Just a bad shift...

[0.adamantite]

I've had a string a bad shifts recently, and today was no different. A crashing patient in room A while my admission rolls into room B ... the blood is done in room C ... the UAP rings my phone, room D is vomiting ... a family member approaches me while I'm hustling down the hallway (a million things on my mind) saying there's something wrong with room E's television remote and it needs to get fixed NOW ...

I do my best and ask for help, but many of my co-workers are in the same position. What do you do? I try to triage needs, but how do you cope when you're patient's vomiting blood and room C is ringing for a pain pill, while your admission is being carted up next door with 6 family members in tow wondering where the nurse is?

When you think that you can stop by room B for just a few to hang their antibiotic, but then the elderly lady needs to use the toilet which can take up to 15 minutes, and you can't leave her alone because she's a fall risk? All the while, you hear the bed alarm of room C shrieking next door and the UAP calls your phone saying that room D's IV has infiltrated?

I guess I could go on and on... but the question is, how do you cope?

[exp626]

There is no transferring staff on a new admission, and often our charge nurse is dealing with other emergencies on the floor. I'd say 5/8 shifts are like this. Many of our patients are also on isolation, total cares who need turning q2-4, demented/fall risk, getting pain medications q2h, almost all are fall risks ... we do an average of 1 discharge and 1-2 admissions each shift. It's a good day when I don't have a rapid response. I know many units are like this. I like my job. I guess every once in a while it gets to be too much.

I'm still not good at triaging patient needs, especially since we focus so much on patient satisfaction. For example, while dealing with all of this, a patient's family member pushed the 'emergency' button in a patient's room, and of course I (being one of the only staff out on the unit at the time) ran over to make sure everything was okay. The patient's family member wanted their mom's food reheated. I said that because the patient was on Contact Precautions, we couldn't reheat the food, but could find her something else if she gave me a moment. She glared at me and said "You mean my mother has to eat COLD food?" (cue crashing patient puking in background) I just had to apologize and say we'd get back to them. I'm sure I will hear a compliant from it.

Seriously???!!! The code button to get food heated?! I'm going to assume she thought it was the nurse call light. Because she needs to understand that this dispatches the code team from across the hospital, and if people everywhere are pushing it to have their food heated, the code team becomes desensitized and doesn't arrive when her mom does code. But I work on a busy PCU unit as well, and sometimes I have to decide between these type of conversations (which will invariably irritate entitled visitors who WILL fill out the survey), and letting the LOL fall off the BSC I had to leave to answer the code button. But I'd have to come back for that important conversation, no matter how irritating. Besides that, while PCUs are known to be crazy busy, it sounds like you need help. I count myself lucky to have a 4:1 ratio with our PCTs having 6-14 pts, depending on our census or staffing. I've worked with less nurse/pt friendly ratios, and this is by far the best and safest.

[imintrouble, BSN, RN]

Not all shifts make me wish I was dead, but I no longer want to do even one.

On top of everything else, I've been around long enough to know it's not going to get any better, any time soon.

Why would any fresh faced new grad choose this profession?

There are percs, but they just end up chaining you to a job you don't like.

[Guttercat, ASN, RN]

Just a patient….. I think it is sad how hospitals overwork in my opinion one of their most valuable assets. Make sure to take time for yourself, and always remember you have patients who respect and admire the work that you do and will always be grateful for people like you.

What a nice thing to say. Thank you for posting.

Keep in mind, however, that many a hospital administration does not view nursing staff as an "asset," because our services are not billable. As opposed to physicians, we cost the hospital money. We are (in certain circles) considered a necessary evil.

That does not mean the Administration is not grateful for great nurses, because they do, but if they could replace us with cheaper labor, they'd do it in an eyeblink. And, in some cases they do just that.

The latest phenomenon is rapidly expanding technology and government imposed reimbursement standards which has changed the context of the actual delivery of care dramatically. What used to take five minutes to accomplish, now takes ten.

