I had a super miserable shift yesterday. I'm a new grad, barely off orientation, in a crazy busy ER with a difficult population. I have 6 patients, who ought to range in severity from "You came to the ER for THAT?!?" to IMU. I should never have an ICU patient.
In a 2 hour period, I got 3 new patients. No problem, that's busy but I can do that. The problem is that these were the patients:
1) Came in for knee pain. Hx of liver disease that the patient said he saw an outside doctor for, but he had enough ascites to look pregnant, his legs looked like CHF and he had crackles. Oh, and he had an episode of angina last night, but "I'm here for my knee. My chest pain got better when I sat down for awhile and took some Tums. Why yes, it was in the middle of my chest and now that you ask, it did feel like pressure instead of pain." Ok, the monitor looks ok so I'll keep you and just run an EKG, enzymes & a chem 8. Oh, the EKG says possible current ischemia? Wait, the troponin is elevated? And his hematocrit is 6???? Let's talk to the patient again--oh, a history of melena, awesome. Hey, residents, this guy needs someone to look at him now. Can I move him to a resus room? No, not until the ICU consult is done? But he's got ischemia and a GI bleed and terrible liver issues and he's threatening to AMA because I won't let him eat!Sure, I'll just hang the blood and the protonix and octerotide, which means multiple calls to the pharmacy since we don't have that on the floor. Oh, hi ICU consult. No, those 2 20s are the best you'll get without an EJ or a central line, and you'd better be happy we got those in. I know you want larger bores, but I can't make veins magically appear. No, I will not take your 20 verbal orders, we don't do that and do you not see me pushing this guy to the resus rooms now that you've agreed to take him? I literally told the doctor "I think we should bring this guy over to the resus rooms. I am not the nurse you want taking care of this patient right now."
2) Dialysis patient sent to me from the resus rooms because she was "stable." Her K was OMG HIGH even for a dialysis patient. She was Spanish only, but why isn't she responding to most of my questions? My Spanish sucks but I can at least assess a dialysis patient. And why is she saying she had dialysis 1 week ago at this hospital when our records show it's been more than 2 wks. Hey, Spanish speaking coworker, can you ask this patient if she'll take her Kayexalate? Why is the patient just staring at me instead of taking it or protesting? Hi renal fellow! Wait, why are you calling the ICU right now? Usually our resident does that. Oh, we're trying to get her a bed RIGHTNOW and not 5 minutes ago? Hi, charge nurse? Come pick up the dialysis patient. Report? She refused the PO Kayexalate and she's unchanged from when you dropped her on me 2 hours ago despite me protesting an insane K and AMS together indicated she wasn't an IMU patient.
3) Guy comes in with vague chest pain x forever. Oh, and I fell at home a few weeks ago and it's been hard to breath since then. Fine, let's do some enzymes and a chest xray per protocol. Look, negative enzymes but the chem 8 indicates new onset renal failure. His potassium is WHAT? Awesome, let's push the cocktail. Oh, you need to take him to the resus rooms for a chest tube because his entire R lung is white on the xray? Here's the lab on the line with critical values for half his chem 8.
My other 3 patients were pretty low key and very stable, which was good because they were all getting ignored for HOURS. Like, one guy came in with a family member and I just glanced at him every so often to make sure he was still breathing. I figured the family member would tell me if he started doing something weird. Safe? Not by a long shot, though I didn't realize how unsafe it was until I was talking to my old preceptor this morning.
My charge nurse came by when she realized how bad my patients were and sent me to lunch. I was so frustrated and exhausted I started crying in the middle of the floor! I gave report to a few of my coworkers and they had almost everything done by the time I came back. The charge nurse put holds on some of my beds so I wouldn't get new patients. The other new grad took lunch with me (at 4 pm) and we ******* about life and I came back and charted like mad until the end of the shift.
I just needed to vent to some people who would understand. Thanks for listening.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I don't know who you are..where you've been...
but your opinion of the "lowly med-surg " nurse 'the idiot med surg nurse' will surely bite you in the AZZ and I hope sooner than later.
I was looking at the post and I understood it to be the Dr. was "looking for that Idiot med surg nurse" as a quote from the MD as I believe this poster works med surg as was commiserating about a miserable day.
It is never a good thing to wish bad on other people as karma has a way of working things out.
I guess my concerns in regards to the crying issue are twofold.
