3:05 patient falls, bleeds, 911. IR, transfer paper, copies of chart, etc.
3:10 patient left alone on toilet by 7-3 falls, hits head, 911. IR, transfer paper, copies of chart, etc.
7-3 not only took no responsibility for fall #2, much less #1, she told me she has to chart, so 'get back to me when those two have been sent out'. Nice.
Back to report.
Count. Narcs missing. Told 7-3 not taking the cart till it's audited.
Phone call, wife is coming to discharge her husband, NOW.
Admissions director comes by, asks why there are two ambulances out front, and "How many empty beds do you have?" Told her "One- the other 2 are going to the ER, but I'm sure they'll be back- don't get any funny ideas, this place is already a DISASTER". Did not tell her about the call from the wife coming to d/c her husband.
4PM, she drops THREE admit packs onto my med cart, says "You need to get housekeeping to prep those other two rooms, and pack up their stuff- if they come back, they're going to the long term care hall. I need those beds!".
5PM, wife comes to take husband. Same exact time, a patient died. But he was DNR, so that was a walk in the park.
2 falls/discharges, 3 admits, a sudden discharge, and a death/discharge. Almost all before the first med pass?
Yes. I confess. I dropped the f bomb. But I learned- never again did I get report without my first making rounds, or getting report given to me DURING rounds.
Me walking in. See that I have 2 patients everyone else has 7. Not a good sign.
AM nurse: So I am 4 hours behind on meds, 3 units behind on blood, she is having more trouble breathing, ICU is full so enjoy.
Me: Full code too huh
AM: Yup.
Fast forward 8 frantic please god dont die hours of 1:1 care. She codes. Well no ICU bed. So we keep her up there coding and vented and everything. We lose pulse 6 different times in the next 3 hours. Family sees her in the AM wants her a DNR. SHe dies 20 minutes later.
I worked a short shift, specific area, I was done, felt pretty good, checked with charge nurse...."I can go home unless you think anyone need help"....."We are probably okay but sure, check with discharge." Of course discharge right away says yes...give lunch relief to so and so.
I gladly comply thinking I can do a 1/2 hour lunch relief and go home. Turns out the patient was medically fine but had a few oddieites that needed clarification from the doctor. I did what I could, getting more tired and frustrated thinking, thank goodness I can "dump" this back to the nurse. She comes back from lunch and is given another patient!!!!!
I did a big mental whack to my own head..... I realized I had come into work earlier than the nurse I was relieving and I had not had my own lunch (I wasn't thinking lunch since it was to be a short shift). And I was starting to feel tired and frustrated!!!! And annoyed with myself......why do I do this to myself....am I going for the Most Helpful Nurse Award!
Oh reading this thread reminded me of another one... it was supposed to be my "easy" patient. An elective admission for continuous EEG monitoring, had had a sedated MRI on the day shift. Tolerated the sedation horribly, day charge RN tried to refuse her from the PACU for hours but the anesthesiologist finally wore the MD down and they agreed to accept her... I came on and she had a BP of 60/30 (this AFTER 3 or 4 fluid boluses), a temp of 33 degrees Celcius, HR in the 40s and RR around 12. Yeah, she was eight. And this was also on a day that I'd driven 8 hours home that morning and had been awake since 7:30 am when I came in to work a night shift. SO do not miss the hospital.
It ended up being okay, and I know I've had worse shifts but I remember this one likely because I was completely on my own.
I am a float (by choice), and on this night (1900-0790), I was assigned to the day surgery department. Yes, a night in day surgery, as some of the procedures require an overnight stay. Nights on day surgery was staffed with 1 RN only.
Anyway, I arrived and got report. There were 7 patients still there, with three supposed to be discharged. I was also getting an off-service admission from ER, but they hasn't received report or even a name, they just knew she was coming.
Dayshift left. One patient was ready to leave so I was going over her discharge info, and my phone kept ringing at the desk. I was by myself so I did not leave to answer. It rang twice for minutes each, and a few minutes later, the porter arrived with a patient in a wheelchair from ER. No report, no chart. I was still by myself, now with 8 patients, 7 of whom were post-op.
I should have sent the admission back to ER, but she was young (late 30s) and able to tell me her name and confirm she was in no immediate distress.
I sent the porter back for the chart, then phoned ER and demand report and expressed my displeasure over them dumping the patient.
a) if I'm not answering my phone I am obviously busy,
b) I am by myself and they know that
c) because they did not speak to me, they had no way of knowing if they were sending the patient into an unsafe situation.
So. 8 patients. 1 of 3 discharges went home, leaving 7. Second potential discharge was having pain and nausea issues. I called the surgeon and surgeon decided to keep her.
The Third potential discharge count not void post TURBT and was having wicked bladder spasms. I called the urologist who decided to have me insert a 22Fr three-way, start a CBI, and keep him over night, too.
(Easy insertion, fortunately, and along with a O&B supp, instant relief for the poor man.)
I now, however, have 3 CBIs to manage. 7 acute patients (6 of them post-op), no help, one admission and all the paperwork that goes with it, one ortho-type having pain issues that were persisting, two who need to be dangled/stood, all seven with meds, vitals, charting.
Plus I also had to complete the night duties, which included prepping the charts for the next day's slate and running lines for the outpatient slate, too (antibiotics, transfusions, iron, that sort of thing).
I managed, but it was busy and there was no one else to help. I did not get a break. The supervisor got an earful about ER dumping the patient (I get that many floor nurses do everything they can to delay admissions, but this time ER was truly out of line).
Details are lost now (this was at least 5 years ago), but I still remember that night and how hectic it was, especially when there was literally nobody to help with any part of it.
