Meltdown moment...when was yours?

i've had too many to count, but the one that immediately springs to mind happened 5 or 6 years ago. i was in charge in the icu, and not only were we full to bursting, but we'd had a couple of sick calls. i spent hours and hours on the phone trying to line up staff, board out some of our more stable patients to other icus (specialized patient population) and deal with the patients we had who were going down the tubes. one of the cardiac surgeons and one of the cardiologists had a fight about their mutual patient -- right in the patient's room -- which ended with the cardiologist decking the cardiac surgeon. (usually it's the other way around!) and then one of surgeons tracked me down where i was trying to make an ice bag for the injured surgeon and said, "i just wanted to let you know that my patient is going to be a little delayed."

"which patient?"

"the one who's coming from moose dung community hospital. the balloon pump wouldn't fit into the helicopter, so they're trying to take it apart to see if they can fit it in."

this was the first i'd heard of any patient coming from mdch!

"oh, by the way," he said over his shoulder as he was walking away. "they called quite awhile ago, and i forgot to tell you. sorry."

oh yeah. they'd called quite awhile ago to say the patient was coming. they'd called again to tell him the balloom pump wouldn't fit on the helicopter. they'd called him a third time to tell him they were borrowing a travel pump console from goat spit general hospital a few towns over and they'd called a fourth time with their eta. somehow, all four of those calls had slipped his mind, because when i headed back for the nurse's station and my "brain sheet," i heard the unmistakable sound of a helicopter landing in our parking lot. did i say i had no beds? "no problem, we'll open a bed in pacu -- you'll just need to send a nurse since they don't do balloon pumps," said the every-helpful nursing supervisor.

did i mention i'd had sick calls? i ended up taking the fresh post-op (and retaining charge of a 22 bed icu!) while the nurse who was going to take the post-op went to the pacu to admit this balloon pump patient who couldn't go to any other icu because they don't do balloon pumps, either. and then i stayed four hours of overtime (making it a 20 hour day since i was doing a double to start with) to tend the patient in the pacu before he got whisked off to the or! during my last hour, the anesthesiologist wanted me to turn the patient for him so he could listen to breath sounds. (did i mention the patient was 120 kilograms?) (i'm told "imbecilic moron" is redundant).

at that point i'd had about 20 years of experience.

and then there was the time i was in charge of a 12 bed ccu full of eps patients, balloon pump patients, ventilated patients and one patient on dialysis. it was a sunday afternoon, and the maintenence staff felt it was the perfect time to change out the emergency generator for the new one they'd bought. it was a complicated procedure involving lifting out the old one with a crane, then slowly lowering the new generator into place and hooking it up. no electrical storms were predicted, the city grid was good and it looked like an auspicious day for such a task.

until the crane lowering the new emergency back-up generator into place slipped and dropped it on the main generator, thus destroying both of them. the good news is that the electricity only went out in part of the hospital. the bad news is that that part contrained the er, the or, the cath lab and both icus.

we had no lights, and no outside windows. the hospital didn't provide flashlights and the penlights each nurse carried to check pupils weren't very big, very bright and didn't last very long. ventilator batteries don't last very long, and balloon pump batteries last even less long, especially when someone had forgotten to plug in the balloon pump during a very long sojourn in the cath lab. we only had two portable monitors and 5 or 6 eps patients. one rt who had to decide which patients to bag, which to delegate bagging and which could (probably) survive an emergent extubation. the dialysis machine had no battery and we had to pump the blood back into the patient by hand. our phones didn't work, although there were three payphones in the lobby. one of the doctors took up a collection of quarters so that i could run the phone list from the payphone in the lobby to try to get some help.

did you know that the thing to do in that situation is to call 911? i didn't! turns out the fire department has a portable generator that they bring. we got through the crisis, power came back on, and i was congratulating myself and the staff for getting through without losing a patient and only losing one staff member (hit his head on a cupboard door in the dark and knocked himself out.) then my nurse manager came in and announced "this place looks like hell! couldn't you have at least cleaned up after yourselves?"

that was a meltdown moment! (12 or 13 years of experience)

My meltdown moment came about 2 weeks after I got my license. I was working as a nurse on the same psychiatric unit that I had worked on as a tech through school. Actually I was still orienting (I had about 3 weeks to go). There was a really big snowstorm and the two other nurses I was supposed to work with called in. So I show up after fighting to get there through the storm and it is just me and the tech for the night. The day shift nurse tells me that the hospital is so short on nurses and the best they could do was send an LPN from the float pool to help with meds, but she has never worked our unit and never done psych before. Oh and guess what, I am charge nurse. :banghead:I start freaking out already saying I can't be charge, I'm still on orientation. I really considered quitting right then and there before I even took report, but I didn't because I really like my job and unit.

