So it's been a while since I vented here about work. I thought things were getting better, I just celebrated my first year as an RN working at the Hospital. Things were getting better, the pt. assignments were easier and my time managent skills are awesome now. But for the last few weeks I have been getting the worst of the worst.
I have been admission one every night I have been working for the last few weeks. I thought the clown show was over dealing with all the crap and being admission one, also I wasn't the new kid on the block any more, I have been charge nurse a few times and have been asked to precept, they are waiting my answer b/c of the last few weeks I have had.
We have a brand new grad that started night shift with us on my floor 3 months ago and is not recieving the abuse I did last year. When I was 3 months into my firt year it was sheer torture, we even joke about how bad my pt. assignments were, and how the new girl is never admission one, gets the "easy pt's", and is not being shown any skills as far as Interventional Cardiac nursing is concerned.
My first week off orientation I was pulling femoral sheaths which in reality I wasnTt susposed to be doing but you surrender to the night whn you are understaffed and all the RN's have a femoral sheath to pull on top of 5 pt's. that are fresh from the cath lab or the CCU, I was hanging blood, starting lines, doing nursing skills that i was pushed to do and wanted to learn, I was asking questions, Which, when, where, WHY AND HOW.
I was asking for help from my senior staff and taked to the doctors even if they didn't want to hear what i had to say. I was laughed at for calling RRT's and Codes and told i was over reacting, but when the code team showed up no one was laughing b/c every time the pt. was in disress. I never stood in the corner during a code or RRT, I was INVOLVED and still am, I the one every one comes to now when any pt. is heading south and the other nurses ask for me to assess and my opinon before calling any shots. I was affected emotionally if something I did wasn't the right way, and I put up with so much crap and abuse from the staff and other nurses I almost quit.
So last night was the kicker. I was admission one, fine I am used to it, BUT in my opinion the new girl needs admission one from the ED on a regular basis to develop assessment skills and interaction with MD's. All nurses on my floor when they were fresh meat recieved the worst of the worst, but not with this new RN she has poor assessment skills due to lack of admission exp., she's never hung blood, I swear lately I do one blood transfusion a shift any more, she has only pulled one sheath, when I was 3 months into my first year I had already pulled 13 (I keep count), and latley I have had more femoral sheath pulls then ever infact I am now certified in femoral sheath pulling and venous sheath pulling I have done over 38 sheath pulls.
I thought maybe she was related to one of the nurses on my floor or she knew some big shot at the hosp. b/c they arn't making her assignments challangeling. She dosen't know any big shots in the hosp. and isn;t related to any of the RN's. And last night was the straw that broke the camel's back.
I get to work, it's my 2nd night in a row, no problem, it's friday and USUALLY things are pretty QUIET..hehe yea right. I have 5 pt's, Ok that's great and they are the same pt's I had the night before so I knew them. I also I see I am admission one yet agian and she is admission 4. I said to the day shift charge nurse that made the assignment, I was admission one last night, every shift last week, and every shift I have had for the last 3 weeks. I even showed the back log of pt. assignments to my charge nurse(the night shift charge nurse) There it was in writing ADMIT I under my name every time. I also showed her the new girls assignments for the last few weeks, not once in 3 weeks was she admission one ,I even went back 5 weeks to show this pattern. The day shift charge told me,"this is her 3rd night in a row I gave her a break." I said," last week I worked 5 12's in a row and I was ADMIT I every night and you didn;t give me a break. I am no longer the new kid on the block. So this has got to stop now." Yea yea yea I got alot of lip service from the day shift charge:vlin:. So I turned to my Night shift charge and said, "Why is this being allowed? You see it right in front of you, in writing."
My charge nurse for night shift looked and realized that this was happeneing. She apologized to me and knew I was annoyed. I am not one to be a nit picker, infact I am far from it, but I see me being taken advantage of b/c I never open my mouth about my pt. assignments, I am here for the pt's. But when I start to see a pattern that blatently obvious and can be changed I will open my mouth.:igtsyt:
Anyway, I get the faxed report from the ER. I see the pt's name and knew the pt. from a previous stay on my floor, I also knew there was going to be a crap storm that followed along with this pt.. I recieve the pt. from the ER and made sure there was a bed near the nurses station b/c of the pt's previous stay on my floor. The ED nurse forgot to tell me the pt was being transfused with 2 units PRBC's. The first unit was half done when the pt. arrived on my floor.
