I'm a new nurse working on a med/geriatrics unit since july and I just had the woooooorst shift ever today!!
Got report in the AM, saw that I had a lot of anormlal labs, so a lot of phone calls to doctors.Plus, I had 8 IV's to give between 9-10h AM! Like okay I can do that no problem. 3 of the IV accesses I needed were infiltrated.First was a man who constantly tried to pull it out. Got a new one, started the IV just to see that he had cut the IV tubing with his teeth like 10 minutes later!!!!! Another was a lady that just could not have an IV access on her right arm because she had a breast surgery a few months ago. But her left one was swelling a lot she was a really hard stick. Another patient could not had his blood test done during the night because he was too aggressive also had to be stick and was a success thanks to my wonderful colleague. By the time all of this is done, I have 15 files with new consults and orders and doctors asking me various things. I felt that I could not help my coworkers at all this morning because I had so much work myself!! I try to help with patient hygiene every morning but just didn't have time.
By the time I had to go to lunch I was able to get everything done and was hoping that I could start to chart in the afternoon! Big mistake!
As soon as I came back from dinner, a woman became hysterical, pull her IV out, started screaming, crying, etc. Had a lot of trouble to give her some Haldol to calm her down and had to send someone start a new IV. The same aggressive patient that we had to stick in the morning and tried to hit us everytime we touched had fever. Doc called, septic workup was ordered (so a lot of manipulation agaaaain for this poor man) and eventually done. New orders just started to pile up on my desk, but had to give my afternoon IV's, write down report and actually start to chart!
WELL, eventually I got out of work (almost 1hour late!). Charge nurse told me to write overtime, but I felt like crap. I feel like I needed so much help today and felt overwhelmed most of the time. Never happened to me before! A doctor even asked me some questions about one of my patient and I actually just did not know what to answer because my head was so full of everything I had to do, write down, etc.!
I can definetly say that this has been the hardest shfit I have ever worked on.
Felt good to vent, and I was wondering about you, nurses of allnurses, how was your hardest shift?
1) 17 subacute/rehab pts by myself with a TMA. The SNF had two 20-bed TCU units. Mine had 17 pts, and the other had 8. Census was based on the whole TCU -- I only had 3 empty beds, but since the WHOLE unit had fallen below their cutoff, each unit got 1 RN/LPN and 1 TMA. (Well, we had CNAs for typical CNA tasks.
Sure she could pass scheduled pills, but I had all non-PO and prn meds including IVs and insulins/BG checks, treatments, assessments, had to do all of the MD and lab communication, family communication, MDS documentation, teaching..... I saw my last pt at 12:30 (shift was 0630-1500).!!! Well I mean I laid eyes on him, but didn't DO a dang thing for him until 1230.
Had that OTHER unit had more full beds, MY unit would have had another RN/LPN.
When I said something to my supervisor, she acted like I was being a princess.
One day later that week with the same staffing, I had THREE incident reports -- two falls and one 2nd degree burns from the coffee at lunch (not as bad as Stella Liebeck's, thank God!) Granted that was a kitchen staff issue and an extra nurse couldn't have prevented his spill... but it sure would have been nice to have help while I was doing the wound care and usual incident report stuff. YEAH....Here.I.Stand was being a princess.
2) In an LTACH, 5 pts, 2 of whom were on vents (with active weaning plan -- not LTC vents). No lunch and no pump breaks. Solo wound care for a burn pt who had set her pants on fire. It took me TWO HOURS, between applying the topical/Adaptic/trauma pads/Kerlix one-handed, because I was holding her leg with the other. She'd had fentanyl and Versed prior, but the way the MAR was noted, I initially didn't see she also had additional prn doses available for midway through. So after the 1st leg I had to go back to the Pyxis for more drugs.
While in there, I hear on my Vocera that another pt's IV was beeping. I replied that I was in the middle of a big dressing change, and I would be another 30 min or so. 30 min later, the pump was still beeping.
Aaaaaand....a wife yelled at me for being 20 min. late with her husband's Dilaudid.
Did I mention that that morning, I had already done a 1.5 hr wound vac dressing change??? Pt was a para with four stage IV's on his bum. All were bridged together, so it took some serious artistry.
2a) at same place; I had initially been assigned to do a 1:1 in the ICU. It was in the fall sometime, and one RN said she had gotten a flu shot but didn't have her VAR, and refused to wear a mask. She was escorted out; I got to take over her 4 pts with ZERO report..........and I got to admit a 5th. Who was a total anal orifice.
WELL, eventually I got out of work (almost 1hour late!). Charge nurse told me to write overtime, but I felt like crap[/Quote]
DON'T let that "crap" feeling convince you that you don't need to be paid what the hospital owes you!!! Sometimes it truly isn't a time management issue -- it is an issue of having 12 hrs to do 13+ hrs' worth of work! You earned your OT -- treat yourself to a small splurge or get ahead on a bill or feel good about the little windfall your savings account received... DON'T decline the OT pay!
