Need to vent about my crazy day at work..

[christvs, DNP, RN, NP]

Hi! I am in my 4th week of orientation now as a new RN & what a day I had today! I had 3 patients today: one is pretty stable except she has hyponatremia (it was my 4th day in a row of having her), my second patient was a poor guy with everything under the sun wrong with him (A flutter, endocarditis, multiple bacterial & viral infections in his joints, mouth, etc; horrible joint pain, a bed sore) & this was also my 4th day in a row of having him as well. Then at 7:45 AM I get my 3rd patient-who just came up from the ER-she had an ectopic pregnancy & I had to assess her, do her admission sheets & be done fast cuz she was scheduled for surgery within the hour. So I'm trying to get the pre-op pt all squared away first, but then I find out pt. #2 has a high blood sugar so I get him insulin, & I kept getting interrupted by family members, doctors, etc. so it took me until 9:25 to get my pre-op pt all done (& she is crying when I go to talk to her by the way cuz she's worried about her surgery-understandable. I felt bad for only listening to her a little & giving her a tissue & trying to keep going with my assessment)& they came to take her to her surgery at exactly 9:30 -phew! I just made it. :) So then I went to do my assessments on the other two-my hyponatremia pt was ok-except she was soooooooo worried about every little thing. And she was on a 1200 cc fluid restriction so I tried to explain to her how much she could drink during the day/during each shift....OMG! All week long I've had her & every day I spend sooooooo much time teaching her over & over how much she can drink but no matter how clearly I explain it, she still says every time "But I don't understand these things." ugh! Then my really sick poor pt. takes a turn for the worse-they think now he may have a bowel obstruction-but they can't get an NG tube in him (is the doc incompetent? I don't know!) even though he is vomiting all day-plus he has got to be on a zillion meds! Before he got sick & started vomiting he was still scheduled for his PO meds-& he has about 15 of them due at 9:00 AM. But it was such an ordeal to get him to swallow then cuz he had a lot of trouble getting them down, so he only took a couple at a time-& he couldn't get the big ones down (so I told the doc about that) & then I had a swish & swallow for him to take & he BARKS at me "You said I was done with my PILLS!!" OMG. I tried to stay calm & say he was in fact done with the pills, but now he has a swish & swallow to take (like he has been taking every morning this whole week!!!) so he finally takes that. Then I am about to give him a heparin shot in his belly when he yells "WHY DIDN't YOU GIVE ME THAT WHILE I WAS TAKING MY PILLS!!!!" But of course I couldn't cuz I was holding his pill cup in one hand & his water in my other hand as he took his sweet time (about 15 minutes) to take all his pills-so I pointed that out to him-that I only had two hands & could only do one thing at a time! Ugh! Then he was on every 2 hour IV morphine, then on IV Reglan & Zofran for his nausea, not to mention an antiviral cream for the herpes lesions around his mouth (yes I wore gloves!) & a CPM machine for his leg (on every 4 hours, off every 4 hours), plus did I mention he has a PICC? So I had to flush that per protocol with saline & then heparin....and then he had 3 bags of IV antibiotics to hang at various times, then his sugar was high again-so time for more insulin! Augh! When I finally took my lunch break at 1:30-2 PM, the SECOND i got back, "Christine, your post-op pt. is back." ugh! Time to do vitals on her again, do another assessment on her, chart it, look at the PACU sheet on her, check her post-op orders, talk to the nasty MD to clarify her post-op orders, get her pain meds, & then I was running back to my other guy to hang more antibiotics, empty his Foley (oh & I had a lazy CNA today-she didn't do several things she was supposed to-great, even more work for me!) I did notice that I was so annoyed by her laziness that I forgot all about being shy about asking her to do other things for me (cuz she was literally sitting around!) I asked her to do several tasks -which I was proud of myself for asking her-& then I made sure I watched to see that she really did them)-then I gave report to the 3-11 nurses & by the time I punched out to go home it was nearly 3:45 PM! (we're supposed to be done @ 3:15) Geez louise! And I'm back again tomorrow.

Thanks for letting me vent to all you patient souls who are still reading this! :) By some miracle, I still really do like my job-but I just have such a headache right now! Augh! I need to get to bed early tonight! :)

-Christine

[grinnurse, RN]

Christine-

Sorry you had such a trying day. Hopefully today will be better for you. I hate days like that when all you can do is put out fires. Glad that we have allnurses.com to vent on though!!