I have become a pro at blood transfusions . So I ask the new girl if she want's to learn and do my transfusion with me, great learning exp. for someone who has never done one. She says to me, "that's your pt. why would I want to do that?" I said, "you told me about 30 min. ago you have never done a blood transfusion, and this is the perfect opp. to learn. I can show you how to set up the Y tubing, and how to run NSS before you start transfusing, and all the forms you need to fill out before you hang the blood, the things you need 2 nurses to check, and observation for adverse reactions." My charge nurse said to her, "that's a great idea since it would be your frist time." The new girl said, "It's time for my break, that's YOUR pt, YOU can do it YOUR self." I was shocked and appauled:hlk:..my frist transfusion I ever did was on another nurses's pt. about a year ago, and i wan't given the option of saying no, I was TOLD I was going to do it, with no questions asked.
Anyway it gets soooo much better. I assessed my pt., thank god I knew the pt. and had taken care of her last time she was on my floor and knew what to expect, she was aphasiac due to an old CVA which I knew from her last stay, a peg tube, confused, and with a Hgb of 7 due to a GI bleed. ALSO the resident in the ED put a TLC RIJ and it was seeping, not oozing, 2 CXR's had been done in the ED to conform placement, and there was placement so it was't a bleed, no hematoma, good return from all 3 lines and flushed beautifuly but the sutures were in an odd position and everytime the pt. moved her head, which was quite often, it would cause the sutures to seep small amounts of blood. I even called the house MD to CYA on this one, he confirmed it was ok for use. The pt. aslo had a #20g HL in the left hand just incase.
I leave the room for 5 min. to get the paper work for transfusion. I walk back in the room and it looks like a crime scene. The pt. pulled out the #20g HL with her teeth, and there were only 6 teeth in her mouth. I look at the pt. and she is chewing like a dog on the 20g HL, as the end of the angiocath is hanging out of her mouth and there is blood all over the pt's mouth, the sheets, the floor, the surrounding chairs in the room, the bed and the WALLS, somehow the blood managed to get on the farside of the WALL like 15 feet from the pt:barf02:. As I look at the pt. I am having flash back of every Steven King movie ever made. The pt. just smiled at me, with the HL in her mouth that she was nawing on, bloody toothy grin and all:lghmky:. I look at her hand and there is no blood comming from where the HL was, her hand was clean, only a small I mean small amt. of blood like a finger stick amount of blood. I was so CONFUSED. I called another nurse in to witness this horror show and help me figure out what the he** happened in the 5 min I was away from the room. The 2 of us instantly opened the pt's mouth to see if she swallows any part of the HL, thank god she didn't It was compleatly intact, HL, 20g angiocath attached and venigard dressing all hanging out of the pt's mouth.
Oh I forget to mention the pt. is non-ambulatory so the blood on the floor like 10 feet from the pt. really made me confused. So I look at the TLC it's got a dry dressing , no blood, and tegaderm over it so i could see when it needed to be changed. We take the gown and every thing off the pt. roll her over, no rectal bleeding, I make the pt swish and spit to get the mouth cleaned out and then my charge nurse tells me to test the gag reflex to see if maybe she vomited blood, Nope, no bloody sputum or hemaptosis.
I realize that when she pulled it out with her mouth she must have spit the blood return from the angiocath all over the room, and she must have place her whole mouth over the IV and pulled it out, spitting the blood all over, I don;t know how b/c her 6 teeth are all molars, in the very back of the gum line..and the hand she pulled it out of was the hand that is flaccid. Then the pt. starts to go for the TLC trying to pull it out, while smiling at us. Blood is still every where, me and my girlfriend are tring to keep the Pt. and the TLC safe. B/c if she pulled out that TLC it would really be a crime scene straight outta CSI.
I scream for my charge nurse to page the house MD and for him to get his butt up here NOW and to get soft mitt restraints(ours look like boxing gloves, that's what we call them too they are so funny looking), my charge comes in and is shocked by what she saw, she had the boxing gloves in her hands, and said to me, "Imagine if the new girl had this admission insted of you, what could have happened, Because you know the pt. and have previous exp. being her nurse in the past you knew not to leave her alone for long periods of time, and you even knew to put her near the nurses staion." I said "that great and all but give me the bleeepin mitts". The medical resident called back insted of the house MD and asked if I could take a verbal order for restraints. I said, "NO you have to come up here and sign the 4 page form, and while were at it I want a 1:1 (pt watch) for this pt. also b/c last time she was here she managed to get the mitts off and almost pull out her peg tube, I am not taking any chances." He agreed.
