Need to vent about my horrible night!! UGGG long

[txspadequeenRN, BSN, RN]

well i worked last night at a nursing home that i go to on a regular basis but normally would be taking the skilled medicare hall that has 24 patients or so. anyway i ended up with the bad end of the deal and got the split which means i have 42 patients while the other nurses have 24 or so..big deal i can handle it. everything went ok until about 4 am when one of the patients was riding the light to go to the bathroom the cna reported that she was having frequency and c/o severe pain when urinating . so i said well lets get a clean catch and ill get on the phone and get some orders. called the doc but he had himself a on-call doc on for him that night ...but anyway after that wonderful conversation got the order for ua/c&s but he also started her on cipro 500mg . i wrote all the paper work out did all the charting . then went to talk with the patient about the new orders and what we needed to do...mind you i have never worked this hall.i want to mention here the cna brought me a urine sample labeled with with mrs x bed b. the patient looked at me like i had 10 heads when i started talking about how long she had had the urinary pain ....:uhoh21::uhoh21::uhoh21: the cna got the a and b beds mixed up..lets not forget she is a staff cna that has been there many months. it was really mrs. y in the a bed, so i had to restart the procedure all over again. this means i had to error out all my charting and call another doc..ok fine whatever. got the new orders from the other doc and went on about my business...this &^%* doc that was on call ..the one i spoke to first called me back two hours later and explained to me that at 4 am there was no need to call a physician for anyone having s/s of uti. that is a non- emergent matter and could have waited until 8 am. i told him that any patient that is in pain is a emegency and i have to take care of the patient even if that means calling the doc at ..yes, 4 am. well he became a little mad at me wanting my name and such ..ranting about how there is no way to get the lab there that early and i would have to wait until 8 am anyway... when i told him we had stat lab services and because of the time of the morning the lab was already there he said..."humm well i don't think so"...whatever.. bye i don't have time for that mess cause i now have a cna standing beside me telling me that a man down the hall is screaming about not being able to urinate and his abdomen hurts so bad "he is going to explode"... i verified by the cna that he had not pee'd much all night..thanks for telling me now!!! patient did have some distention and very tender in that area. because this man had his foley removed yesterday and has bph. anyway got the order to re-insert the foley..anyone guess what happens next !!! you guessed it meet resistance an the patient is screaming bloody murder. so now it is 6:30a and the next shift is already here... i give report on this man to the oncoming nurse and she starts talking about "well you and me will just go in and re-insert this foley together"...uhhh no we wont i have had enough and my shift is over..the nurse(not the one i was giving report to ) working the other side said "why would you try again she just told you she could not get it in"...uggggg i could not make this nurse understand that she takes over from here. i guess she was expecting me to stay until the problem resolved itself...the last i knew she was over on the other side of the building trying to get someone else to put in the foley...i just don't know....but all i knew is that i was all kinds of frustrated and just needed to report and leave.... cause i have 3 more nights out there.. thank for letting me vent!!!!!!

[Jules Anne]

I can't imagine that a Doc would have nothing better to do than to call you back to tell you not to call him. If he was so tired, why didn't he just go back to sleep? Someone should really warn med students that they'll have to be on call someday...

[TazziRN, RN]

{{{{Queenie}}}}

[Tweety, BSN, RN]

There are some days that are just like that. Been there and done that. I hope the rest of your days go better.

I would have waited to report the UTI a few more hours.

[allantiques4me]

Im sorry you had such a bad nightThere are easier,less strsful jobs out there.

[muffie, RN]

[[[[[[[[[[[[[[[[[[queen]]]]]]]]]]]]]]]]]]]]]]]]]]

[wjf00]

I am sure I will be roundly ripped for this. But I have to ask. Why would you call the Doctor without assessing the patient yourself? In California, CNA's can't assess, so it is contingent on the RN to assess the patient before calling the MD. It would be safe to say an NICU nurse with 1or 2 patients has no damn clue about working in LTC, but I am still thinking it might be prudent to assess before calling. At the very least you have the correct patient and save the extra phone call.

[jill48, ASN, RN]

got the order for ua/c&s but he also started her on cipro 500mg

at least the orders were appropriate, that's one good thing:yeah:

the cna got the a and b beds mixed up

i'm glad you didn't ream her for this...it happens:o

that is a non- emergent matter and could have waited

excuse me? i don't think so pal. if my patient is in pain it's not going to wait and since it needs to be taken care of now, then i guess you can call that an emergency, now what?

he became a little mad at me wanting my name and such

i will gladly give you my name and such, and i will gladly give the medical director your name and such when i call him to report you. if you found it appropriate to order a lab and an antibiotic for mrs. x, why was it not appropriate for ms. a? because you don't like what time it is? too bad.:angryfire

because this man had his foley removed yesterday

after the removal of the foley, was anyone checking q few hourse to see if he was voiding on his own; don't need an order for that, it's called common sense, duh:trout:

"well you and me will just go in and re-insert this foley together"

we will? really? no, i don't think so. we are going home, oh i'm sorry, i mean i am going home and you are doing the foley. there is no we in you. you want me to work your entire shift or just the parts you don't want? :uhoh3: :uhoh3: :uhoh3:

:uhoh3: :uhoh3: :uhoh3:

[jill48, ASN, RN]

Yeah, I'm still not good with the computer. So the above post shouldn't all be in the quote box because the comments in black are mine. I'll figure this out one day.

[katfishLPN]

I also would have assessed the patient first before calling the doc. and i also would not have called the doc at 4am for s/s of a UTI... maybe 6:00 - 6:30am but not 4am. Sorry you had such a bad night. Hope the next few are better.

[chaoticnme]

It sucks that you have inadequate help at your facility. Its an honest mistake you made trusting the CNA. I saw you said you had 42 patients. You should have assessed the pain yourself. Like I said, honest mistake. You need to report this staffing inadequacy and really think if you want to stay in a job like this with this many patients. Your license is on the line here too. This job seems too stressful and over loading.

If the patient is in pain you should have called. Especially if you had already called about the other one and he was ok with it. The MD was just irritated about being woke up twice is all.

You will run into many nurses who expect everything to be done when they come on shift. They dont realize that things happen and you cant always do that. Thats their problem, not yours.

[katfishLPN]

I actually have been thinking... You say the patient was in severe pain as reported to you by the CNA. Obviously enough that you felt you needed to call the doc at 4am but you didn't think it was necessary to go assess the patient first? If my CNA told me a patient was in severe pain that is the very first thing I would do is go and assess the patient then if necessary call the doc at 4am. It just seems odd that the pt. was in such severe pain a 4am call to the doc. was warranted but not an immediate assessment????

Just a thought.