First, I have 3 daughters and I see one of my primary responsibilities to them to teach them the skills they will need to function in an adult world. I'm not raising children, I'm raising adults. I'm becoming more aware each day of the double standard that society (yes, that includes parents) holds boys and girls to as they are growing up. It seems that girls are given a "pass" on the expectation that they must develop age appropriate skills for coping with their emotions. This isn't because girls are incapable of developing these skills. It's because society draws a parallel between physical strength and emotional and mental strength. This is incorrect.
While, on average, females may not be as physically strong as males, I don't believe females are mentally or emotionally weaker than males. Society simply doesn't levy the same expectations on females as they do on males. This is a HUGE disservice to our daughters.
I want my daughters to be respected for their mental and emotional strength as well as their strength of character (among other things) I do not want them to be ACCOMMODATED or tolerated because of behavioral problems attributed to their gender. Therefore, I teach my daughters how to COPE with their emotions and how to fix the problems that are causing them to feel like crying. This approach is far more EFFECTIVE than crying at a problem only to find the problem still there when the tears clear.
The second issue is professionalism.
A previous poster mentioned that she had seen Dr.s cry and throw temper tantrums. Again, unprofessional behavior should be called out regardless of the gender or hierarchical position of the person displaying it.
And please god, dear baby Jesus, can somebody explain how "*Professionalism* stems from letting out your emotions"? I've only seen the perceived professionalism of badly behaving adults eroded by crying, temper tantrums etc., whether in public or "private".
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
As a RN/manager/supervisor with 33 (34 next month) in the critical care/ED arena......I would hire a new grad if I felt they had the "right stuff" Of course they will have to have more guidance and time. But that ED assignment of the OP would rattle the cage of an experienced ED nurse.
Of course I have cried at work. In the back room or behind closed doors. that what smoking was helpful for.....emotional outbursts, get it out of your system, decompress, and get back to work. Ah...the good ole days. I would NEVER let a MD know they upset me enough to make me cry for I would never give them that satisfaction the arrogant %^$#^#@. I've cried in the way home. I've cried on the way there. When I first moved to New England at my first ED job....I was treated so poorly by ny fellow nurses that I wanted to quit nursing all together.
But I refused to be defeated, or browbeaten, into submission. Get your bad day out of your system. Have a good cry and adult beverages. Then get up get dressed and go back to work to fight another day. It will get easier but there will always be those days that if one person walks through that door you are going to stab their eyes out.
It sounds like you're doing ok .....:hug: Don't let the naysayers get you down.
I don't understand why so many people insist that nursing can't be considered a profession unless held up to some arbitrarily, impossibly high standard.
I've seen doctors cry both out of frustration and sadness. On the flip side, I've also seen them throw pretty epic temper tantrums, certainly without further disciplinary action. (Also don't think that I'd compare crying with punching a hole in a wall. One causes property damage. The other is just embarrassing.)
*Professionalism* stems from letting out your emotions in the proper environment, with the right people. Not from bottling them up.
I'm not sure why crying is unprofessional. Crying in front of other people might be unprofessional but crying is called normal. I'm glad there are people out there who think they are super humans and better than everyone else though.
I don't understand why so many people insist that nursing can't be considered a profession unless held up to some arbitrarily, impossibly high standard.
Hippygirl, you are so right! But, the problem is deeper than people selecting 'arbitrary' criteria; they are deliberately selecting specific traits they possessand hold these as the 'high standard' for professionalism (or standards for what makes an effective nurse, or a great wife, or a perfect father). These are typically not quantifiable traits, making it easy for the competitive or ego-driven individuals to conveniently assign their own traits as the 'gold standard' by which all others are measured.
This behavior is apparent everywhere, and you've probably seen it as recently as this morning. Someone (wearing freshly pressed scrubs) observes, "That is SO unprofessional... she looks like she slept in those clothes!" Or, "How do others see us when his arms are covered with tattoos?" Obviously, the speaker in these situations thinks (and wants YOU to believe) that wearing creased scrub pants or lacking body art makes a person an exemplary employee. When employees make these references to me, my response has been, "How does that impact patient care?" They stutter and stumble and talk about 'images' and 'professionalism' and dredge up their grandfather and his intolerance for such things, and point out that he came to America, blah, blah, blah.... When they ran out of steam, I ask again, "So, how does that impact patient care?" They'd usually abandon the argument (at least with me), but I'm sure they're not really convinced, because what they truly want to believe (and have others believe) THEY are a great employee and their colleague is not. You can't change someone's underlying insecurities in a conversation or two, nor do you really want to--people who need this kind of 'evidence' of their superiority sit on a precarious and dangerous precipice where they and their ego could crash with a little introspection.