OHH My night was just getting started at this point. One of the other pt's I had last night that I had taken care of the previous night was a VIP pt. Meaning the pt's related to someone who works at the hosp. This was no ordinary VIP pt., it was the Uncle of the V.P. of Operations a big shot at my hosp I mean BIG SHOT. The pt. was a CVA with left sided weakness, and slurred speech. Pt. was NOT, I mean NOT confused. The previous night the pt. had a 24 hour EEG that he tore off his head and decided to also rip out his HL. He tried to get out of bed, but after explaining that his left arms and legs had no feeling and if he were to get out of bed he could fall or hurt himself, he understood and used the call bell. His family also reinforced this over and over.
Last night I came into the VIP pt's room met his nephew the BIG SHOT he was very personable, even though I have met him a million times before, he didn;t know me from a hole in the wall, but now since it's his family member I am taking care of and I am the only nurse his uncle. knows by name he really made it a point to know me. I talked to him about how his uncle wants to use the bathroom but dosen't grasp or understand that he could hurt himself if he were to get out of bed, and that's whay I have multiple urinals in the room, and even a commode would be dangerous b/c he would still have to stand to use the commode and that's not feisable, I also said how I placed the call bell in his right hand, the good hand and showed him how to use it and made him show me how to use the call bell. I also said I would like to move his uncle to a room closer to the nurses station for fall precaution and saftey reasons but the only room available was a double room.
Nothing happened, the pt. remained in his room, which was on the back end of my unit, out of line of sight, and sound unless the call bell was being used.
After the family left I placed his call bell in his right hand and said if you need anything press the red button, but I will check on you every hour any way to see if you ned to use the urinal or just need me. The pt. said "I promise I won;t get out of bed, and i will call you." I also knew from the previous night and from what the family told me he was stubborn and won;t ask for help, he will try to do things himself w/o asking for help. I explained how It's my job to care for him make sure he is safe and how asking for help isn't something he should be ashamed of..I said, "I'm a nurse that what we do, I am here to help and heal you!" He smiled and said, "you're my girl"...
I left the room to admitt my Interview with a Vampire meets Carie the Steven King Movie patient from the ER. I was so held up with that bloody mess that I asked my girlfriend to check on my VIP pt.
She comes running into the crime scene room only to tell me, "You VIP is RIP" I said "WHAT??????":omy: She said, "He's on the Floor". I sprinted from the from the crime scene room to the VIP/RIP room. The VIP pt. was on the floor face pressed agianst the side of the bed and said "I needed the urinal but it was on the floor, so I reached down ,and.. well I slipped out of bed:sstrs:." I said "why didn't you use your call bell, you have a urinal right here next to you on you table on your right side and one in your bed and another one next to the call bell so if you needed to go you had your choice" He said, " I didn;t want to bother you." At this point I myself am having runs of SVT and CP b/c I know that one of my biggest fears as a nurse, having a pt. fall, let alone the Uncle of the VP of Hosp. Operations, just came true:idntdt:. I had placed urinals next to him and had them next to his hands i had 3 of them easy access, even the family saw me place them and said i was the only nurse that took the time to show him how to use the call bell and make sure he had urinals. So I have no Idea how the urinal was on the floor on the opposite side of where I placed them. I placed them on the right side and the urinal he was talking about was on the left side like in an odd spot that there would have been no way the ones I placed could have landed in that spot.
Anyway, The VIP pt. is like 250lbs of dead weight:deadhorse, he's trying to use his cane to hook to the ceiling IV pole, that's the only room with old ceiling tract IV pole, there's urine all over the place. 4 of us nurses try and lift him, yea right, the ER orderly was still on my floor from my heplock eater admission. I ran down the hall way as he was rolling away the gurney to go back to the ED and was screaming, "Mister Orderly Dude(why I said dude I will never know)" I looked like a total lunatic covered in blood from heplock eater, and urine from Mr.VIP. The orderly truns around and smiles, He had a full grill of gold teeth and said his nick name is Prince...I said, "Grillz, We need you help" He began to laugh at me..He came in the room 5 of us managed to pick the pt. off the floor, as we lift Mr.VIP into bed I had the brunt of the weight and ended up in the bed with Mr.VIP:smiletea2:. The pt. said, "It's been a long time since I've had such a young looker in my bed":flowersfo. We began laughing as I jumped up, only for this shooting pain to go right across my shoulder blades and down my spine and to linger arounf my upper back feeling like someone kicked me in the upper part of my back.