Okay so i psych myself up, saying "It's going to be okay, you can do this." And it probably would have fine if that night wouldn't have been sent straight from hell to test me. Turns out I am walking into the 7 patient we already have, plus I have 2 brand new admits one from 1820, and 1840, and there was an admit that came at 1400 that no one had even started on. So I have three admissions, 2 who are fairly stable and frequent fliers, and one who is crying so loud you can hear her through the glass partition in the nurses station and before I can even go out to talk to her to calm her down, I get a call from the ER saying that the police have brought in an Emergency Detention patient and that they are on there way up in the elevator and "Oh, by the way, he is in straps and you probably will need to keep him that way."

So I hurry to get out there to meet him, grab the tech, and the police help us get this guy restrained in a seclusion room. So I am hurring back to the nurses station to call the doc to get Ativan for the sobber, Haldol for the restrained guy, and call my supervisor to get a tech to sit 1:1 for the restrained guy. Before I make it there a patient stops me and says she is having chest pain so I take her B\P and it is through the roof, like 180\100, or something. So I go in the nurses station, close the door, ask the secretary to page the psychiatrist, the CP ladies MD, and the supervisor, and then I start sobbing. I just felt so overwhelmed I couldn't stop crying.

So of course this is the time the supervisor arrives, sees me crying and freaking out, and instead of staying and offering to help, she goes back to her office and calls my unit manager and tells her I can't handle it as charge nurse.

It all worked out in the end though, I got my extra tech. Thank God the tech I was working with was really good, she did so much to keep the milieu together and work on the admission paperwork.:bowingpur I got orders for everyone and CP lady got better with a little attention and Nitro. Everyone got medicated, and went to sleep.

We made through the night, nobody died and all the paperwork got done. Unfortunately, none of the patient got the attention they deserved but you can only do what you can do. It really was one of those nights that makes you question your career choice.

i've had too many to count, but the one that immediately springs to mind happened 5 or 6 years ago. i was in charge in the icu, and not only were we full to bursting, but we'd had a couple of sick calls. i spent hours and hours on the phone trying to line up staff, board out some of our more stable patients to other icus (specialized patient population) and deal with the patients we had who were going down the tubes. one of the cardiac surgeons and one of the cardiologists had a fight about their mutual patient -- right in the patient's room -- which ended with the cardiologist decking the cardiac surgeon. (usually it's the other way around!) and then one of surgeons tracked me down where i was trying to make an ice bag for the injured surgeon and said, "i just wanted to let you know that my patient is going to be a little delayed."

"which patient?"

"the one who's coming from moose dung community hospital. the balloon pump wouldn't fit into the helicopter, so they're trying to take it apart to see if they can fit it in."

this was the first i'd heard of any patient coming from mdch!

"oh, by the way," he said over his shoulder as he was walking away. "they called quite awhile ago, and i forgot to tell you. sorry."

oh yeah. they'd called quite awhile ago to say the patient was coming. they'd called again to tell him the balloom pump wouldn't fit on the helicopter. they'd called him a third time to tell him they were borrowing a travel pump console from goat spit general hospital a few towns over and they'd called a fourth time with their eta. somehow, all four of those calls had slipped his mind, because when i headed back for the nurse's station and my "brain sheet," i heard the unmistakable sound of a helicopter landing in our parking lot. did i say i had no beds? "no problem, we'll open a bed in pacu -- you'll just need to send a nurse since they don't do balloon pumps," said the every-helpful nursing supervisor.

did i mention i'd had sick calls? i ended up taking the fresh post-op (and retaining charge of a 22 bed icu!) while the nurse who was going to take the post-op went to the pacu to admit this balloon pump patient who couldn't go to any other icu because they don't do balloon pumps, either. and then i stayed four hours of overtime (making it a 20 hour day since i was doing a double to start with) to tend the patient in the pacu before he got whisked off to the or! during my last hour, the anesthesiologist wanted me to turn the patient for him so he could listen to breath sounds. (did i mention the patient was 120 kilograms?) (i'm told "imbecilic moron" is redundant).

at that point i'd had about 20 years of experience.

and then there was the time i was in charge of a 12 bed ccu full of eps patients, balloon pump patients, ventilated patients and one patient on dialysis. it was a sunday afternoon, and the maintenence staff felt it was the perfect time to change out the emergency generator for the new one they'd bought. it was a complicated procedure involving lifting out the old one with a crane, then slowly lowering the new generator into place and hooking it up. no electrical storms were predicted, the city grid was good and it looked like an auspicious day for such a task.

