My first "Why did I choose nursing?" shift

Nurses New Nurse

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I was lucky enough to land a job on a Medical-Tele unit in August after graduating with my BSN in May. Although I know it's not my "dream job" I was so excited to start working in a broad area that would be helpful if I wanted to advance my career/education.

I've been off orientation for about 6 weeks & it's been a tough road. Working the evening shift 3p-11:30p I do A LOT of discharges, admissions & transfers from other areas of the hospital. I've slowly gotten more used to the chaos & I'm usually thankful to be pushed so hard to advance my time management skills but nothing compares to what I had last night.

No LPNs were on so we had five RNs primary-ing four patients each with one unit clerk (a tech essentially). Upon getting report I found out I already had an admit assigned to me, a discharged patient that was simply waiting for a ride, another patient with plans to be discharged later in the evening & a stable patient that would be on my unit for the night (that's 4 patients total, our normal ratio). I wasn't too worried at first, until my first discharge left & my manager assigned me two additional admits at once. YES, TWO AT ONCE. Before my first one had even arrived. Thankfully I had already assessed, gotten vitals & charted on my stable patient (there's those time management skills), so he was settled until the 1800 med pass. I continued to do as much as possible to get my rooms ready for my admits & get my discharge done but I've learned quickly that sometimes no matter what you do, you cannot avoid the perfect storm. (That's what I call it when you get report on all your admits/transfers/post-ops at once all while your other patients need to get up to the commode, were incontinent in bed, need prn pain meds, etc.) So I got report on my first admit who needed a PCA (I've never set that up before, but our most senior nurse is here tonight, I'll just have to ask for her help later *sigh of relief*), and after getting her to the unit, settling her in & finishing up her admission for the most part, report was called on my second admit... Ok... bring it on I guess. His chief complaint was hemoptysis, and according to the ED nurse he still needed one more unit of blood as his Hgb was 6.6. WHAT?! That would've been nice to know when you requested a bed from my manger. How am I going to fit that into my night?! I held back a scream and instead said "Okay, send him up." And while he was en route to his room the ride arrived for my other discharge, so I attempted to go over his paperwork with them, but then he "Had to take a ****" (his words I swear, not mine) so that would have to wait. I moved on to my admit who had just arrived & went through most of his admission assessment & stepped out to grab something to find another nurse going over my discharge paperwork with my patient. He apparently got inpatient after he went to the bathroom, but I'm just thankful someone caught him before he left with nothing! I thanked the nurse & continued on with my second admission when report was called on my third. Not even a half hour between! I quickly found out that my GI bleed admit would also need another unit of blood that they did not have time to start downstairs in the ED, but she said they could get the 250 flush bag of Normal Saline going at least.... He came upstairs saline locked... With no fluids going at all :banghead::banghead::banghead:

So the night continued on & I somehow got all my admission paperwork done, got consents signed, fed people that wanted food, passed their meds, made them comfortable, got the PCA pump programmed with the help of my savior senior nurse, and got one unit of blood hung & started and unfortunately left the night shift nurse with the other unit of blood, but the 250 flush bag of normal saline through the blood tubing was running & ready to go. My report went late as I explained each of the admits thoroughly to two different night shift nurses. The look of disappointment I received from the night shift nurse that received my patient that still needed the unit of blood killed what little bit of hope for the night I still had left. She had an admit coming too, and I know she'd be busy with that, but that wasn't my fault, our manager does the staffing, not me, and did she understand the night I just went through?! UGH.

I tried my hardest to get everything done, I really did. Everyone else on the floor was really busy with their assignments too, they all felt bad for me, they told me they did, and they just kept saying do as much as you can, but I still felt like that wasn't enough. I got in my car after leaving the shift late & just cried cried cried the whole way home. I was sure I missed something. As I sit here typing this I'm still sure I missed something. I was spread so thin I can't imagine I got it all done. I'm so nervous to go back & see the mess I created. I actually asked myself last night why I decided to take such a hectic job? Why am I a nurse? I normally never have that attitude. I've read on posts here time & time again that it gets better, but I can't imagine a night like that ever being manageable. How do I get over this feeling that I forgot something? I not only needed some time to vent today but I just need some reassurance that it'll be okay, because at this point I'm truly feeling like it won't. :sorry: I'm defeated.

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My goodness I didn't realize this was so long, I just kept typing away & never really looked at how much I said. My apologies, readers!

