Those extra-stressful days

[CiaMia, BSN, MSN, DNP, RN, APRN, NP]

I'm hoping this is the right forum for this, heh...!

I'm not an RN (yet - taking prereqs and applying right now) but I work in a related field. I'm a day habilitation program manager - we provide nursing oversight, PT, OT, SLP and help people with developmental disorders (and usually low vision/blindness/hearing loss/needs wheelchair, walker, cane...) work towards goals and independence.

For the last 2 weeks and next week I'm also covering for a friend who is on vacation, overseeing a residential program of 5 ladies (one currently in rehabilitation after a hospitalization). Two of whom come to my day program. The lady in question that my day of unfortunate events is MR, in a wheelchair, on 2l O2 all day or BiPAP when sleeping, has been taken to the ER twice over the last week with shortness of breath/wheezing/coughing and been assessed and discharged... previous hospitalization diagnosed with pneumonia and a UTI (admitted 9/23-9/24, ER visit 9/28 and 10/5).

So. Last night, she wasn't doing too well. NP stopped by to check on her. Bilateral lung crackles. Loss of appetite, stomach discomfort. Told me to call the hospital her PCP was at this morning to get her an urgent care appointment, told me I'd have no problem, to drop her name if I needed to. Wanted to question whether she could increase nebulizer treatment to q4-6hrs, not q8, get her some kind of cough suppressant, and have her lungs checked again (and have someone put together the x-rays/chest CTs from each of the ER visits to see where the progression was going).

Okay. Sure. So I called this morning, got put through to the triage nurse. Told her all of the above. Dropped NP's name.

Was basically laughed at.

"You're telling me all these things, which one are you going with? Which one are you asking us to look at?"

Um. All of them?!

"If she's been going to emergency, just take her to emergency."

But... you're her primary care?! You KNOW her, have her records...

So she says she'll call me back and hangs up.

Calls me back, and says "okay, spoke to the doctor, he says to make a regular appointment". Gives me his direct line to reach him.

I already did. Days ago. The earliest they could give me was 10/19. THIS LADY IS CRYING, IN MAJOR DISTRESS, and to top it all has come to her day program with a blood red eye (thought it was conjunctivitis, but read on..!).

At this point, I've already had a member of staff tell me he needs to leave early because of an appointment he found out about last night - no wait this morning - no, it was last night - so he can't stay the whole day and has to miss a meeting that was meant to be specifically FOR him and a few other people on the team. I got kinda ***** with him about it, and felt like crap about afterwards.

And another individual has gotten really behavioral and started grabbing on to and pulling staff's hair and refusing to release it.

Nice.

So by now I just want to cry. Literally, I feel like that's it, I cannot do this. I'm not going to be able to do my job because I'm too busy trying to deal with this poor lady. I'm not even doing a very good job of THAT because I'm so torn and trying to do my job too, and clearly don't have any clout or for whatever reason can't get this triage nurse to take me seriously enough to listen to me and take my concerns seriously (probably because I sound like I'm about to cry heh). (My supervisor was out at a training so I didn't really have any support on-site).

So I'm trying to hold it together for the staff team (and myself). Our on-site RN offers to call the hospital to play the "I am a nurse" card. I say it's okay for now, I'll see what happens after I call the PCP. It goes to voicemail. So I leave one. In the meantime, the lady in question starts to deteriorate a little bit, complaining of stomach pain and eye pain. No respiratory problems though. RN takes temp and BP - temp low and BP elevated (through sweater).

NP calls after seeing my text message re: refusal and calls the hospital. Calls me back saying they'll admit her and monitor for a few days. HA. And hallelujah.

Get documentation we'll need and head off to hospital. After dropping the individual and another member of staff (supervisor of the residential coordinator I'm covering for) off, I head back to MY program to try and do MY job. Another member of my team is sick and needs to leave early. We're out of dishwasher detergent and apparently no-one else can go out and get any but me.

Field calls all afternoon - individual being transferred to another hospital because, OH HEY, the pressure in her eye? FOUR TIMES WHAT IT SHOULD BE. Hence the infections, discomfort, anxiety. So, okay, emergency surgery it is.

So, I spend time running around keeping people in the loop (upper management, the guardian). Have to liase with the ridiculously unimpressive and sometimes downright noncompliant staff team and coax one of them into driving over to pick up the poor lady's brand new wheelchair since she was transferred in a bed.

Another member of staff, from my program, comes to my office door and says she's leaving early because she's "had it up to here today". So she's skipping out on this meeting I'd worked really hard to set up too.

(THAT was the point at which I shut my door and cried )

And what kills me is, the poor lady in question HAD A PCP FOLLOW UP APPT ON 10/5 that we had to cancel because I couldn't take her since I had to be at my OWN job, and the residential coord's supervisor couldn't take her because she wasn't at work that day. Maybe I should have advocated more, or tried to find some way I could have taken her. I don't know.

Anyway. So that was my day. Sorry for rambling and probably seeming completely nonsensical. I just feel wretched because 1) I don't feel like I did my job well; 2) I don't think I did the job I'm covering for well; 3) I feel like I probably seemed completely stressed and frazzled and like I couldn't handle any of this which SUCKS because I've asked on-site RN to be a reference on my nursing school application...

When you feel like a day is just getting way too overwhelming, what are your coping strategies? How do you pull yourself back from that brink of, I give up I can't do it? What would you have done differently in any of the above situations? I'm just feeling low about the whole thing in general.

[noreenl]

oh Honey!!! i feel for you and this is absolutely the place for you to vent!!!! I wish u had been supported better and I probably woulkd have screamed about an hr before u started crying!!! Hang in there!!!! :kiss:flwrhrts::oornt: