Venting after a very busy shift

[Dani_Mila, BSN, RN]

My little background: I work in a progressive care unit/telemetry. I've been working at my hospital for about 5 months. I have been a nurse for about 5 years mostly working in subacute rehab then have recently transitioned to acute care at hospital setting. I work night shift.

Well, it was last night was just a horrid shift for me. I came in and took my reports. One of my patient was transfered to our floor 15 minutes before change of shift due to hypoxia and hypothermia. Pt was cachetic, smoker, former drug abuser, COVID + with PNA, had a multiple abscess in his lungs that's being treated with 2 ABT. Pt was on 4L then needed to be on 12L therefore he was sent up to our unit. The day shift nurse received a report and passed it on to me. She stated I don't know about this pt and she barely gave me anything regarding his PMH, previous assessments, and etc., therefore I treated this pt as an admission instead. Well things were going OK at the start of shift, we were treating his elevated lactic acid, he has a warming blanket over him, his O2 sat was fairing fine on 12L high flow NC. Then suddenly, his O2 sat decreased in low 80s and he was asking for more O2. I put him on a non-rebreather (NRB) at 15L, Called the RT to evaluate this pt, we placed him on a heated high flow NC since he was not improving with the NRB. Well, that did not work so I RRT this pt, MD and ICU PA was at bedside ordered a bunch of test and an CXR. ICU PA ordered an Ativan IV for him. His CXR revealed R side PNA and COPD. He finally slept for a while and was on the heated HFNC and on top of that the NRB mask. He was satting in the upper 90s. I asked the ICU PA if he should go to ICU because he is on max O2 and anything further than that would be intubation, we tried to place the pt on BiPaP but he felt like he was "suffocating". She said not at this time since he is tolerating the current intervention and has been satting fairly well. Pt's family came to the hospital because the ICU PA told them that he should be comfort care however family decided to change their mind when they got to the hospital and wants to keep him full code, the pt also stated that "he did not want to die".

I was so busy with this pt that my med pass was late, I had 3 other pt's to take care of, thank God I had 2 of them previous shift so I knew about them. I barely sat down to document. One of my other new pt, 91 yo female, was complaining of chest discomfort and her BP/HR elevated. EKG read Sinus Tachy and MD ordered troponin to trend, while my other one was picking on his wounds and just bleeding everywhere, he is alert and had to educated to refrain from picking his scabs. It was so busy that I have not yet documented and it was almost the end of shift. I passed my morning meds early so I could have time to sit down and catch up. I checked on my critical pt with hypoxia and there he was removing his NRB and heated HFNC. I spoke with him about keeping it on and he started getting agitated, pushing my hands away, he did not want anything. His O2 sat decreased to 70s. Mind you, this was almost at 7AM. I notified the night charge nurse who was giving report to the day shift charge nurse that my pt had to be RRT again. The day shift nurse came, but I have not yet given report as I was in the pt's room. Well this pt was RRT, I was praying to God that it's the same people to come so that I don't have to explain his tedious situation. My charge nurse was awesome, she came in to help me on both RRT. She gave report to the ICU nurse that came, I was just fairly exhausted mentally and physically. Mind you I am 8 months pregnant as well. Pt was not having it, he was agitated, pushing us away when we attempted to put his mask on, he did not want the BiPaP at all. The day shift MD finally said he needs to go to ICU to be intubated. I was like thank God. Honestly, this pt should have been transferred to the ICU after the first RRT. It's not my call to transfer the pt, but the ICU PA. I even voiced my concern to my charge nurse that if he gets worse he will need to go to ICU. They did not want to intubate him yet because he was tolerating OK.

Overall, it was a mess for me, I stayed on the unit for almost 2 hours past my shift, finishing up. I didn't really get to sit down at all until 0740. I cried going home because I felt like I barely did anything, I am mentally and physically exhausted, felt guilty for not focusing on my other patients since one patient took majority of my time. My time management sucked. My nurse manager was on the floor and saw me still charting and it was 0830. She asked me if that pt that had been RRT twice was mine and I said yes hence I'm still on the unit. I just felt inadequate like maybe I should have done more. Ugh, it was a rough shift.

[Lisah.]

So glad I read this, it  actually sounds like you're doing an amazing job, I mean are you kidding Mr? In what universes to nurses and doctors not snap at you and Bute your head off and make you cry when you're not doing a good job. Sounds like your getting the hang of it. Stay focused on your goal, your amazing and smart and it takes guts to go from skilled to hospital. Stick with it.

[Tweety, BSN, RN]

On 7/19/2022 at 5:14 PM, Dani_Mila said:

O didn't really get to sit down at all until 0740. I cried going home because I felt like I barely did anything....

You worked nonstop without a break, stayed two hours late and you feel like you barely did anything?  Stop this self-talk right now.

I do know the feeling that when you do you best you feel like it's not good enough, especially when one patient takes up a good deal of time and you feel your others are neglected.   But at the end of the day you have to acknowledge you've done your best.  

[Dani_Mila, BSN, RN]

I found out that the reason why they did not take this patient was because they were short staffed in the ICU and since he was "sort of stabilized" that they did not want to keep him yet ??

[Been there,done that, ASN, RN]

You were taking care of an ICU patient. Staffing/ house  supervisor stuck it to you because they did not want to find another ICU nurse.  

" I just felt inadequate like maybe I should have done more" . Why would you beat YOURSELF up over the impossible situation you were handed? The only thing you could have done was be more assertive  that the patient belonged in ICU. As charge nurse, I would have relieved you of your other patients.

Congratulations on your baby to be.  I hope you will be getting a decent maternity leave. Use that time to look for another position. Your current unit sounds like Hades.

[nursej22, MSN, RN]

As previous posters said, you did a great job. This is actually not an unusual scenario for what I presume is a step-down/progressive care unit. You assessed, intervened, called for help, and advocated. And your patient survived, thanks to you. 

And congrats on your baby!