I am so proud of myself!

[christvs, DNP, RN, NP]

I just finished my 9th week as an RN in orienation (3 more weeks to go!) & I had the busiest evening on 3-11 PM last night & I had to write all about it here of course. :) It was wild, but for some reason I kept smiling (well, most of the time!) My preceptor only took one patient & I had the rest-which was between 4-5 for the shift. But geez, it really felt like I had 9 or 9 patients cuz one of my new admits (yep-I had two!) took up nearly all of my time. He had edema all over, so I hung IV albumin for that...then he needed 2 units of plasma-so I kept checking that he was ok during those transfusions...then he was on every 2 hours IV morphine (He had cancer-lymphoma)-& he was diabetic so I had to make sure the NA was staying up with VS & blood sugar checks...& his throat hurt from his chemo so he was on every 4 hour hurricane spray (gave that for the first time yesterday & he had all these other IV push meds like hydrocortisone, pepcid, etc...in other words I was practically camped out in his room! And on top of that he was a new admission for me, so I'm trying to do a really complete assessment on him especially initially & also ask him all the history questions but he goes "I have cancer, I don't feel great Christine. Just read my chart, ok?" I wasn't offended, I just wanted to make sure I filled out all the paperwork! So when his wife came to visit him later, she answered my questions thank goodness. He was on my case the whole night & if I was 5 min late with his morphine he told me I was late. So I said "I know you're in pain. But I also have 4 other patients who are all calling me at the same time, & some of them wanted pain meds too. I can only be in one place at one time." So he didn't say anything after that! Then the next time I came into his room (plus, I felt I was in with him so much that I was barely seeing my other patients-I mean they were more stable than him, but I would have liked to make sure they were still ok from time to time!) the next time I went to see him, he said "Hey, are you Armenian?" I was stunned that he was wide awake for the first time & that he was actually making conversation with me instead of barking orders at me. I said yes, & he said "Because I noticed your name on your badge. I'm middle eastern too. Are you going to be my nurse tomorrow? Because you are such a nice nurse." I was so shocked! I felt bad that I was complaining about how demanding he was to my co-workers. Oops! Then my other new admit...he was only there (supposedly) for observation after a procedure...but he ended up staying my almost entire shift from 3-10 because he felt anxious. I told him that because he was eating & drinking & going to the BRP fine & since he said his pain was a lot better that the docs said he could go home & that I have all his paperwork ready. But he kept saying I feel anxious I better stay. ?!?!?! He looked perfectly fine though! So I asked him do you have CP? No. Can you breathe ok? Yes. Is your pain better since you got the vicodin? Yes. Do you have nausea? No. Nothing was wrong! I even asked him "Well do you want me to ask your doctor to come see you so you can talk about what is worrying you?" No he said nothing is really worrying me! Then he asked if he could have a sleeping pill! And his wife was with him too & said yep, he gets all panicky. But he wasn't! He was just sitting there very calmly. And I am not the type of person who just brushes patients' comments aside-he was really just sitting there. So finally I said I'd ask the doc, & then I came back & said the doc doesn't want to give oyu anything else cuz you were under anesthesia today & I gave you the vicodin after that. So then he says "Well can I go home then?" !!!! OMG! I said, yes, I told you many times you could go home! AUGH!!! So finally he goes after I took out his IV & went over his DC instructions with him-then as he is leaving both him & his wife say "You were such a nice nurse. It really makes things easier when your nurse is nice." :) So I was happy to hear that-& happier to see him go to! Esp cuz my other guy was calling for more pain med right then, & my third pt. wanted meds too & his IV kept beeping & my 4th pt wanted to see me too for something. During all this craziness, I also found the time to DC two OTHER patients...don't ask me how. My preceptor was helpful until 8 PM & then she left for home ( she was up from 3 AM) so the charge nurse took over as my resource person-but I was still frazzled cuz the charge nurse can only do so much if she is at the desk-although she did help me with some things thank goodness-& so did another nurse who took pity on me running around like nuts. did I mention I never took a break at all? My nursing assistant was very good but even she was driving me nuts cuz she kept coming up to me for every single thing & I know she has to but then she started asking me questions on OTHER patients who I did not even have! So I told her I don't have them please ask the nurse who does have them (hello!) she was driving me nuts cuz obviously I was so busy I couldn't even sit -& I was trying to keep up with all my charting but she kept interrupting me! OMG!

Anyhow-I made it somehow. I 'm just proud that I handled all that esp, with my preceptor leaving & all. Honestly, I''m not afraid of when I'm done with "orientation" in 3 weeks cuz I feel like I'm on my own most of the time anyways! :) But what a night! Was there a full moon?

-Christine

[Tweety, BSN, RN]

Whew Christine you did a very good job!!! Kudos on that.

As a preceptor myself may I please offer one bit of advice....please take it or leave and know it's said with kindness and constructive.

You said "But I also have 4 other patients who are all calling me at the same time, & some of them wanted pain meds too. I can only be in one place at one time."

That's not always the best thing to say in my opinion. I never tell my patient "you're not my only patient". What you did right was acknowledge his pain. Demanding patients are a challenge for sure.

Anyway, I'm like you, it feels good to work your butt off doesn't it?

[christvs, DNP, RN, NP]

Whew Christine you did a very good job!!! Kudos on that.

As a preceptor myself may I please offer one bit of advice....please take it or leave and know it's said with kindness and constructive.

You said "But I also have 4 other patients who are all calling me at the same time, & some of them wanted pain meds too. I can only be in one place at one time."

That's not always the best thing to say in my opinion. I never tell my patient "you're not my only patient". What you did right was acknowledge his pain. Demanding patients are a challenge for sure.

Anyway, I'm like you, it feels good to work your butt off doesn't it?

Hi Tweety! Thanks for the advice. I was trying to let him know that I wasn't ignoring him & pointed out my other patients so he would understand what I was doing cuz he would sit there & watch the clock & tell me I'm late! But I know what you're saying & I did feel bad for him since he was in so much pain. What do you say then to a demanding patient who tells you you're late, where were you, etc? Thanks! :)

[Tweety, BSN, RN]

I ususally acknowledge that "yes, I'm a few minutes late, I'm very sorry, I'm concerned about your pain, here's you medication, what's you're pain level, etc." and take the focus off of my being late and back onto taking care of him. Usually, if you show concern for them and that you're not late because you're lazy and don't care, it works out.

Sometimes if I'm having a very bad day with the patient and he's been that way all day, I ignore their criticism and say "here's you're pain medicine, is there anything else I can do, I have time now".

But yes, sometimes you just gotta say "you're not my only patient...get a grip!' lol