12/28/2016
I'm really feeling so discouraged after the day I had today. I was hoping that maybe by posting this, some fellow nurses ( who have the time to read my jumbled word salad description of today)would commiserate, offer support, constructive criticism.. etc……I don't know, something maybe? LOL!
The Day started uneventfully after getting report on only 6 seemingly very stable patients. I remember thinking HECK YES! Only 6 patients and only 1 blood sugar!! EASY DAY! The nurse I get report from leaves a lot of this out that I have to dig through the chart to find half the times, which is what I am supposed to do anyway, I know this.. but with all the stuff going on today, I honestly didn't even have the time to open charts period until midmorning… example of important information left out by this particular nurse: Pt has 02 ORDERED continuous, but was told in report it was PRN… another example: Skin blisters suddenly appearing the last few days but not reported or charted while she had them under her care… One Patient was being discharged, one had a family education scheduled ( where the case manager arranged the pt's family to be there while we discuss medications, wound care, etc). The day started like usual, I counted the narcotics with the night shift so I could start pulling meds, and happily chatted with the night charge nurse and her orientee as they waited to leave for the night. I finished pulling medicines early, and then completed my one discharge paperwork and printed my family education materials for another before passing meds ( Shift started at 7, it is about 745 at this point).
One Patient is tube fed and NPO, meds crushed. That morning for her scheduled tube feeding and daily meds, She was sitting up in bed watching Fox news, Alert and oriented, she knew her name, where she was, why she was there, that it was winter time outside and only a few days since Christmas. Physical Therapy was scheduled mid morning and I helped the tech transfer her from the bed to the wheelchair, the patient was then able to stand on her good leg and assist with the transfer.
Approximatey 15 mins after being taken to therapy, the Therapist brought the patient back, stating she would not respond to her and kept dozing off. This was the first time I had taken care of this patient, so I was unsure if this was normal for her or not ( going from Alert and oriented to drowsy and unable to follow simple commands). I asked the tech, who had taken care of her the previous weekend what she thought, and the tech also stated she had not seen her like this and that it was unusual behavior. Vital Signs were completely stable, pt was not on oxygen sats were around 97% on RA. Since the patient would not follow my commands, I left the tech with the patient with the vital sign machine hooked up for monitoring, called the nurse practitioner on the floor and returned with a blood sugar machine Even though the patient wasn't a diabetic, I checked her sugar and it was 172. Pt stated she was having a hard time breathing, although sats were normal for her, we placed her on 2 L O2. No adventisious breath sounds were heard with a stethoscope, but audible wheezing could plainly be heard when the patient was breathing. CT scans and other tests were ordered stat, and things were so hectic and we were so short staffed that in order to get the orders into the computer, I had to take the order sheet to another units secretary to have them entered because our secretary was on break. CT immediately calls to have her on a stretcher, my tech had disappeared, I paged her overhead with no response twice. Meanwhile, the phones are ringing non stop, no one at the desk and I'm trying to answer phones, refax orders etc.. knowing CT was on their way, I retrieved the stretcher myself, grabbed clean sheets and begged for someone to help me transfer the patient, who was by now unable to assist at all with her moving. I grabbed an OT from the hallway who was nice enough to help knowing nothing about this patient and we got her on the stretcher right when CT tech showed up to take her. As we were transferring her, I could smell that the patient had just defecated for the 2nd time that day. The CT tech jerred at me, like Im some neglectful nurse for leaving my patient in her own poop, then also seemed annoyed that he had to wait while she was cleaned up. Keep in mind that I have other patients calling for me while this is going on, but with the tech now helping in another room and unable to assist, I again needed help rolling the patient, because she could not even roll at this point. Luckily, the wound nurse was walking by and she kindly answered my plea to help. It seemed like an eternity, but it was only 2-3 mins… meanwhile, the CT tech is waiting in the hallway, annoyed and offered no assistance whatsoever. Then he has the nerve to comment there was no ticket to ride in the chart… umm yeah, dude like I had time to fill that out between running around finding a stretcher and someone willing to help me transfer the patient safely, oh, and then cleaning the patient up. I think I might have gotten a little snippy with him. Patient is taken off to CT and Xray calls for them too.. I said she was in CT and couldn't they just coordinate something? They said they would…
