You know the shift is gonna be a hot mess when ...

NICUNurseEliz · Sep 4, 2016

You know it's going to be a rough day when you walk into your pod and someone hands you a mask and surgical cap for bedside surgery starting right then on your patient who perfed one hour prior. :unsure:

(On the pediatrics floor) when you walk in and someone says, "we're not sure where your patient is. We think maybe he ran down the stairs.. Security is looking for him now." Excellent. Let me know when you find him. :)

When you walk in to your patient's BP being 10/5, have one PIV (which is starting to look a little ugly with dopamine running through it), no art line, and the surgeon is struggling to get a jugular line in. Oh, and the blood bank is calling to tell you that your 7 blood products are ready for transfusion. :nono:

Creamsoda, ASN, RN · Sep 4, 2016

You know your shift will be a hot mess when your patient is on a PEEP of 25, Fio2 100, PaO2 50, febrile @ 40 degrees Celsius, maxed pressors, white count
Glad I had a cup of joe.
Who wants to continue?
"You know your shift will be a hot mess when..."

Well at least you know they probably wont live that long into your shift....incoming hot mess admission afterwards! :geek:

CardiacDork, MSN, RN · Sep 4, 2016

You know it's going to be a rough day when you walk into your pod and someone hands you a mask and surgical cap for bedside surgery starting right then on your patient who perfed one hour prior.

Totally know what this feels like. Bedside abnormal surgery as I'm walking in and the surgeons operating are the residents I knew as baby first years and second years now as 3rd and 4th years hoping for the best!

CardiacDork, MSN, RN · Sep 4, 2016

Well at least you know they probably wont live that long into your shift....incoming hot mess admission afterwards!

That is true. When I have a patient that I know is not going to make it .... that we know is circling the drain ... Family will either withdraw or they'll die shortly. The good thing is that it takes a long time to get all the death paper work filled out by the MDs, the Chief Nurses, and so forth. Then the funeral home has to come so that always gives me like 1 to 2 hours to catch a break, some food and check on my 2nd patient.

Seasoned · Sep 5, 2016

...when certain hateful nurses are on duty!

FurBabyMom, MSN, RN · Sep 5, 2016

That is true. When I have a patient that I know is not going to make it .... that we know is circling the drain ... Family will either withdraw or they'll die shortly. The good thing is that it takes a long time to get all the death paper work filled out by the MDs, the Chief Nurses, and so forth. Then the funeral home has to come so that always gives me like 1 to 2 hours to catch a break, some food and check on my 2nd patient.

AH! Something the floors have we don't. A break when patient's die. I do remember that now! It was only if there was not going to be an autopsy or if a funeral home had been identified by the family though...

You missed the third and fourth options - the patient will die, family will withdraw, the patient is managed until such time they are able to be an organ donor or the family insists we try "one more thing" and the patient goes to the OR emergently to code (or bleed out) and die.

For us it's kind of like we're working like crazy trying to save a patient, they arrest, we're running a code, and it's either "successful" or not. Time of death gets called, ALL of the machines get turned off, anesthesia finishes up the code record and splits (if you have a CRNA they will often stay to help with morgue care, generally if it's a resident you can forget it), we get to call the charge and the house sup to notify them of an unexpected (non-organ donation) OR death. If we're on massive transfusion whoever is holding the blood bank phone gets to call them with time of death. We pick up the death packet, some of it gets filled out either by anesthesia or the surgery service (good luck tracking it back down) and some parts get filled out by the OR staff. Our charge nurse has to call like nine million people... As staff, we get to do morgue care (leaving all lines/drains/tubes intact) and surgery does their best to close... We have to do the transfer and discharge process for the EMR. Then you have to help transport to the morgue and take all paper chart components to medical records (as well as depositing any belongings/valuables in the safe if patient is unidentified at time of death). Super fun is putting 15 trays back together in some semblance of the correct order, as is trying to play tetris cramming trays onto case cart(s) to be sent for reprocessing.

Bonus points when time of death is called, you notify the OR charge and you're being assigned a "to follow" case. Or if you're being reassigned to give lunch or something else.

FurBabyMom, MSN, RN · Sep 5, 2016

Not necessarily. I mean, you have to be able to leave first for them to call you in...

I should add - most commonly I take call over the weekend. I no longer take specialty call or whole weekend (Friday 1900-Monday 0700) call. My weekend call is now assigned in 24 hour blocks. I generally get to escape. Though there was the one Sunday night where the charge called me in at 2200 and I was not relieved until after 0500 (no break, no lunch, nothing) and expected me to stay for day shift. Um, no. Heyll no. Going home to take a nap and will consider coming in to do lunches.

Or they see you and tell you to go somewhere and do something because you came in a few minutes early and the call team (who got called to come in at what would actually be the normal start time) isn't there yet. Bedside ICU chest cracking, anyone?

