So I am running a team with 9 patients, 2 new admits come up from ER. Med/Surg with no aides. One patient has q1hour neuro checks, One drug addict who overdosed and I am trying to keep a close eye in case she needs any more narcan. 2 demented patients who pull out their IV's and keep trying to climb out of bed. One CHF patient who is a DNR-CCA and her lungs sounds are getting worse. One new admit is a closed head injury with CHF and needs assistance with everything. So far OK.
The second admit (5 minutes after the first has arrived from the floor) is dx with hypokalemia. Every two hour vitals. Needs everything-foley not put in in ER. Wrong IV fluid. Needs a KCL bolus that I must make up and there is no NS on my floor or the next floor to mix it up. Also must hunt for a pump to run it. So I beg borrow and steal to get everything she needs. It is night shift so we do labs until 5:30 a.m. She arrives at 3 am and her second set of cardiac enzymes were due at 1 am an ER didn't do them. I get them. I put her orders in the computer. She is scheduled for 6am labs CBC,BMP, Mag level ect.....
Fast forward to 5:30 am and the admitting doctor makes his way up to the floor to check his patient and says "Could you come here and look at this" as he is reviewing the order sheet. I come over and he starts to scold "I wanted these labs done when she arrived on the floor" "Really?" I say. "Because the order reads (as I point to the order sheet) CBC, BMP, Mag level qam. And as for policy, qam labs are drawn between 5;30 and 6:00 am." He looks at me as if I have grown another head and then says "But I wanted them when she arrived on the floor."
Then he says very condicendingly "What do I need to write to get something done when a patient arrives on the floor with you as their nurse?" I think to myself &*^%$#@ but say "you could write now, or stat instead of qam". He looks at me again as if I am a moron and I know, I just know that he does not get it. Then he takes me to another chart for a patient that I requested 2 point soft restraints for after the third time they pulled out their IV. This patient is on a special bed because he crawled over the rails during day shift and took a nasty fall and by the way-his toes have gangreen and I am hoping they will not fall off during my shift.
Doctor says "I would appreciate more documentation for the need of restraints when you ask for an order for them." Really? Because the nurses notes read "confused, combative, attempting to crawl over railings of bed'. Next entry "Pulled IV cathater out, confused." Then charted the next IV started. Another entry on taking the second IV out. All that is missing is the third IV pull out that I have not yet documented but will. So I review with this doctor what has been charted and of course I will document the last IV pull out. (After I am done washing my hair in the patient's bathroom lol). Anyways..............Some days just stink like that. Thanks for letting me vent.
