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.
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 work on a renal/tele/medsurg floor. These stories sound like my typical shift. I am happy if I only have 1 AMS pt at a time. No details as I tend to block out painful memories.
MSICU. Had one patient with an open abdomen and my other room was empty. Get an admission approximately 2000 (I was night shift at the time).. GI bleeder who didn't want blood work done, thought it was unnecessary. Forget the fact that he was filling bedpan after bedpan with liquid maroon stool Got him settled in, talked him into blood work which the tech started to obtain, went to help turn my other patient for his bath. That guy dehisced while turning. Trauma and surgery come, open his abdomen at the bedside, repack it. Filled two canisters with blood from his abdomen.. never dropped his BP though, apparently it was all an old hematoma. Regardless.. imagine that scenario. Finally get that somewhat under wraps, they want to send me for a bleeding scan for my GI bleeder. They opened up the nuc med department for him alone. He and I go down (he's not tubed so it's just me and the nuc med tech). My BP is dropping as we're down there, no pressors, only NSS and one whopping unit of blood, and he's laying in a pool of bloody stool.. I call the residents, we want this scan so we can hopefully stop the bleeding but I'm getting nervous.. they send someone to evaluate him in nuc med and the doc says "Just hurry up and finish the test so he can get back to the unit." Sweet. So we get back without incident (thankfully) and get him settled back in. At this point it's 0400 and I haven't charted a thing or taken a break. I run to the breakroom to heat up my lunch, and get back to see orders for my GI bleeder to go to IR to be cauderized. Seriously? Thank goodness I have awesome co-workers.. one of them took my patient to IR for me so I could catch up :) What a night..
16 patients on med surg. 2 RNs and a charge nurse. RN#1 has six patients in her load (a reasonable group for this particular unit) RN#2 (me) has the other ten patients AND first admit. The charge nurse? Well, when I went in her office to ask for help- she was painting her nails. true story
I will never forget the night I was in one of the "intensive care" rooms in the NICU where I worked. We were super busy with 8 sick babies (vents, new micros, drips, frequent A/Bers, etc). There were 4 nurses.
All of the sudden...
--Nurse #1 gets ill and needs to leave.
--Code button goes off next door. Nurse #2 needs to assist with an extended full code.
--Code button goes off again in another room. Nurse # 3 must leave to asisist. Another extended resuscitation.
So here I am, left all alone with 8 critically ill neonates. Just as I am running from bed to bed checking kardexes, doing vitals, giving meds, charting vent checks, saving A/Bers, the resus nurse comes in and drops a brand new 28 weeker in a warmer, then runs away frantically to another delivery call (and admit).
It was truly one of those times you don't know whether to laugh or cry!
11 patients in pedi. Only me and an LVN, who in this state, is not allowed to push IV meds or start IV's or give narcotics or do assessments. So I had 11 patients. We no longer hire LVN's for this reason.
I nearly blocked it out, but when I read the question, it came back to me.
Myself and one other RN, the only two nurses on 11p-7a. Acute care med-surg. Out of 36 possible beds, 32 are filled. I remember there were a couple of isolations.....specifics I really HAVE blocked out! ONE---count 'em, ONE care tech for the floor. And supervisor's answer to this? "well, no one wanted to come in and I can't short another floor just because you're short". SERIOUSLY?? Heaven forbid another of the med-surg floors has to work shorter than planned...we were facing SIXTEEN patients apiece.
What did we do? Yelled, cried, refused the assignment. And ultimately began passing meds, answering lights so the patients didn't suffer because of stupid staffing administrators.
At some point we got a second PCT floated to us---gosh, thanks, but how about a NURSE?? Took what we could get. One of the nurses from another unit was called to ours to work on MAR/24h chart checks (really, hours of paperwork on top of this patient load...NOT gonna happen). Oh, and that MAR help didn't arrive until the wee hours of the morning, so we were using the old MARs to record meds for the new day, as we didn't yet HAVE new MARs to work from (nothing checked, lots missing as anyone who works nights knows happens).
Everyone lived. And somehow, THAT is the part that administration got out of the situation....that it was "manageable".
Got him settled in, talked him into blood work which the tech started to obtain, went to help turn my other patient for his bath. That guy dehisced while turning. Trauma and surgery come, open his abdomen at the bedside, repack it. Filled two canisters with blood from his abdomen.. never dropped his BP though, apparently it was all an old hematoma. Regardless.. imagine that scenario. Finally get that somewhat under wraps, they want to send me for a bleeding scan for my GI bleeder. They opened up the nuc med department for him alone. He and I go down (he's not tubed so it's just me and the nuc med tech). My BP is dropping as we're down there, no pressors, only NSS and one whopping unit of blood, and he's laying in a pool of bloody stool.. I call the residents, we want this scan so we can hopefully stop the bleeding but I'm getting nervous.. they send someone to evaluate him in nuc med and the doc says "Just hurry up and finish the test so he can get back to the unit." Sweet. So we get back without incident (thankfully) and get him settled back in. At this point it's 0400 and I haven't charted a thing or taken a break. I run to the breakroom to heat up my lunch, and get back to see orders for my GI bleeder to go to IR to be cauderized. Seriously? Thank goodness I have awesome co-workers.. one of them took my patient to IR for me so I could catch up :) What a night..
turnforthenurse, MSN, NP
3,364 Posts
That has to be illegal....