Yesterday, I feel like I failed as a nurse.

[ABQLNDRN]

Hi friends,

I haven't been here in a while and I apologize. This is a great site and I have missed you.

For quick reference, I am a Labor and Delivery RNC with 7 years of experience as a nurse, 5 of which have specifically been in L&D. I have done a stint as a permanent Charge Nurse, during which I realized that I really just love bedside nursing at this point in my career and kudos to all the nurses who enjoy management...meetings drive me crazy...politics drive me crazy...not my gig.

I feel like I failed as a nurse yesterday. I felt as though my patient assignment was too heavy. I was barely able to provide safe patient care--and never specifically told my charge nurse that I could not handle the assignment she gave me. I implied, hinted, asked for RN assistance from time to time, but never specifically said "I CANNOT HANDLE THIS ASSIGNMENT," and therefore feel like I failed.

I am ashamed of myself. This is not who I am. I am the nurse who speaks up. I am the nurse who confronts MDs and other providers when they need to be confronted. I am the one everyone else goes to when they need to muster up courage to speak to someone "above" them. I am the nurse who brings critical patient safety issues to the attention of the DON if necessary. So, I can't figure out why I didn't tell my CN yesterday that I was drowning.

I had the SICKEST patient on the floor. In the other two hospitals I worked at in the past, this patient ABSOLUTELY would have been on-on-one. She had HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome that was steadily worsening. She was on MgSO4. She had a very premature fetus...HIGH RISK. My CN, around 10am said that she was going to have to temporarily give my another pt to watch until RN Suzy Q (changed to protect the innocent) was done with her current patient situation, a C/S that she was almost finished recovering.

Well, let's just say that that never happened. That "temporary" situation became permanent. I struggled to stay on top of my HELLP patient's worsening situation. I could barely squeak in enough time to listen to her lungs on a regular basis to make sure her lungs were CTA...she was barely cranking out adequate urine. The (excellent) doctor who was overseeing her care couldn't read the last set of VS because, hey, I hadn't gotten a chance to sit down and chart them because I was in my other patient's room taking care of HER. I could bore you with more details of things I didn't get to do because of that assignment, but they wouldn't matter. The point is, my HELLP patient did not receive the amount of care that she needed and deserved.

I want you all to know that this is not a matter of me being upset because I was busier than the other nurses; I LOVE being busy. I PREFER to be busy. I am not complaining about the acuity. Challenge me with the tougher patients--I love to be challenged. This is a matter of the CN having given me an assignment that pushed me past my "tensile strength."

What I am wondering from you all is, do I have a legitimate concern, or am I just whining? If I am just whining, I will shut my mouth and learn to deal with these sorts of assignments. I know we all get hosed on pt assignments and I can take my hosing and keep on going. I just felt as though I couldn't provide safe patient care and I failed because I said nothing to my CN.

I will never, EVER, say nothing again. I will accept whatever humiliation and being gossiped about that I have to...I WILL protect my patients better in the future.

Thoughts??

[klone, MSN, RN]

I'm sorry. We've all been there (and as an L&D nurse myself, I've really been there). It's good to vent. And you'll be stronger for next time you're given too big of an assignment.

[nurseprnRN, BSN, RN]

I would print this out and give it to your manager. She might not really have known or understood, and it might be the eye-opener she and her managers need to see. You have seen what courage it takes to do this yourself; perhaps it will inspire her to do the same. Offer her support, and she will be able to give you support, too.

[OCNRN63, RN]

I think most nurses, at one time or another, have done what you did. I think when you're a conscientious nurse who really wants to do a good job, you feel like you're supposed to be able to handle everything without asking for help; saying "No" is a personal and professional failure.

Don't let this incident get you down. You know you won't do it again. Maybe you could sit down with you manager and discuss it from the vantage point of how you could manage a situation like this better.

I'll bet you're an excellent nurse. Learn from this and move on.

[Ruas61, BSN, RN]

You didn't fail.

You just hit a really bumpy stretch of road.

None of what you relay leads me to think you did anything wrong or terrible.

In fact, it seems you did well in spite of it all.

Looking back, we can easily second guess or beat ourselves up over situations.

I am not saying one shouldn't do so but sometimes we are harder on ourselves than is needed.

You sound as a very conscientious, competent, caring nurse who has good insight to safe practice.

[Morainey, BSN, RN]

It was a bad day. Everyone has one from time to time. Sometimes you leave work feeling like you just barely managed to keep all your patients alive. It's okay to speak up and say "I need help". Don't wait for someone to swoop in because to them it might look like you have everything under control. Don't beat yourself up.

[plinytheRN]

I feel like this all the time, I work on such a notorious med/surg telemetry unit where our nurse turn over rate is so high because they give us such heavy patients loads every shift. I am so frustrated and angry how unsafe the ratios are with such sick patients. I literally have a list of things that go on in this unit on how poor care is executed due to the lack of time and help. The manager won't hear it, just slowly trying to hire people, in the mean time I fear for my license and feel lucky if I even get a lunch break. I want to get out ASAP. I am so sick of being expected to perform all these tasks perfectly with little help, not to mention I can hardly afford anything on the pay. It's modern day slave labor, we run all day, are expected to know everything about all the patients, admit and discharge all day, and have little or no time to go to the bathroom and eat a decent lunch. It's every shift. Overworked, underpaid and unappreciated. Feeling so burnt out.

[Sun0408, ASN, RN]

Some days are like that. We do the best we can. I'm sure you did the best you could with the amount of pts you had plus this very delicate pt. With the worsening condition of the pt; I'm surprised a higher level of care was not needed. We typically get most of the HELLP mothers in our ICU until more stable.

[SleeepyRN]

I agree completely with Ruas61. Just the fact that you are beating yourself up over this, shows me you are a good nurse. Don't let one day shadow the 7 years of all the GOOD you've done. I think you've solved half the problem already. You've vowed to not let yourself not speak up when you need to. However, because as you stated, this isn't typical of you (that you do normally speak up when it's called for), I would reflect on why you didn't this time. Maybe you hinted at it a little by saying you'll "accept humiliation" in the future. If other nurses would gossip about you for requesting assistance, they either have not been in that type of situation before and are ignorant to the situation (unlikely) OR are accepting unsafe patient loads/acuity themselves and NOT speaking up. If the latter is the case, and they never learn their lesson like you definitely did, THEY are the unsafe nurses. Not you. Know in your heart you're doing the right thing by advocating for your patient's right to competent care.

[lovemyjoblandd]

I guess the important question here is, did both of your patients have good outcomes?

Sometimes we are not able to provide patients with specialized care in our field. Is it fair? no. Does it happen? a lot. As long as you met the patients' needs, kept them stable, followed orders, and did your absolute best to provide for your patients, that is what matters.

I hate when I have a natural labor patient who is only a 3-4cm and already really struggling, needing lots of comforting and redirecting, but I also have an obs patient with a 24 hour urine that needs to pee every 20 minutes and I keep having to leave my labor patient. That is just the way it goes sometimes. As long as the outcome is good and you are safely caring for your patients, sometimes you just can't ask for much else. Take it with a grain of salt, next time speak up, and let it go.