Stressed and confused

[szccdw]

I have been dealing with a dilemma mentally for almost a week now. Last wednesday i went to work at my med/surg job and it was a nightmare. On a floor of 36 med/surg patients we only had 2 CNAs that day. There was no charge nurse scheduled so they had to call float pool and have one sent to our floor. Normally the charges nurses we have are nurses from our unit and they are very involved with the staff as far as helping out. This woman that was sent did nothing but sit at the desk and chit chat. I had to do my own VS due to short staffing, do my fingersticks, and feed 4 people (which would nt have been a problem if I had the time). By the time I got started on my 730am meds it was between 1000 and 1030am. Two of my patients (I had 6) should not have even been on a med/surg floor but instead in ICU. I had called the MD for each of these patients earlier that day about this and they both just said "keep monitoring them". My day consisted of answering constant call lights for ice, juice, walks to the bathroom, etc (all of which I don't mind helping out with if I'm not in the middle of my med pass). I was constantly behind all day. I ended up working from 630am to midnight. ALL my meds were late, insulin was late, and dressing changes were late. I ended up at work so late because at 630 when I should have been started to count off and give report I was giving 4-5pm meds. Then I had to do ALL the dressing changes I never had a chance to do. All my assessments had to be put in the system. All my orders that had been called in to me by the various MDs (we have phones we carry around) had to be written up. Families had to be called back that had left numerous messages and I was never able to return their calls earlier in the day and my chart audits had to be completed. I was soooooooo disgusted with my day. I love being a nurse but was ready to walk out of my facility that day. I was not the only one left in this situation and believe me the attitudes and morale that day were not good. My first mistake was punching in before checking out what was going on with the schedule. I won't do it again. I work this week and have NO plans of going on the floor if this is the same situation again. I keep replaying this day over and over in my head and the quality of care for the patients that day was zero. Had a family member decided to curse me about the care their loved one was receiving they would have been justified. Did I leave out that at between 6 and 7pm both MDs call me back and say "I've been thinking about what you said earlier today and has there been any change". I answered no. MD #1 says well let's try this. We hang up I do what is ordered call back and let them no there is no change in the patients status. MD states well lets d/c this particular med and get an EKG done. I state OK and begin the process of writing up this order. MD calls back AGAIN. I decided I want to cancel the EKG and we need to send the pt to ICU. duh, did I not say this earlier in the day. MD #2 calls checking on his pts status. "No change sir, I'm doing his VS as we speak, one moment". "His B/P is 59/43 with the dinamap let me get a manual". I come back on the phone "sir it is still the same. MD states "bolus 500cc of NS and repeat if systolic is not above 95". Pt has no IV access so the night shift nurse who has been waiting to get report states "I'll get that done for you". She makes a few attempts and another co-worker makes a few attempts and both are not able to get anything started. I call the MD back with this info and he states to have a PICC put in. We can't get the PICC nurse to answer her phone. We have her paged overhead and I won't even go in to how long it took her to call the floor and finally respond. Meanwhile this man who is a fullcode still has this low B/P. He also ended being sent to ICU. This is the type of mess I was having to deal with. I told one of my co-workers that when I came in this week I did not plan on punching in if the floor was going to be short like this again and she told me when another nurse did this she was written up. How can I be written up because I don't want to put my license in jeopardy. Had something tragic happened the board would have said you should not have punched in and taken the assignment knowing the situation. I'm really stressed about this and go back to work in two days. AHHHHHHHHH!!!

[nursingisworkRN]

I am sorry you had such a bad day. It sounds beyond terrible. Be proud that you handled the situation as well as you did, and that you did take excellent care of your pts. Get some much needed rest and enjoy your 2 days off-you have earned it. Sending you some positive thoughts and a margarita! :)

[RunningWithScissors]

szccdw, call in sick and take a mental health day. You owe it to yourself to take more time to chill.

[CritterLover, BSN, RN]

i hope you filled out an incident report to alert risk management of this unsafe situation.

[Kymmi]

I suppose the hospital can write you up if you come to work and dont punch in to assume your shift. I assume that would be the same as what is considered a "no show". You are right to protect your license though. Here we have assignment despite objection papers that we fill out and hand into the supervisior. Im not really sure how they would assist us if legal action was taken against us though. I know of a few nurses I've worked with that have punched in to work however they refused to accept the assignment and once I remember her assignment was changed. I also remember the other one that was sent home without pay.

I work in ICU so it is rare that I have more than 2 patients at a time however I know depending on what is going on with those patients it can still be a very hectic day however Im lucky because my unit everyone sticks together and works very hard at making sure all patients are taken care of regardless of who is actually assigned to them.

I guess if was in your position I would assess my patients and take care of the most urgent needs first and worry about the rest when I knew all the critical needs of the patients were meant ie meds, insulin, dressings.

Im not sure because you didnt really say if the patient with the low b/p was running that low all day long or if that happened right before transferring to ICU however if that was a all day thing that would have been the patient I spent my time on and made sure he had IV access, bugged the MD until he was transferred to ICU and if that MD didnt help me I'd have found someone that would have. Any patient with a b/p that low needs to have IV access and be in ICU as quickly as possible (unless they are a DNR).

Sounds like you had a terrible day and from what I read on the boards here that happens more than I thought it did. I havent done floor nursing for a very long time and I can really say Im glad I dont. I really enjoy ICU and I love the group of nurses I work with.

Good Luck and I sure hope things get better for you.