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
DON'T let that "crap" feeling convince you that you don't need to be paid what the hospital owes you!!! Sometimes it truly isn't a time management issue -- it is an issue of having 12 hrs to do 13+ hrs' worth of work! You earned your OT -- treat yourself to a small splurge or get ahead on a bill or feel good about the little windfall your savings account received... DON'T decline the OT pay!
I can't "like" this enough. We are our own worst enemies when we enable our employers to use us.
First day off orientation horror story here too! Former 23 weeker, now 25ish weeks, vented, (who I had never previously taken care of on orientation) with a significant history of bradycardic events. Would clamp down and I would have to manually ventilate MULTIPLE times. After about the 3rd time of doing this, within the hour of being there, I called the NNP. Seemed non-chanlant and didn't seem to care much - The baby had been doing, so I sort of understood.
Mom and I did cares and I'll never forget it, she said, "He looks different." Yea... That sent my alarms off plus he was touchy. He continued to brady and needing manual breaths. I mentioned it again to the doctor so he would be aware of the situation. He initially decided to do a round of dexamethasone. Right before I left to carry out those new orders, the doctor says actually lets do a sepsis workup before giving dex, just to be sure. I collect the labs and send them. Meanwhile, I know I called the NNP at least 3 more times, when I finally said, "Can you just come look at him and watch what he does?" She probably hated me for bothering her so much and seemed annoyed but she did come and sit in the room and I showed the excessive amount of support I was having to give. But she still seemed very much unphased. At this point, I was wondering if I was just being hypersensitive, being my first day with a vent by myself. Or if something was actually happening.
Within 2 hours, the trach aspirate came back positive for pseudomonas. I got the call and in came the army. Oscillator and nitric, central lines placed, the works. It was horrible and I questioned myself for a good 6 months about the whole ordeal and pretty much blaming myself.
It was a doozy that I really had to work through on top of being new and just learning. However, now, not to toot my own horn, when I look back on that day, I am amazed on how smart I was and didn't even know it. In addition to the insane amount of advocacy I did for that baby. The NNP was not impressed but I guess I persisted because deep down I knew it wasn't normal. I wasn't able to put the picture together, but I had pieces and I knew they meant something. Even not knowing the baby at all, I knew there was something brewing, and I still don't understand how the two previous experienced nurses went through both shifts without doing anything.
I will always remember that mom saying he looks different, gives me chills.
Second worse shift. Four baby assignments for everyone. I had two scheduled discharges. Ended up discharging three. Fifteen minutes after the first discharge, I got an admission - that I did by myself, no help from anyone. The new baby was going into the same room as the one I just discharged, but it hadn't been cleaned yet, so I had to clean the room. Needless to say, the shift was a mess of just teaching and discharging, plus taking care of my last original baby and getting my admission tucked in while teaching the new parents.
I got my last discharge out about an hour before shift change. Was talking to a co-worker for a second as I had cares on my last baby in 5 minutes. Another nurse was walking out her ONLY discharge at that time and also had cares. She wanted someone else to do cares and feed. I was asked and said I couldn't as I have cares now. I was then practically made to feed the other nurses baby. I was already upset at this point because I ran my *** off all day, with no help and now was being made to do someone else's work instead of my own.
Finally got to my room to do cares 10 minutes late and I was approached and asked, "What makes you think you can say no to me?". ***** WHAT?!? At that point, I just shut my mouth because if I started, I wasn't going to be very nice. Still makes me extremely PO'ed to this day.
The hardest shift for me is my first shift on my own as an RN at noc shift. I literally had 20 patients to be checked blood sugar in the morning together with passing meds to a total of 45 patients. It was very overwhelmed since I didn't know the patients and their meds. Some patients had a low blood sugar, and some others had high blood pressure. Thanks God that the experience nurse on other unit came to helped me out as soon as she finished her patients. Otherwise I didn't know how I could survive my first shift.
Toughest shift? First day off orientation 9 months ago: My patient threw a PE in the middle of me giving off going report to the next nurse and my other patient BP dropped into the low 70/30s with free air in the abdomen. I had to send them both to the ICU.
I went home crying because it was supposed to have been a simple assignment. It quickly went left.
There were so many working in the hospital, one of the weirdest was when I was a new nurse, and listening to a patient's lungs and doing an apical, and the heartbeat stopped. I thought "this isn't funny," and then realized what had happened and called the code. The operator asked what room I was in, and I just hoped the room # on the water pitcher was correct, because that's what I told her. The lady lived another 24 hours and then died.
Another worst I had was when I was doing agency to pick up some extra money. It was my first time in the facility, and I had 48 patients plus a new admit with two STNAs. That night really sucked, and then the oncoming shift was angry that I didn't get the over 20 blood sugars all done before they got there, was over about 30 min getting them done. Good times!
Wow, some of these are so bad:( I'm so sorry for everyone who had to deal with such horrible shifts! I see that mine really is nothing compared to that!
StrwbryblndRN
658 Posts
All that I read so far, I will not add mine. My worst shift does not compare.