Ok, I can now officially say that I have had the night from #@**! To start off with, my hospital is in the middle of some renovations (which makes things interesting to say the least). As soon as I hit the door yesterday, I had two patients fresh from hip fx repairs (by fresh, I mean they hit the floor about the exact same time I did!). One is a middle aged alcoholic on watch for withdrawl, the other is 100 years old (almost 101--not kidding). Another pt claims that someone gave him meth without his knowledge which induced a MI. Straight away (before report), I had to go do assessments on my two new surgery pts who seemed fairly stable at the moment. I went to get report, stepped out on the floor and all hell broke loose. My 100 y/o became non-responsive with no bp to be found. Telemetry reports showed she was in a sinus brady rythm in the 30's! (did I mention that I am in the middle of hanging blood at this time? for my first time EVER)) OK guys, I'm new and I will readily admit I had not a clue what to do. I immediately turned her on her head (trend) and called for my charge nurse. Within minutes, the ER doc arrived. We increased her fluids (after a bolus of NS) and the situation was resolved (for now). Not more than 2 hours later, same thing. Only this time, my meth/MI guy across the hall went into respiratory distress. Called RT for him and played the same game with the 100 y/o as before. Crisis adverted for the moment. Left 100 y/o in trend for the rest of the evening. Seemed to help (for a while). Now it is getting to be about 4am and I have not charted one thing! I have passed all my meds, but have not done any real assessments on any of my other patients. Did I mention that meth/MI guy has now pulled out his IV? LOL! After spnding a great amount of time on the phone with the dr, I run through and do quick assessments on my pts (at this point they were all breathing and that was about the extent of my assessment). I sat down and charted everything I could remember, but wonder now if it even made any kind of sense. During my charting, one of my other pts who is completely "with it" mentally decides to have a horrific nightmare on me. She apparently thought someone was after, ripped out her IV, stripped off her clothes and was standing in the hallway naked and covered in blood. Got her woke up and reoriented her. She was terrribly embarassed. Pt redressed, IV restarted and now I realize that her antibiotic that was supposed to be hung at 1300 the day before was still sitting there. It had technically expired so had to remix it myself, fill out an incident report and get it going. Now, I can finish my charting...yeah right. So I am sitting there wondering how I am ever going to get finished and this twit I work with asks is I could help her with her chart checks!!! (she has been a nurse for 10 years and has not offered to help me once tonight. not to mention that chart checks were the least of my concern.). I simply looked up at her and asked her if she had lost her mind! So it is now 30 minutes after my shift and I am getting close to being done when 100 y/o craps out on me again (the next shift was still in report), so back on the phone with the doctor AGAIN. Another bolus, more trend. By the time I was finished it was an hour and a half past my shift. I apologised to the next shift for everything I had done or not done and told them if they would just let me sleep until noon, they could call me then and let me have it. They assured me this would not happen. I told them not to make promises until they saw the mess I had left for them. I did get a call from work around 1100, but it was not from the nurses, it was from our lady that does our schedule. They need help tomorrow (today 9/1), can I come in from 7a-1p. Sure I said and back to sleep I went. I felt like a horrible nurse guys. I did not give my patients the care they deserved last night, but I gave them ALL I had. To be honest, I only got one bathroom break last night and did not have time to eat anything. I left this morning ashamed for all that I knew I had missed, but also proud that everyone was still breathing when i left. I think I held up OK under the pressure (not that I am ready to do it again anytime soon) but my poor charge nurse (who normally has nerves of steel) literally went into the bathroom to cry last night. Please someone tell me that everyone has had these nights and it will be ok. how do you handle these situations and what else could I have done? Just for the record, my 100 y/o was on her way to CCU while i was on my way out the door this morning.
The fact that while cracks showed up on the surface, you were able to prioritize, keep your wits, and give the best care your could give considering the circumstances is commendable to say the least. No one ever said that nursing was easy.
And it isn't.
And there are shifts that are going to go like that. What is important is that you kept your priorities straight and did the best job that you could. In my mind, you defined yourself that night as one to count on when the going gets tough.
Give yourself a pat on the back because by all means, you deserve it.
Next time that it happens, take ur scheduled breaks. Unless the patient is coding, your charge nurse can cover for you, and are able to do some things that are quite immediate. Now people might say that taking a break is like forgetting about a need of a certain patient, but if u have 8 or 9 patients, then chances are if things are going bad, alot of them need different things at the same time. So taking a breather when you're supposed to is a good thing, it will help alleviate ur stress. Think of yourself as another patient that you also need to take care of. You'd be better off taking care of them when you're not too frazzled.
Next time that it happens, take ur scheduled breaks. Unless the patient is coding, your charge nurse can cover for you, and are able to do some things that are quite immediate. Now people might say that taking a break is like forgetting about a need of a certain patient, but if u have 8 or 9 patients, then chances are if things are going bad, alot of them need different things at the same time. So taking a breather when you're supposed to is a good thing, it will help alleviate ur stress. Think of yourself as another patient that you also need to take care of. You'd be better off taking care of them when you're not too frazzled.
Thanks you guys for the encouraging words. I think you have a great point about the breaks too. I was there for 12 hours and didn't take a break at all, not even my lunch. I remember one of my instructors saying to me that she's a much better nurse when she takes a bathroom break and gets something to eat. I'm sure I would've been in much better shape, physically and emotionally, if I had. Next time I'm going to keep that in mind! Promise! Here's to a great Labor Day weekend at work!
I felt like a horrible nurse guys. I did not give my patients the care they deserved last night, but I gave them ALL I had. To be honest, I only got one bathroom break last night and did not have time to eat anything. I left this morning ashamed for all that I knew I had missed, but also proud that everyone was still breathing when i left. I think I held up OK under the pressure (not that I am ready to do it again anytime soon) but my poor charge nurse (who normally has nerves of steel) literally went into the bathroom to cry last night. Please someone tell me that everyone has had these nights and it will be ok. how do you handle these situations and what else could I have done? Just for the record, my 100 y/o was on her way to CCU while i was on my way out the door this morning.
You are definately not alone. I have been working now for 3 mos as RN and have had 2 days when I was in this type of situation. I handled it by crying all the way home and reading posts on here b/c those days could have been a heck of a lot worse. I always feel bad too when I leave on days that I can't do everything that needed to be done and it's never the case of sitting on my buns. Then I got a great peice of advice from the nurse who was House Super one day. She said "There is no way some days that you can do everything no matter how hard you try. That's why you have the next shift. They pick up where you left off!" Can't tell you how many times that right before shift changes an IV goes bad and it's left for the night shift to handle. All I can do is my best. As the other posters have stated, sounds like you did great under the circumstances and they were all still alive when you left. I can't believe they did hip repair on a 100yo!!
and reading posts on here b/c those days could have been a heck of a lot worse. I always feel bad too when I leave on days that I can't do everything that needed to be done and it's never the case of sitting on my buns. Then I got a great peice of advice from the nurse who was House Super one day. She said "There is no way some days that you can do everything no matter how hard you try. That's why you have the next shift. They pick up where you left off!" Can't tell you how many times that right before shift changes an IV goes bad and it's left for the night shift to handle. All I can do is my best. As the other posters have stated, sounds like you did great under the circumstances and they were all still alive when you left. I can't believe they did hip repair on a 100yo!!
babynurselsa, RN
1,129 Posts
ON nights like this if all are Pink, Warm and breathing then you did fine.
Yes, we all have one of those shifts once in a while and you don't get the pillows fluffed or the back rubs given, OH WELL.
Your patients were alive, they got their meds and the important stuff got managed.\Pat yourself on the back