It is now almost lunchtime, and I'm dashing to check blood sugars on my remaining patients. In between that, bathroom call lights are going off, which we aren't supposed to walk past even if they aren't our patient. The 2 techs working the hallway are still in another patient room, so I answered 2 lights before I could even check blood sugars and get stuck in the bathroom with a patient I know nothing about, assisting her off the toilet with her walker. Back at the nurses station, my head spinning Phones ringing mercilessly, I have too much going on, supposed to be going to lunch at 1145 myself but it is impossible and I can't escape this feeling that I'm forgetting something ( a lot of things actually). This patient wants pain medicine, other facilities calling in to give report no nurse to take the report. I run give the pain medicine, then dash back to take report. Nursing admin calls to say due to low census we are dropping a nurse and a tech on a floor that was dangerously understaffed to begin with. 4 admissions, 4 nurses, now losing one, down to 3 nurses at 3 pm. I'm terribly late for my scheduled lunch at this point, charge nurse wants me to wait to be last to go, which I'm fine with, except 30 mins before my rescheduled late lunch, my admission rolls in and is a hot mess. Trach, MRSA oozing infected old pacemaker site, new pacemaker site, stage 2 pressure ulcer on coccyx, stage 1 on heel, day old daikins soaked wet to dry dressings and complaining of 8/10 pain. I put an armband on the patient removed old ones, checked vitals signs were stable and no 02 needs for Pt at this time, asking some of the admission questions as I'm putting on pt armband and photographing all wounds. CT brings other patient back, MD now wants CT with contrast on that patient, meaning now patient needs an IV, family ed scheduled at 1430 and it's past 1400 now. Charge nurse says go to lunch, so I did. I stepped back on the floor after my scheduled lunch ( really honestly I had no time to take lunch, but our hospital policy demands it), CT calling back as soon as I come back from lunch wondering if IV started yet, Wife of pt receiving education at the nurses station, wondering where the heck I'm at.. I needed help and no one could help because there wasn't enough nurses. Finally charge nurse states she will do family ed for me while I start IV on CT contrast pt. CT contract pt also has meds due that have to be crushed and a feeding due. IV started, pt fed and given meds, CT notified to come get the patient, another patient needs her dressing changed as it was oozing and also needs pain medicine. Of course, no dressing supplies in the room… pt scheduled to go home the following day, had surgery the beginning of the month and as I look at the patients stitches, it is wide open with underlying fascia showing.. This dressing is to have been changed twice daily but what I was looking at was unbelievable. The skin was about to tear loose from the stitches! It had dehisced. In the middle of that, new admission calling for pain medicine that hadn't been ordered yet, and CT is here to get the other patient, only the stretcher has now disappeared. The CT tech did not want to transfer the pt in her Wheelchair, left again and said he'd come back later. OMGGGGGGGGGGGGGgg….Finally find tech to look for stretcher, Call Dr to get order for pain medicine for new admission he hadn't seen yet, give pain medicine and complete the patients admission, only I'm not able to properly dress the wound because I have no orders for Daikin's.. I did the only thing I could do, and that was to bring all necessary dressing supplies in the room and wait for orders. Dr comes in to see his new admissions, and as he's reviewing charts, I told him about the other patient with the dehisced lumbar incision. He just about **** a brick because he said he was never told about this, and proceeded to ***** the nurses out ( me included) for not letting him know sooner, instead of the day before pt is to leave. I apologized, and stated this was my first day with these patients, and I just wanted to make sure he'd seen it because it didn't look right to me. After seeing it, he just shook his head, told the PT she would not be discharging and wrote new orders for infectious disease consult and for the surgeon to evaluate the wound. Trying desperately to chart PRN meds and complete the admission paperwork, I'm handed 3 more patients to care for, since they are sending a nurse home. I was not given report on these patients, all I had was her notes from her own report, had no idea what patients needed treatments, which ones needed anything at all. All this is going on, and it's time to give report to leave, and give one more tube feeding and 5-7 pm meds. Overhead, a code is paged meaning a patient had fallen … to the room of one of the patients I was given in the middle of the day, after the original nurse was sent home.. Of course, as I get to the room, pt is lying in a pool of blood, is disoriented, claiming his arm is broken and that he called for help but no one came… more vital signs to check and pt to assess, night shift nurse attempting to help get pt off floor before even getting report.. Attempted to notify MD, MD on another floor admitting another pt, left message with secretary on that floor to have him come upstairs ASAP due to pt falling, Pt family had to be notified of fall, statements gathered from the person who found the patient and the tech for that patient, along with a fall report, electronic version and paper version, med report list of last 24 hours of meds from pyxis.. night shift nurse patiently waiting for report with what I think was pity in his eyes..