Kelly

[Nesher, BSN, RN]

You are on orientation? Where is your preceptor to help you trouble shoot some of your situations? Where is your preceptor to deflect some of the stuff from the two pt's while you try to focus on your preop? Sounds like you are not getting what you need out of this orientation. The idea is not to slam you against an wall and see if you can still walk and take a bit more. NO, the idea is to nuture you along as you learn to hone your critical thinking skills, develop stategies for difficult situations.

Why is the pt with a possible bowel obsruction taking in anything orally by the way?????? Why didn't you put in a NG? Since when do docs do it? Why wasn't everything switched to IV form?

At any rate all I can say is where is your preceptor?????

[suzanne4, RN]

I have to agree with Nesher, where was your preceptor? Or even charge nurse?

And if a patient is suspected of having a bowel obstruction, there is no reason that they should be taking po meds.................nurses usually place the NG tube, except some facilities still require that a physcian place a Cantor tube, if this is what they were trying to do. The Cantor tube has a weight a the end that will sometimes be able to open an obstruction. But his meds should have all been given only in IV form...........

[Bijou-Spice]

christvs--I have been reading your posts as you have updated us through on your various orientation experiences......so I have noticed the confidence you have gained. You are growing to be a awesome nurse.....I would have had a melt down in your situation!! And I agree with the others, where was your preceptor!! My final thought...someone will be fortunate to get you as their preceptor some day because now you understand what a new grad needs!

[christvs, DNP, RN, NP]

christvs--I have been reading your posts as you have updated us through on your various orientation experiences......so I have noticed the confidence you have gained. You are growing to be a awesome nurse.....I would have had a melt down in your situation!! And I agree with the others, where was your preceptor!! My final thought...someone will be fortunate to get you as their preceptor some day because now you understand what a new grad needs!

Thank you! :) I do feel more confident now than I did a month ago when I started. As to everyone's questions on why my patient (I'll call him Mr. X) was not NPO-I knew they were questioning a bowel obstruction on him & on the 3rd day I had him the docs made 4 attempts to put in an NG tube (the other nurses on my floor told me that only nurses in the ICU in my hospital put in NG tubes-on other units the docs do it) & they couldn't get in the NG tube for whatever reason. Anyhow-I had my Mr. X from M-F every day & he had tons of trouble swallowing his big pills (& he had 15 pills every morning-ugh) so when I heard on day 4 of having him that he was NPO now I called the doc in the morning to double check about whether he wanted me to give him his pills or not-& the doc said still give them-then I heard later on that they did tests & he did not have a bowel obstruction after all. I probably should have found out what he did end up having-but honestly, I was sooooooo wiped out from doing 50 gazillion things for this patient every second that I was just so tired after I gave him all his meds & treatments. My lord was I sick of having this patient! I was jumping up and down with job today cuz I have the next three days off-woo-hoo! :) I did learn a lot from him-but honestly, I feel like I'm not getting a ton of help from my preceptors (I've had 9 different ones at this point). The preceptor I had thursday was great-she actually checked up on me at times-what a concept! But I did go and get help when I needed it-like when I couldn't get the IV pump to work, or I had a question on how fast to run a 250 mL bag of antibiotics, things like that. I feel ready to move up to 4 patients next week-but at the same time I can't be taking patients like Mr. X (who should almost be in an ICU setting!) & then 3 more on top of him-cuz I need to get used to 4 somewhat stable patients first-just to get used to taking care of 4- & then I can move up to more complex patients-don't you think that's reasonable? I get the feeling that my preceptors think I will learn more if they leave me alone most of the time-I think this is good most of the time, but not when I have patients like Mr. X! Plus I was going nutty trying to figure out what to do with the post-op patient & Mr. X & the third patient. I feel like I did a good job considering everything-but I agree with whoever said I should be getting at least a little more guidance. Although I am being forced to learn pretty quickly this way! The other nurses say I'm doing a good job, but I do feel nervous when left alone almost the entire day with a complex patient like Mr. X. Wouldn't you guys too? Just curious what you think. :)

- Christine