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Breathe! We all lay awake wondering what we missed, what can go wrong because we missed it, and what kind of trouble we will be in tomorrow because we missed it. We all have the nights from hell, and we mange to get through them.

it sounds like you got done what you could. It also sounds like you spent time making sure report was accurate and thorough, so if you did indeed miss something the night nurse will have caught it by now.

You managed to get through orientation and the manager assigned you a nasty set of patients because she BELIEVED in you! No one wants a bad outcome, if they thought you couldn't do it, you wouldn't have gotten the assignments that you did! I think one of the most difficult things for all of us new nurses is to try to have the same faith in ourselves as management has in us. I bet anything you get to work on your next shift and find out all your patients are doing great and that you missed nothing at all!

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I had a night last night where I felt the same way. It all happened at once, with multiple issues arising at he same time. Ended up forgetting to input one set of outputs on a pt with a foley (even though I'd written it down and starred and circled it!) and was called at home, as pt's foley was removed and he hadn't voided since by 4 p. I felt like my head was swimming all night and felt horrible when the day shift nurse had to call me. Thankfully, that was the only issue, but I still feel a little nervous to be coming off orientation in a week.

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Specializes in MICU, SICU, CICU.

Please take what I am about to say as constructive feedback and not criticism.

If your pt was actively bleeding, the unit of blood should be started as soon as it is ready. It should be a high priority. A pt can have an MI due to severe anemia. That is why the night nurse let out a big sigh.

Four patients is not unreasonable for a telemetry unit. They probably turn over half of their census everyday. Hang in there and you will acquire some wicked good skills that will serve you well throughout your career.

I know that it was a very difficult shift and that you were stretched too thin. Speak up next time, say I need to start this blood would you please discharge this pt. You should always ask yourself, who is the sickest and fix that first. You survived and everyone is okay so kudos to you.

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Specializes in cardiac/education.

Way to survive, OP!!! :)

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Specializes in Critical Care, Postpartum.

Hugs for you...Where was your charge nurse during all of this? If you are at the point of being overwhelmed, you need to reach out to him/her. If you're getting two admissions, ask if s/he can admit one while you get the other. If not, as you mentioned, there are senior nurses on your unit working that night who you could have asked for assistance. I started on a very busy, stressful ICU stepdown unit and those senior nurses were quick with their admissions and assessments. I could always go to them when I was getting overwhelmed and falling behind.

Also want to mention that nursing isn't done in 12 hours, it's 24 hours. Hang in there!

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Please take what I am about to say as constructive feedback and not criticism.

If your pt was actively bleeding, the unit of blood should be started as soon as it is ready. It should be a high priority. A pt can have an MI due to severe anemia. That is why the night nurse let out a big sigh.

Four patients is not unreasonable for a telemetry unit. They probably turn over half of their census everyday. Hang in there and you will acquire some wicked good skills that will serve you well throughout your career.

I know that it was a very difficult shift and that you were stretched too thin. Speak up next time, say I need to start this blood would you please discharge this pt. You should always ask yourself, who is the sickest and fix that first. You survived and everyone is okay so kudos to you.

No criticism taken! I even thought when I woke up the next morning, "Wow, I could have done last night better...I should've done this first & then that & everything would've gone much smoother." Looking back I realized I should've just got my admits settled, worked on getting the blood, and done all the admission paperwork in the room with them while their blood transfused since I needed to remain in the room anyway. Although it was a very stressful experience it was also a great learning experience, thanks for the support! :yes:

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Hugs for you...Where was your charge nurse during all of this? If you are at the point of being overwhelmed, you need to reach out to him/her. If you're getting two admissions, ask if s/he can admit one while you get the other. If not, as you mentioned, there are senior nurses on your unit working that night who you could have asked for assistance. I started on a very busy, stressful ICU stepdown unit and those senior nurses were quick with their admissions and assessments. I could always go to them when I was getting overwhelmed and falling behind.

Also want to mention that nursing isn't done in 12 hours, it's 24 hours. Hang in there!

Another thing I realized once I got home... My nurse manager leaves for the night at 8 and by that point I was too busy to even think about where she was. Once she was gone the nurse in charge was busy with her own admits & transfers... It was a busy night all around but next time I know I'll be someone asking for help!

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Thanks for the support & advice everyone. Nursing is TOUGH but it's great to have a support system here. And don't worry, I still want to be a nurse... :) Realized the next day there are more tough days to come but I'll make it.

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