I cleaned up Mr.VIP. and knew the 1 million phone calls I was going to have to make to CYA on this one, and this one espically:yldhdbng:. I had to call the House MD yet agian, for an order for a 1:1 pt. watch for Mr.VIP b/c I wan;t going to take anymore chances, and for him to come eval. Mr.VIP. Mr.VIP Denied any pain :no:and had no gross visiable injuries. I had to call the night Shift Hospital Nursing Supervisor and explain what happened and also explain who the pt. was since it was the major VIP pt in the hosp. and begg her to pull a nursing assistant from another floor to do the 1:1 pt. watch since we were running out of nursing assistants on our floor b/c 2/3 CNA's were already doing pt. watches on our floor, and that we need one CNA for the floor to help us nurses b/c we were at full capacity and needed help. Thank GOD it was the Night shift nursing supervisor that knows and loves me. She called me back 5 min. later and managed to get a CNA from the ICU to do the pt. watch for Mr.VIP.
Yea having fun yet?? My back was killing me, I had to fill out an incident report, the House MD shows up signs off on the orders, evals the vampire pt. and Mr.VIP. He signs the incident report for Mr.VIP, only for me to screw up the original incident report :imdbb:and have to rewrite another report and call the House MD back to the floor to sign the correct incident report.The problem I had was I had paged him about 10 times b/t 2-6am and he didn't call me back, the House MD's are done their shhift at 6am.
At 5:55am I page him one last time and I am freaking out on the inside :scrm:b/c the House MD's have been known to leave and not follow up on things, he calls back at 6am, and says "Ang, I didn't forget about you, I am standing right behing you at the front desk." I turn aound and He is laughing at me and says, "I am having flashbacks of last year when you first became and RN." I said, "Yea and I remember the same time last year when you were cardiac fellow and not the house MD and how you would actually return my phone calls and pages." We laughed and he signed the correct Incident Report, he even read the thing and commented on how well I handeled the situation with professionalism and grace and minus the 1000 pages I had made to get his orifice back to my floor.
So after this whole circus side show night, I come home this morning to my townhouse, 1 hour away from the hosp. I work at, to the lovely sounds of jackhammers and construction to my front side walk. I look like hell, I smell like hell, and am ready to loose it, I think the construction guys knew b/c I camly said, "I just got home from a 15 hour nightmare night shift, how long are you going to be out here I have to try and sleep today and go back to work tonight?" The guy said, "I understand compleatly where u are comming from, we are done with the noise, we will be gone in 30 min." He was pretty cute too, I myself was not cute in any sense. I looked like a 72 hour psych hold:jester:. And what did GOD grace me with, 30 min. later, they were gone. Only fof me to lay down and have the pain in my back become so bad I couldn;t lay flat or lay at all on any side and I tried for about 2 hours, and after 800mg of Motrin and 1000mg of Tylenol and still no relief, I decided to call out tonight, call my doctor, and save my soon to be 28 year old back. I haven't called out in over 6 months.
The only good thing to come of the night from hell was my charge nurse said to me at 8am this morning, as I was trying to give my last report and finish, she said "Ang you are a great nurse:nurse:, one of the best I have ever seen, you are good and I mean great at what you do:nmbrn: and how you treat and care for your patients.Don;t worry about what happened tonight with Mr.VIP, you acted accordingly and took all the steps, precautions, CYA's and even went the extra mille to make sure that day shift dosen;t have to deal with residual problems from last night's debacle. That's what makes you a great nurse. And the vampire pt., if it wasn;t for you, none of us would have remembered that pt. You actually remembered what room she was in lsat time she was here and what nursing home she is from. YOu are a great nurse and all the 'tough love' you endured over the last year from the staff and nurses makes/made you who you are today, do you think anyone else on our night shift would have done what you did with the exception of a few, and you know who the few are, and you are one of them. Every time i work with you I admire you enthuaism, diligence, intelligence, compassion, and care you have and how you can be direct and demanding without being a (bleep) unlike some of the nurses we work with. You are a great nurse girl, you have a spark and a gift don't ever let anybody take that away from you!" I can't get those words out of my mind b/c for her to say that means alot to me considering she is one of the ones who pushed me in the beginning and made my life miserable as a new RN. And now I understand why she did that she saw something in me.:rcgtku:
Ok so that was my night from hell, one of the worst nights I have had iin a long time but every horrible night is a major learning exp. for me...I know it's a long post but I had to get it out..Thanks for reading and listening to my rant......MY FIRST YEAR AS AN RN IS NOW DOWN IN THE RN HISTORY BOOKS, ALL I CAN SAY IS BRING IT ON!!!!!!!!! :prdnrs:
