Longest Shift You've Worked

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As nurses, there may be times we are required to work long days. The other day, I successfully worked my first 23 hour shift.

What is the longest shift you've ever worked? 

Specializes in retired LTC.
5 hours ago, hppygr8ful said:

...... At the end of the day when my body is winding down I want it to be able to do so in peace. Even the patient's family was against sending them to the ER. 

There is a severely delusional thought process going on here.

Hppy

 

Sadly, when a pt is in acute distress, this is NOT the case! The panic and pleading look in their eyes just begs the staff TO DO SOMETHING, DO ANYTHING.!

But nsg homes can only do just so much. When a pt is just gasping for air or is writhing in pain, where is the end??? Esp if knowing that the situation can, and often DOES worsen. And freq the family is NOT present to witness the agony, and yes, I say AGONY, the pt is experiencing. And yes, I've positioned the pt, have oxygen running, am doing min-nebs, medicating as well as I can, but it is NOT ENOUGH for this pt to die comfortably and in peace. Family & PMP are aware.

I fully support being able to 'pass away in peace'. But tooo often that is not the case, and you're expecting me to watch the pt SUFFER & STRUGGLE!?!?! Hell, we treat animals better than to let them suffer!

No wait!! Just let me close the door and come back in about an hour! (NOTE: I'm being smarty!) So, yes, I'll work to transfer the pt. To leave them otherwise, just smacks of neglect & abuse. I don't have some magic wand to wave to make everything all better.

I just pray I've done everything I would want done for me and/or mine.

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Specializes in Rehab/Nurse Manager.
11 hours ago, hppygr8ful said:

So now we are bullying the resident into going to the ER when they clearly don't want to go. If the resident is of sound mind let her/him be. This is exactly why I would not want to be in a nursing home. At the end of the day when my body is winding down I want it to be able to do so in peace. Even the patient's family was against sending them to the ER. 

There is a severely delusional thought process going on here.

Hppy

 

I'm sorry.  It wasn't meant to be bullying at all.  For a patient who supposedly wants everything done, it seemed as if being further evaluated was in their best interest.  The person was absolutely miserable and refusing everything.  I involved family and the provider because I wasn't entirely sure she really even knew what she wanted 

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Specializes in Rehab/Nurse Manager.

Managed to only work 10 hours today.  But, there was an instance where I tried to delegate but I don't think I was successful.  There was a care conference today during which family requested staff receive training using a mechanical lift and repositioning in a Broda chair.  I mentioned that I would be happy to notify and have our staff educator follow up with this.  It seems as if this was not a good suggestion as the social worker was quick to add, "Or SilverBells may also be able to help" when others present seemed alarmed.  In other words, it's pretty much expected that I will be completing this task, even though our educator would be the better person to do so.  So, it's not like I do not try to delegate.  It's just that when I do, I receive push back, so my workload keeps piling up. 

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Specializes in Rehab/Nurse Manager.

It seems as if delegating tasks involving staff or patient education is not going to go over too well.  I'm generally met with subtle disapproval when I do so. 

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Specializes in Psych, Addictions, SOL (Student of Life).
2 minutes ago, SilverBells said:

Managed to only work 10 hours today.  But, there was an instance where I tried to delegate but I don't think I was successful.  There was a care conference today during which family requested staff receive training using a mechanical lift and repositioning in a Broda chair.  I mentioned that I would be happy to notify and have our staff educator follow up with this.  It seems as if this was not a good suggestion as the social worker was quick to add, "Or SilverBells may also be able to help" when others present seemed alarmed.  In other words, it's pretty much expected that I will be completing this task, even though our educator would be the better person to do so.  So, it's not like I do not try to delegate.  It's just that when I do, I receive push back, so my workload keeps piling up. 

So what's keeping you from pushing back. Does you job description include training to use with type of device. All they can do is fire you which would open you up to go job hunting.

Hppy

 

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Specializes in Pediatrics, Pediatric Float, PICU, NICU.
32 minutes ago, SilverBells said:

Managed to only work 10 hours today.  But, there was an instance where I tried to delegate but I don't think I was successful.  There was a care conference today during which family requested staff receive training using a mechanical lift and repositioning in a Broda chair.  I mentioned that I would be happy to notify and have our staff educator follow up with this.  It seems as if this was not a good suggestion as the social worker was quick to add, "Or SilverBells may also be able to help" when others present seemed alarmed.  In other words, it's pretty much expected that I will be completing this task, even though our educator would be the better person to do so.  So, it's not like I do not try to delegate.  It's just that when I do, I receive push back, so my workload keeps piling up. 

That’s not really push back, especially if you didn’t say anything when they suggested you may be able to help. You simply could have said “that would be something our educator will need to do but I can reach out to her now to coordinate that.” Simple as that. 