I make it through report, but still have narrative charting to finish and my fall report to complete. Every one of my patients, even the ones I inherited had all medications given on time, including PRNs and blood sugars checked and treatments done, but I did not complete the charting from the few hours the departing nurse didn't bother to close out her charts before leaving.. She did it but didn't chart it and I didn't think it was right or fair to chart something I did not do or even observe being done!
All of this, in one day.. Oh and I didn't mention that we also had a code that day too.. I've only been in nursing for a little over a year, but this was by far one of the hardest days I've ever had. What could I have done differently to manage time better and to prioritize? Any tips or constructive criticism would be appreciated. Is this normal to be this understaffed, with no one to help with patient care ( tech) and a charge nurse with a patient load the same as mine who can offer limited help? I'm scared I will get into trouble for not documenting something correctly, or for forgetting something.. or for not being able to tell the physician about the dehisced wound until later in the day, when I finally saw it myself? I mean seriously, the wound dressing was supposed to be changed 1 time every shift, and the pt had been there weeks apparently. WHY WOULD NO OTHER NURSE SAY SOMETHING? Agghh, I'm so frustrated.. and I have a feeling every hospital unit is going to be like this.. am I right?I feel these patients have too high of an acuity to safely care for 9 at one time… prime example is Pt falling. I like my job, I like being a nurse, but I can't understand how this is safe nursing practice???
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Testing12345
9 Posts
Thank You to everyone who has answered my post, It truly has helped shed new light on things for me - more importantly though, your answers have allowed me to place things into perspective. I can chose to dwell on everything that went wrong, or I can chose to think of me working that day as serving a purpose... mainly, the pt with the dehisced incision about to be discharged.. I truly did help her by making the DR aware of the deterioration and probably saved her a lot of trouble and pain and a future hospital admission.
By looking at things differently, as you guys have allowed me to do, I am no longer agonizing over the past. I am satisfied that I did the best that I could (ok, maybe not the most efficient way, but still.. I'm learning more about how to be a nurse everyday that I work, and I'm sure I will learn something every day as long as I am nursing)
And yes, Mr. Do I can also look back on my post and "see" that I totally had a nurse rant.. yes, I became that naïve nursey new nurseington just out of school who thinks every shift will be princess shifts..
So.. bottom line, I take away many fruitful pointers I will work on. Namely, Delegation and Prioritizing. Ya' know, the stuff that can't be taught and that makes a truly good nurse (after 30 years or so, lol). For a long time I had a really hard time with trying to ask a tech to help me without trying to sound like I'm bossing them around, which can sometimes be hard to do. Most of the techs where I work have been a tech for longer than I have been alive, they know more about nursing than a new nurse with a shiny new license will ever know, and I try hard to give them the respect they deserve. It's taken nearly a year to earn respect from the veteran techs, but I will work on not being so timid in asking for help and being more like, "Hey, I NEED help PLEASE Get your orifice in here ASAP!" I will also work on communicating with my charge nurse and the nurse supervisor when I'm drowning. It's hard for a newer nurse to ask for help from other more experienced nurses, because you don't want to look like you can't do it. OMG DUH! It's taken me a year of nursing to realize that sometimes asking for help from other nurses is not a reflection of skills, it's a confident realization that I cant do 10 things at once!
No More super hero nurse attempts for me.. Lived it, learned it, got the headache and the stress badge, learned the hard way, but I learned!
Thank YOU once again for those that answered me, and for being my caregiver when I needed a nurse! This was totally awesome and a much needed reminder that I must always remember why I became a nurse in order to be a nurse to someone else!
Plus, when all else fails, as someone else pointed out - there's always wine and hugs.