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

[CardiacDork]

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..."

[dream'n, BSN, RN]

Charge RN of 26 bed inpatient oncology unit: 22 pts. and expecting 4 direct admits for chemo, floor split between 2 LVNs and 1 new grad RN (just off orientation & not chemo certified) and a float RN (experienced but not chemo certified or use to oncology). Staffing is trying to get another RN to come in for expected admits. (Our normal ratio on days was 1:4-5). Don't recall the exact number but at least 1/3 of the patients getting chemo, which is the charge nurses responsibility, along with hanging all the blood products & IV pushes for the LVNs (both of which are numerous on oncology). I knew it was going to be an extremely busy day but...less than an hour into the shift the float reports a chemo spill. ������ In the middle of cleaning up said chemo spill new grad calls a code--had no idea her patient was going bad. We rarely run codes in oncology, most of our patients are DNRs. Thank God for code teams! Needless to say, it was a really bad day...

You are tougher than me. I think I would have stroked out right then and there. But not until after the staffing office had gotten a BIG earful from me.

[Cricket183, BSN, RN]

I don't even know what to say to that. After 8 years of working oncology the thought of this gives me palpitations.

I have to admit my heart skipped a beat or two!

[Cricket183, BSN, RN]

You are tougher than me. I think I would have stroked out right then and there. But not until after the staffing office had gotten a BIG earful from me.

Luckily we had a great clinical manager who was on the phone with staffing as soon as she walked in the door. (Although we didn't get another RN, they did contact bed control and delay our direct admits.) And both the clinical manager and our oncology coordinator were the type of management who weren't afraid to get their hands dirty. So they helped out between meetings and cancelled/delayed what other responsibilities they could. We made it through the shift, but it was a bad day.

[Chilled1121, BSN]

When the Joint Commission makes an early bird appearance.

[Here.I.Stand, BSN, RN]

When one patient has begun stooling after 5 days, and the other is a newly admitted tPA stroke on contact isolation. True story.

Edited to add: for my non-neuro colleagues, tPA administration means neuro assessments q 15 min x2 hrs, q 30 min x6 hrs, and q 1 hr x16 hrs. Added neurovascular and groin checks if they had been in IR.

[NursesRmofun, ASN, RN]

You are a 12 hr traveler in an 8 hr unit...

You are told you are getting 2 patients, one a discharge and the family is angrily standing at the door to the room. Then you are told to take a patient from a nurse who tells you she just got report and she hasn't even gone in the room yet. Then you get a forth patient and can't find the nurse to get report from. Then 2 hrs into the shift you are told you are being floated. That was fun...NOT!

Oh my. Travelers sure do earn their money some places, don't they. Not sure it would make you feel any better, but our float nurses go through the same thing at my place of employment...except not the 12 hr mixed with 8 hr thing. We all do 12 hrs., but the kind of patients and changes are the same.

[sevensonnets]

Patient died on night shift but the family isn't here yet so patient hasn't been wrapped. Family isn't answering the phone. Central is out of morgue kits and doesn't know when they'll get more. And, by the way, admitting is on the phone. This is the only open bed in the building and they need it for an urgent admit that needs to be prepped for surgery by 8:00. Then a visitor comes to the desk all wide-eyed because they came to see mama and went in the wrong room and did we know there's a dead body in there? True story and I'm sticking to it.

[NursesRmofun, ASN, RN]

Charge RN of 26 bed inpatient oncology unit: 22 pts. and expecting 4 direct admits for chemo, floor split between 2 LVNs and 1 new grad RN (just off orientation & not chemo certified) and a float RN (experienced but not chemo certified or use to oncology). Staffing is trying to get another RN to come in for expected admits. (Our normal ratio on days was 1:4-5). Don't recall the exact number but at least 1/3 of the patients getting chemo, which is the charge nurses responsibility, along with hanging all the blood products & IV pushes for the LVNs (both of which are numerous on oncology). I knew it was going to be an extremely busy day but...less than an hour into the shift the float reports a chemo spill. ������ In the middle of cleaning up said chemo spill new grad calls a code--had no idea her patient was going bad. We rarely run codes in oncology, most of our patients are DNRs. Thank God for code teams! Needless to say, it was a really bad day...

[ReadyToListen, CNA, EMT-B]

...when I had to change into OR pants before 0900 and I don't even know my patients' names yet!

Or in my home of ER, walk in and see the bright orange intubation box open, nobody in sight, and a potpourri of scents coming from rooms that ought to be closed on night shift! Yeeek!!!

[Twinmom06, ASN, APN]

a bit different as I'm inpatient acute dialysis

when you get a text that you have an assignment of 6 patients, walk in to 8 patients as there have been 2 admits overnight, and

#9 is in the ER having skipped a week of dialysis with a K+ of 7+ and +4 pitting edema, and the nurse you're working with (only one other) can't possibly stay past 5 pm.

[Spookysushi]

When you receive a confused and combative direct admit for a liver transplant with and the attending tells you to move as fast as humanly possible to prep the patient for surgery. So you then drop everything, frantically try to get them lined and labed (with those great ESLD/ESRD veins ) send them for their pre op imaging studies, rush to get the paperwork together to then find out the liver was bad, then discharging them all within a few hours. So much work for nothing and sad for the patient and family.

[RN0310]

The off going nurse says, I'm sorry before she gives you report. You can hardly hear the nurse in report because the nurses station is full of organized kaos....