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You may consider finding a therapist ASAP who can help you with boundaries and assertiveness. Until you’ve done the inner work, you will be spinning your wheels like this forever. Don’t abuse yourself and don’t let others abuse you. All the best ?

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Specializes in General Internal Medicine, ICU.
3 hours ago, SilverBells said:

Managed to only work 10 hours today.  But, there was an instance where I tried to delegate but I don't think I was successful.  There was a care conference today during which family requested staff receive training using a mechanical lift and repositioning in a Broda chair.  I mentioned that I would be happy to notify and have our staff educator follow up with this.  It seems as if this was not a good suggestion as the social worker was quick to add, "Or SilverBells may also be able to help" when others present seemed alarmed.  In other words, it's pretty much expected that I will be completing this task, even though our educator would be the better person to do so.  So, it's not like I do not try to delegate.  It's just that when I do, I receive push back, so my workload keeps piling up. 

Um no? That wasn’t a push back. That was merely a suggestion from the social worker. You realize you don’t actually have to take everybody’s opinions and suggestions as commands and directives right? You could’ve just as easily reply to the social worker’s suggestion with a “push back” of your own—“I would be happy to help the educator if need be, but for now, let the educator do her thing,”. 

If this is how you respond to everyone’s opinions and suggestions, no wonder your workplace is dumping everything on you. You internalize other’s casual remarks as directives, and seem to have no spine of your own to establish any sort of boundaries. Are you that conflict averse that you can’t even stand up for yourself? Do you see all opinions opposing of your own as push back? Or do you secretly just enjoy the drama? 

If you enjoy being a door mat and punching bag to your workplace, then continue with whatever you’re doing. If you don’t, then you need to seriously make a change. 

How on Earth did you survive as a floor nurse with all your tendencies??

 

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Specializes in Psych, Addictions, SOL (Student of Life).
On 7/19/2021 at 7:44 AM, kbrn2002 said:

Unfortunately this happens in LTC frequently. Especially if there is any doubt about the residents cognitive ability to make sound decisions. The family that supports the residents right to refusal of care is quite often also the family that will hire a lawyer because the facility didn't do everything they could. 

So basically bullying that resident and family with repeated questions "are you sure you won't go to the ER to be seen by a doctor?" is CYA for the frequent charting about the refusal of care necessary to protect the staff when the resident is declining and refusing a higher level of care.

Best course of action is have a care conference with the resident and family, discuss palliative care and once all parties are in agreement with what if any interventions are to be taken get it in writing! Get that DNR order if it's not already in place [you'd be shocked at how many LTC residents clearly on the last of their nine lives are full code!] and care plan for comfort cares only.  We would even go so far as to get a specific MD order stating no hospitalizations if the resident does not want to go to the ER for evaluation and treatment.  

Even with a DNR code status until that comfort care order is in place the nursing staff including the unit manager has to be in CYA mode and document every refusal of care thoroughly. Part of that CYA charting for a resident with a new or recent history of refusals is updating the unit manager or whoever the manager on call is. I'm sure they don't like getting that call especially in the middle of the night but to CYA you bet that call is being made. I'm sure the providers don't like it either when the night nurse calls to get an order to transfer to the ER knowing the resident will probably refuse yet again, but again in CYA mode the order has to obtained so the nurse can document that MD was updated, orders received and resident continued to refuse. 

Delusional thought process? Yes, probably it is but in our lovely litigious society it has to be to protect the facility and staff.

I feel the need to clarify my statement. It is delusionl for SB to feel that it reflects poorly on her. We all know that sometimes no matter what we do to intervene a patient's condition will worsen and they pass from this earth. These are the kinds of thoughts we saw in Donald Trump who was fond of saying "Only I can fix it. " somethings just can't be prevented. This is delusional thinking at it's finest. Since SB has not shown any inclination to follow any of of they very reasonable suggestions offerec I will default to the response of  " My that is a problem! Good luck and take care. "

Hppy

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Specializes in retired LTC.
11 hours ago, hppygr8ful said:

...... Since SB has not shown any inclination to follow any of of they very reasonable suggestions offerec I will default to the response of  " My that is a problem! Good luck and take care. "

Hppy

Well-meaning respondents should just save their collective breath!

For multiple months, SB continues to pull our chains. I find being taken advantage of to be very offensive & disrespectful.  JMO

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Specializes in Rehab/Nurse Manager.

As bad as it sounds, I'm thinking of taking a LOA.  I feel my performance is worsening and that I need more than 1.5 to 2 days to recover.  

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Specializes in Rehab/Nurse Manager.
On 7/20/2021 at 8:10 PM, hppygr8ful said:

So what's keeping you from pushing back. Does you job description include training to use with type of device. All they can do is fire you which would open you up to go job hunting.

Hppy

 

I did not feel it was appropriate to debate this in front of family during a Care Conference.  This type of training isn't specifically listed as a responsibility but more than likely falls under those "other duties as needed" responsibility 

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