A patient comes in, and is given an "emergency button." To a sick patient who feels awful, cold food is an "emergency" and besides, how are they supposed to know about what is going on in Rm A,B, D, and E? And furthermore, why should they have to care or even know?

I think we're trying to promise patients the moon, and that's not fair.

[Wave Watcher]

I go to my safe place. LOL

[Caffeine_IV]

I had a shift like that one the last week of a job that I hated but I had 8 patients and one was coding and in the meantime my pancreatitis was wanting his dilaudid and my antibiotics were overdue.

Everyone is drowning. I just do the best that I can. You can't be in two places at once. I know management is big on us making patient's feel like they are "the only patient" you have and that is hard to do.

[ChristineN, BSN, RN]

I had a shift like that one the last week of a job that I hated but I had 8 patients and one was coding and in the meantime my pancreatitis was wanting his dilaudid and my antibiotics were overdue.

Everyone is drowning. I just do the best that I can. You can't be in two places at once. I know management is big on us making patient's feel like they are "the only patient" you have and that is hard to do.

In the acute care setting, 8 pts is way too many. I can't even imagine

[idrinkpop]

Oh man, I remember those days. I don't know how I survived my years as a floor nurse.

Thus why I work in Case Management now.

[AussiePupOwner]

Days like that can feel so demoralizing. Add to that a nasty doctor or two, meetings about patient satisfaction (warmed up food or getting trays for family members), and staffing cuts and its enough to make anyone want to quit! I was somehow able to tolerate days like you described until they cut our unit secretaries and CNAs and I put in my notice. How was I supposed to do all that and put in my own orders, answer the unit's phone, and do the CNA/PCA work also? I felt like they wanted better care with less resources and I could not SAFELY provide it under those conditions. I did school nursing for a few years and am now starting a hospice position.

[kanzi monkey]

Prioritize and delegate?

Tell the new admission's family (as you pass them in the hall) that there is an emergency on the floor (crashing patient) and please give me a minute I'll be with you as soon as I can! Let the transferring staff hang out with them for 5 minutes while you...

Call a rapid response on patient A

Shut off the pump and grab a quick set of vitals on C

Run past E and tell them you will get an "expert" to check out the remote

Ask the charge nurse to get the new admission settled...

Geez...is this vomiting falling old lady the same time as all the other stuff? Nevermind.

Go hide in a corner and cry.

Seriously, if you have had a lot of shifts like this, your unit sounds like it is severely, unsafely understaffed. Not all floors are like that, and they shouldn't be. I'd look for a transfer.

*sigh*

It's so true. However, this plan would be very difficult to implement because , well, you're more likely to never lead patient A's bedside if they are really crashing.

Guess what? Patient A is also not talking or asking you for anything. They are also not likely to fill out a patient satisfaction survey.

Keep patient A alive and do your best to keep others as physically comfortable as possible. And you need more help on your ward. I have seen floors do very well managing these issues frequently-- FLOORS. Not individual nurses. That's the difference--you need to work as a team and it sounds like you're not given the resources to function. Best of luck to you and your colleagues!

[thenightnurse456]

I've said it before but floor nursing is a customer satisfaction driven environment. It is CRITICAL that the floor nurse keep everyone happy- drs, families, patients, PT, OT, XYZ.

Except the nurse... Who cares how they feel!

Have you thought about transferring somewhere else or getting out of floor nursing?

[calivianya, BSN, RN]

Guess what? Patient A is also not talking or asking you for anything. They are also not likely to fill out a patient satisfaction survey.

Yep, this is the biggest problem with healthcare these days... cold food is more important than dying people, because people who die in the hospital can't complain about their care later. I guess administration secretly thinks we should just let all the sick people die, comfort the families nicely so they like us and don't sue, but then spend 90% of our time in the walkie/talkie patients' rooms since they will actually fill out a survey later. It's ridiculous.

[krisiepoo]

Oh man... My last 3/4 shifts were non-stop for a solid 12 hours but I'm so grateful I have a supportive charge nurse and UAP who are very helpful. I've come to realize I've found a fantastic place to work