Yes...OR to ICU procedures. Generally for us though it's going to STICU, NICU or PICU and doing an ex-lap or ECMO cannulation/decannulation. It sucks though - a tiny human weighing maybe 4lbs attached to 19 or more times their body weight of medical equipment and now having teeny tiny vessels splayed for access for ECMO. Generally the poor parents aren't far away, watching (despite the PICU/NICU staff's insistence against that) and you know they know this is the last ditch effort.

Do we work at the same place? I'm having some flashbacks here.

Maybe? Never know?

At least you have other centers in your region. We don't, and the one time we had to divert all ER and possible OR patients elsewhere, they either overwhelmed the rinky dink hospitals or had to be lifeflighted several hours away.

Yeah, we are really very lucky here. Where I used to work when we did go on diversion it was bad. I was, at the time, in Appalachia. I was at a Level 1 trauma center then (doing neuro stepdown). The night we had something similar happen was the night we had a terrible storm, the Level 2 center lost power (and their generators failed) and had to transfer everyone out. All the stable-ish patients went to community hospitals. The adult critical care patients got flown to us, once we were beyond full they were transferred out to other hospitals. The kiddos got packed up and sent to our facility (only a few had to be transported to other facilities). We were on diversion but it would have been a 3-4 hour flight from where some of our patients were (storm injuries) and a trauma center not on diversion. So they had to land, were stabilized/taken to our OR and transferred out. We had more patients than we should have on our unit (acuity was way up because unless you needed a vent you weren't getting an ICU spot)... Worst night as a floor nurse ever.

Wait, you mean we actually need more resources if it's a 747? C'mon, now, a plane crash is a plane crash. Not.

I mean...maybe? I think so? Who knew?

Been there,done that, ASN, RN · Sep 5, 2016

Currently.. it's a hot mess when I can't get internet access to work from home.

Back in the day , it was a hot mess when I walked into my first patient's room and bloody stool was flying everywhere.

Before breakfast, no less. What other "profession" has to clean up hematochezia, assess the patient for hemodynamical stability .. and notify the physician before they can have an 'efffing cup of coffee?

AvaRose · Sep 5, 2016

I had the worst luck during my critical care clinical. First day I was put in the trauma bay of the ER and my "patient" came in as unresponsive reason unknown and no other details. I guess that was their code for figure it out for yourself. He started out good, except that no one could insert a Foley. I had the dubious honor of the first 2 attempts, then my instructor tried, my clinical nurse and the ER doc even gave it a shot with a baby Foley all with no success (I actually was sort of relieved because it wasn't just the student couldn't get it in...). Then I was instructed to assess his breathing and heart sounds and heard an odd noise. I had no clue really what it was except it was NOT normal (this was an ah moment...that's why they beat NORMAL into us so hard so we could hear not normal). It was a murmur upon further evaluation...one that was not there a month prior at his last check up. Then the patient started going downhill...On top of that while the patient was in for testing there was a code that came in and I was sent to help. The patient was basically a DOA that the ER DOC worked on for 15 minutes but he had been down for at least an hour already...Paramedics shocked him 3 times even though he was in Asystole go figure. Back to primary patient...he needed blood and most of his lab values were critical. Diagnosis Cirrhosis with Ascites and several other problems including the lack of opening in the urethra and the heart murmur.

The following week in the ICU I had a patient who had a leaking chest tube for a spontaneous pneumo and I had to give report to the doctor because my clinical nurse was swapping patients with the IMC...talk about putting the student on the spot. Then the last week of Critical Care clinical I was in the Neuro ICU and ended up floating to the Surgical ICU upstairs for a patient who was going to be an organ donor but went septic and turned into a DNR instead so I helped remove the support eventually after having to wait for the family to arrive while trying to keep enough pressors running to keep the patient from coding then helping once again with cleaning a patient after death. I think I would have felt better about seeing so many things if I didn't feel a teeny bit cursed to have 2 deaths in one clinical rotation...

**NickiLaughs, ADN, BSN, RN** · Sep 5, 2016

Let's see...helicopter on the helipad with another one circling waiting their turn and 12 ambulances in the bay, a line out the door of medics with their patients on gurneys and hear a page overhead of 911 in 5 minutes and the charge nurse asks you to head straight to the trauma bay because there's on,y 1 nurse back there with 3 traumas rolling in. Yet there's plenty of "assistant nurse managers" in the office drinking coffee.

i don't work there anymore.

sevensonnets · Sep 5, 2016

You can expect a hot mess anytime you come in on your off day (if you were dumb enough to answer the phone). Don't get me started on Christmas or Thanksgiving. All the lonely little old ladies arrive in the ED with 2-3 suitcases. Their bellies hurt and they have been vomiting for a week. By the way, what time is lunch?

CBlover, BSN, RN · Sep 5, 2016

When your pt calls the desk at 1850 and says, "My chest hurts and feels real tight..."