Specializes in Peds Urology,primary care, hem/onc.
When I was a new nurse on a pediatric hem/onc/bmt floor I remember one night in particular. I had 3 patients (which was our normal # due to the high acuity) that were all on triple IV antibiotics. The SAME THREE IV antibiotics for all three kids and they were all at different time intervals. The kids were all different ages so the doses were all different to. They also all need peaks/troughs at varying times as well. That night, I gave 36 doses of IV antibiotics in 12 hours. I also gave 2 units of blood and platlets to another patient. All three kids were unstable. I did not pee the whole shift. I did not sit the whole shift. I sat down to give report to the am nurse and she took one look at what was left of my "brain" sheet and was like "oh boy, you had a hell of a night!". I was terrified I was going to give the wrong med to the wrong kid but I didn't. I also hated coming unto shift and walking unto the unit and find it deserted because everyone is in a room coding someone. You knew it was going to be a bad night even if you did not have the patient that was coding b/c everyone was behind on all of their patients.
I was working (1900-0700), progressive care unit. We get 4 patients each. One of my patients got transferred, so I had 3. One of my patients had a crazy high INR and was anemic, so they had 2 units of blood ordered + 3 of FFP. I got an ICU transfer. ICU nurses came down with the patient and I didn't like the way the patient looked to be honest, but ICU needed an empty bed and this patient was "the most stable" so they had to transfer this one out. The patient's primary RN in ICU was at the bedside and I confirmed my assessment with the ICU RN.
Patient's vitals were stable under my care. It was time to start my other patient's FFP, so I went to the blood bank to get it. Did the bedside verification with another RN, started it and very shortly after, the CNA in my ICU transfer's room started yelling for me so I ran over. Patient was awake but non-responsive. Then arrested. So we called a code. All while my other patient's FFP was infusing I immediately sent another RN over to my FFP patient's room to watch them since I had to stay in my ICU transfer's room and provide information to the code team.
One of the ICU nurses who helped transferred the patient responded to the code, so that made things a little easier. Patient went back to the unit to the same RN who gave the patient to me. I later found out that the ICU nurses all knew this patient was going to code, they just didn't think it would have been so soon!
I can't believe some of the posts in this thread, however. I thought I had some bad nights....but my goodness!!
I used to work in telemetry, and I have a bunch of stories from that floor. However, one of the nights I had to float to a different unit (Neuro/GI/Oncology) is a night that will go down in history for me that I will never forget. It was probably the worst/most stressful shift I've ever had.
Of course, I don't remember too many details since it's been over 2 years, and I now work in the happy mother/baby department. :)
I was given a horrible assignment, probably because I was the floater... (which by the way seems messed up, and I still don't understand why floaters get s*** on). Anyway...
I had my max of 6 patients. I had 4 patients with PCA pumps. I had 2 patients with tube feedings. I think 2 patients were total care... and the rest were walkie talkie. I remember it took forever to even get through my 2100 meds... by the time I finished it was 2330 and time to start rounding on my midnight meds. I had to cath one of my quadriplegic patients multiple times... give IV abx to several, in addition to changing out and wasting PCA medications. Towards the end of the shift, they decided to give me an admission... it was an agitated male patient with an NG tube suction who was screaming and wanted to pull out his NG tube... the girlfriend freaked out whenever he freaked out... luckily I got an order for Ativan.
A separate night on telemetry that I will also never forget, I had to call 3 CRTs at the same time! One of my CHF patients had a very low BP, and the doctor didn't want to bolus her, just keep rechecking the BP which I didn't have time for since I had 5 other patients. Another patient has a psych history, and she crawling out of bed and into the hallway yelling "diff hospital! diff hospital!" security came to her room and said they received a 911 call from her room... awesome! Then meanwhile, while all of this is going on... another one of my patients tele monitor showed her HR in the 130's to 140's when she was previously in the 80's and 90's. Thank goodness for my coworkers helping me get through that night!
I remember one patient I had on 4 point restraints, with mittens because of altered mental status... he had a central line and an NG tube feeding. They had to take away the sitter because we were short on sitters, and the suicide precaution room took priority. So... I had tightened the restraints, made sure everything looked okay, pt was pulled up in the bed, and left the room. Not less than 5 minutes later, I returned to find the NG tube out and dripping onto the sheets... At first I couldn't figure out how it happened... but with further investigation, I realized he had scooted himself down in bed to give the wrist restraints more slack, then he used his knees to take off the mitten, and he could then reach up and pull out the NG tube. The CRT nurse attempted to put the NG back in, but the Xray showed it was inserted into his lung... but at least the Dr. said to leave it out for the rest of the shift.
so many of my shifts are like this . especially my first year we were severely short staffed. it was awful. similar stories to these. multiple rrts at the same time . no one to help because we are short to begin with. pt yelling cause they need to be cleaned up but no staff able to help turn them, q1 accu checks or vitals and no aides. mostly all new grads, violent 1:1s, with restraints needing q15 rn checks, then being mandated on top of it, bed alarms ringing but no staff to answer them, have to stand around for 10mins before finding another nurse to waste meds, most pts on isolation. pt needs step down but no icu or step down beds. this was over and over and over. awful. i laugh and get annoyed when people tell new grads co workers will help.I needed help soooooo many times and didn't get it because there wasn't anyone able to help. it was sink or swim. i managed to float but most of my cohorts sunk
I immediately sent another RN over to my FFP patient's room to watch them since I had to stay in my ICU transfer's room and provide information to the code team.
gcupid
528 Posts
This is Hilarious to me.... ! So after 10 minutes, did u begin chest compressions?