until the crane lowering the new emergency back-up generator into place slipped and dropped it on the main generator, thus destroying both of them. the good news is that the electricity only went out in part of the hospital. the bad news is that that part contrained the er, the or, the cath lab and both icus.

we had no lights, and no outside windows. the hospital didn't provide flashlights and the penlights each nurse carried to check pupils weren't very big, very bright and didn't last very long. ventilator batteries don't last very long, and balloon pump batteries last even less long, especially when someone had forgotten to plug in the balloon pump during a very long sojourn in the cath lab. we only had two portable monitors and 5 or 6 eps patients. one rt who had to decide which patients to bag, which to delegate bagging and which could (probably) survive an emergent extubation. the dialysis machine had no battery and we had to pump the blood back into the patient by hand. our phones didn't work, although there were three payphones in the lobby. one of the doctors took up a collection of quarters so that i could run the phone list from the payphone in the lobby to try to get some help.

did you know that the thing to do in that situation is to call 911? i didn't! turns out the fire department has a portable generator that they bring. we got through the crisis, power came back on, and i was congratulating myself and the staff for getting through without losing a patient and only losing one staff member (hit his head on a cupboard door in the dark and knocked himself out.) then my nurse manager came in and announced "this place looks like hell! couldn't you have at least cleaned up after yourselves?"

that was a meltdown moment! (12 or 13 years of experience)

note to self..call 911 if we have no power..i had a rough night tonight so i def. enjoyed your post. hope this never happens again!:bowingpur:banghead:

Ruby............Moose Dung and Goat Spit General Hospitals.....??

:hhmth:

Dear Jelli Belli....I am just starting with prerquisites. You have completley horrified me! As I read your post I was actually laughing out loud because of the insanity of your whole situation...but when I stopped laughing....I began shaking in my shoes.....please tell me this is NOT typical....

ruby............moose dung and goat spit general hospitals.....??

:hhmth:

i was hoping someone else laughed at that! i love you, ruby! can we just have a forum that is your stories? you tell them so well, in such detail - i feel like i'm there! and you make them always professional and funny!

jess

Thanks to every poster for their story.

I live by these rules most days:

1. Even on the best of days, things tend to screw-up.

2. Take a deep breath, count to ten, and do what you can to fix the problem.

3. Ask for help.

4. Be kind.

5. While driving home I can have my own breakdown, meltdown, and screaming

fit.

6. God loves me.

Blessings to all.

one of the cardiac surgeons and one of the cardiologists had a fight about their mutual patient -- right in the patient's room -- which ended with the cardiologist decking the cardiac surgeon. (usually it's the other way around!)

i'd have paid to have seen it, no matter who decked whom.

then my nurse manager came in and announced "this place looks like hell! couldn't you have at least cleaned up after yourselves?"

that was a meltdown moment! (12 or 13 years of experience)

that would probably have ended my nursing career, right there. just as soon as they pried my hands from around the nurse manager's neck.

you're a better woman than i am, ruby!

Brand new nurse

more to come later

Ruby............Moose Dung and Goat Spit General Hospitals.....??

Yep, I was thinking the same thing there Tazzi -

But, then I remembered that I've BEEN to some of those hospitals (often) ---

I do love the INTERfacility RESCUE! (Meaning the patient is so ^#(&@% that recovery may not be possible - what about that doing no harm thing??? - wonder if some folks ever heard of it???)

The doc was real focused on "You fly away now!" Big surprise there!

As for the MELTDOWN MOMENT -

I'm way overdue! I've been so good at maintaining CONTROL that it sometimes works against me! Woo!Hoo! It's coming and it's gonna be BAD!

Around 1 year experience, 7 primaries 11-7 ortho/medsurg. One pt was severely DD and needed a new PEG. General surgeon had attempted replacement unsuccessfully and was going to do it next day.

PEG currently in place can't be used at all, pt needs sz meds but no IV equivalent to her specific med available and pharmacy had known this since 5 pm. Report takes nearly an hour and before I'm even able to swing on my stethoscope, the pt's caregiver is on the phone ripping me a new one because she hasn't gotten a replacement IV sz med.

I call pharmacy to see if they have a replacement, they state this med only comes in liquid and I needed to get a different order. I call the surgeon ASAP and he rips me a new one even worse for about 20 minutes because the order was written at 1700 to replace med with IV equivalent and even though I just came on and had nothing to do with it before now and had no idea why it hadn't been dealt with 7 hours earlier.

Then when I hung up, the nursing supervisor called and asked what was going on because the caregiver had called her all ****** off, too. As soon as I heard her voice, I started bawling. She came up to my unit and helped me calm down :redbeathe and dealt with pharmacy/doc herself. We ended up giving the pt her liquid med rectally.