units, ambulatory surgical units.
Jun 5, '03
Not to be stupid, but does IMHO mean In My Humble Opinion?
Jun 5, '03
"Not to be stupid, but does IMHO mean In My Humble Opinion?"
Yes, that is its original meaning (with tongue firmly in cheek, since the opinion expressed is typically anything BUT humble), though as Internet time has passed, some people have started using it to mean "in my honest opinion." Kind of an elevator-music translation.
Jun 5, '03
I am to assume that you have a 4:1 pt ratio. I realize that this can be as busy as 6 and it sounds that it was. First I hold a firm belief that there should be other nursing staff that are willing and hopefully available to help. Do you have a charge/resource/whatever you call them person that is a nurse???? Where there other nurses that did not have the acute situations that you describe? Let me know but do not let one crappy night [ that we all have ] destroy you!! VENT, discuss and move on.
Jun 5, '03
We used to get up to six patients per shift, but after our last union negotiations I haven't "Kept" more than five per shift, meaning discharge one get another back to five. The thing is that these shifts are not that unique. I have at least two horrible shifts a month, sometimes three or four. I always get a kick out of the law stating now in MN "NO MANDATORY OVERTIME" and then they say the grid shows that we were staffed appropriately. Nurses are supposed to work an eight hour shift and leave the hospital. When you are SO BUSY that you cannot sit down to chart on ONE patient the entire shift and do not get to sit down until 11:30 PM to chart: I got news for you: THAT ISSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
M A N D A T O R Y O V E R T I M E.
I want to work my shift and go home. I DO NOT WANT to chart for 1 to 1.5 hours. I don't care what the money is. I want to go home.
Jun 5, '03
i totally know how you felt,but i guess you are still lucky you have a 4:1 ratio. i work in med/surg floor and we usually start with at least 6 pts.each, and we dont divide the census by acuity but by rooms.sometimes we're lucky if we get the rooms that are all ambulatory or are going home; sometimes we get the rooms that are all total care pts from snf, pts on isolation, or mentally retarded pts that will try to climb out of bed plus if it's your turn to admit.....and this 7a-7p. today i have 7 pts; 1 is asthmatic with pneumonia on aminophylline drip; 1 is on isolation(MRSA-urine); 1 s/p ORIF Left hip with broken 1st toe (1st day post-op); 1 s/p gastrectomy with ngt to suction,on tpn lipids and asked for demerol ivp q4 on the dot; 1 for egd/colonoscopy;2 discharged home around 1400...... but i survived.....How?.....i dont know.
Jun 5, '03
UNFORTUNATELY MOST PLACES I HAVE WORKED SEEM TO STAFF BY NUMBERS ALONE WITHOUT REGARD TO ACUITY OR NURSING HOURS REQUIRED TO CARE FOR ONE VERY SICK PATIENT...ALBEIT MEDICINE IS AN UNPREDICATBLE PROFESSION AND EVEN A SEEMINGLY STABLE PATIENT CAN CHANGE IN A VERY SHORT TIME FRAME..THAT IS SOMETHING THAT CANNOT BE HELPED.. BUT AS A RULE THEIR IS LITTLE CONSIDERATION FRO THE ACUITY OF THE PATIENTS ASSIGNED....WE HAVE ALL HAD NIGHTS LIKE THE ONE YOU DESCRIBED AND I'M SURE WE HAVE ALL CONSIDERED THROWING IN THE TOWEL AT ONE TIME OR ANOTHER... SOMETIMES IT SEEMS
YOU JUST CAN'T MOVE FAST ENOUGH TO GET IT ALL DONE..AND TO GET IT DONE SAFELY....IF THIS IS THE RULE RATHER THAN THE EXCEPTION ON YOUR UNIT. AND YOU ARE OBVIOUSLY THIS EXHAUSTED AND STRESSED OUT..THEN MAYBE IT IS TIME TO LOOK ELSEWHERE...ONLY YOU CAN ANSWER THAT QUESTION...
Jun 6, '03
OOh I am so sorry you had a bad night. try NICU NO NASTY WOUNDS HERE!
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