Healthcare is a business. It is driven by dollars and money--and before anyone launches into 'well, it shouldn't be!', the truth is organizations need to be competitive in order to survive. And, not surprisingly, this is actually an example where free-market economics drives competition, and in turn drives quality, where the ultimate goal is patient satisfaction. To make a consumer satisfied and happy has to do with outcomes and being treated warmly and respectfully. The important professional issues supervisors are concerned with--issues that truly impact patient satisfaction--are honesty, lateral violence, theft or pilferage (especially of meds or narcotics), insubordination, verbal confrontations, unreliability, and patient neglect (which is the ultimate concern).
Until someone persuades me that an employee who cries is impacting patient care, I'll be the first one to hand out tissues then fix the problem that caused their overload. Until then, my energies will be devoted to the real issue on the floor: patient care.
Hippygirl, you are so right! But, the problem is deeper than people selecting 'arbitrary' criteria; they are deliberately selecting specific traits they possessand hold these as the 'high standard' for professionalism (or standards for what makes an effective nurse, or a great wife, or a perfect father). These are typically not quantifiable traits, making it easy for the competitive or ego-driven individuals to conveniently assign their own traits as the 'gold standard' by which all others are measured.
This behavior is apparent everywhere, and you've probably seen it as recently as this morning. Someone (wearing freshly pressed scrubs) observes, "That is SO unprofessional... she looks like she slept in those clothes!" Or, "How do others see us when his arms are covered with tattoos?" Obviously, the speaker in these situations thinks (and wants YOU to believe) that wearing creased scrub pants or lacking body art makes a person an exemplary employee. When employees make these references to me, my response has been, "How does that impact patient care?" They stutter and stumble and talk about 'images' and 'professionalism' and dredge up their grandfather and his intolerance for such things, and point out that he came to America, blah, blah, blah.... When they ran out of steam, I ask again, "So, how does that impact patient care?" They'd usually abandon the argument (at least with me), but I'm sure they're not really convinced, because what they truly want to believe (and have others believe) THEY are a great employee and their colleague is not..
Wow great post and life lesson! Especially the part about assigning a person's own traits as the gold standard!.
I was looking at the post and I understood it to be the Dr. was "looking for that Idiot med surg nurse" as a quote from the MD as I believe this poster works med surg as was commiserating about a miserable day.
It is never a good thing to wish bad on other people as karma has a way of working things out.
YOu can disagree without being disagreeable.
Yes you are 100% right. It is too late to edit my post and I will forever be definened as rude, and an idiot for not using quotes correctly. lol
Yes you are 100% right. It is too late to edit my post and I will forever be definened as rude, and an idiot for not using quotes correctly. lol
And, I found a misspelling in mine! Oh, the horrors! Now, we'll be judged for not using quotes and spelling errors! Thankfully, the opinions of those doing the judging don't really matter!
And, I found a misspelling in mine! Oh, the horrors! Now, we'll be judged for not using quotes and spelling errors! Thankfully, the opinions of those doing the judging don't really matter!
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Yes you are 100% right. It is too late to edit my post and I will forever be defined as rude, and an idiot for not using quotes correctly. lol
No biggie......I was just voicing a different point of view. :hug: That "You" is the collective you, not YOU personally....No one is defined by a single post on an anonymous Internet site nor the opinions of people who are not "really" a part of our lives. It'd the variety of opinions that are important to any discussion. Peace :paw:
Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.
I cried at work, 'cuz my grandfather died and I was really sad and stressed out about it. I don't think it makes me unprofessional, it wasn't in front of a patient, it makes me human.
Esme12, ASN, BSN, RN
20,908 Posts
I was looking at the post and I understood it to be the Dr. was "looking for that Idiot med surg nurse" as a quote from the MD as I believe this poster works med surg as was commiserating about a miserable day.
It is never a good thing to wish bad on other people as karma has a way of working things out.
YOu can disagree without being disagreeable.