You know the shift is gonna be a hot mess when ...

meanmaryjean, DNP, RN · Sep 7, 2016

When I started out, they were still treating the DTs with rectal paraldehyde, a banana bag and four point restraints. I always knew my night was going to suck when I could smell the paraldehyde from the sidewalk

Once you smell paraldehyde- you never forget. Having a flashback to my 1977 LPN days in inpatient psych. More like PTSD

NurseKatie08, MSN · Sep 7, 2016

When you receive a confused and combative direct admit for a liver transplant with and the attending tells you to move as fast as humanly possible to prep the patient for surgery. So you then drop everything, frantically try to get them lined and labed (with those great ESLD/ESRD veins ) send them for their pre op imaging studies, rush to get the paperwork together to then find out the liver was bad, then discharging them all within a few hours. So much work for nothing and sad for the patient and family.

I can't say that I have received a combative direct admit for a liver transplant, but I absolutely HATE sending someone home when the liver is bad. It is SO sad for the patient and family. I had someone once that I had to send home for their 2nd time! It's the worst.

Cricket183, BSN, RN · Sep 8, 2016

That's great. When I worked in Oncology my manager wasn't an Oncology nurse and didn't even have a chemo card

Wow! Just wow! I've worked with an awesome manager and one who wasn't worth a flip. It makes all the difference in the world!

teacupRN · Sep 8, 2016

a bit different as I'm inpatient acute dialysis
when you get a text that you have an assignment of 6 patients, walk in to 8 patients as there have been 2 admits overnight, and
#9 is in the ER having skipped a week of dialysis with a K+ of 7+ and +4 pitting edema, and the nurse you're working with (only one other) can't possibly stay past 5 pm.

When you are work acute dialysis and assigned ICU for the day. You have an assignment of 3 patients on CVVHD, have 3 add ons, your tech is sitting a 8 hour SLED on an acidotic vented patient. You get told that there is a tylenol OD that needs a 12 hour SLED stat. A coworker assigned med surg dialysis gets that started ( leaving med surg dialysis short), and then find out that life flight is bringing in an cardiovascularly unstable pt with a potassium of 7.5 that needs a SLED, but every dialysis machine in the hospital has a patient on it, and the ED has a patient in volume overload on Bipap who needs urgent dialysis also.

carolinapooh, BSN, RN · Sep 8, 2016

No matter what setting, this has ALWAYS been a bad omen for me. That, and someone using the "Q" word....

Seriously.

For me it's always when you hear: "Oh, it was so quiet today..." just before report starts. Double the severity if it's a Friday or Saturday night, or a long holiday weekend. Triple if you walk in with a low census and they send people home.... :mask:

TriciaJ, RN · Sep 8, 2016

I had the worst luck during my critical care clinical. First day I was put in the trauma bay of the ER and my "patient" came in as unresponsive reason unknown and no other details. I guess that was their code for figure it out for yourself. He started out good, except that no one could insert a Foley. I had the dubious honor of the first 2 attempts, then my instructor tried, my clinical nurse and the ER doc even gave it a shot with a baby Foley all with no success (I actually was sort of relieved because it wasn't just the student couldn't get it in...). Then I was instructed to assess his breathing and heart sounds and heard an odd noise. I had no clue really what it was except it was NOT normal (this was an ah moment...that's why they beat NORMAL into us so hard so we could hear not normal). It was a murmur upon further evaluation...one that was not there a month prior at his last check up. Then the patient started going downhill...On top of that while the patient was in for testing there was a code that came in and I was sent to help. The patient was basically a DOA that the ER DOC worked on for 15 minutes but he had been down for at least an hour already...Paramedics shocked him 3 times even though he was in Asystole go figure. Back to primary patient...he needed blood and most of his lab values were critical. Diagnosis Cirrhosis with Ascites and several other problems including the lack of opening in the urethra and the heart murmur.
The following week in the ICU I had a patient who had a leaking chest tube for a spontaneous pneumo and I had to give report to the doctor because my clinical nurse was swapping patients with the IMC...talk about putting the student on the spot. Then the last week of Critical Care clinical I was in the Neuro ICU and ended up floating to the Surgical ICU upstairs for a patient who was going to be an organ donor but went septic and turned into a DNR instead so I helped remove the support eventually after having to wait for the family to arrive while trying to keep enough pressors running to keep the patient from coding then helping once again with cleaning a patient after death. I think I would have felt better about seeing so many things if I didn't feel a teeny bit cursed to have 2 deaths in one clinical rotation...

But I bet your first job was a piece of cake compared to all that! Talk about trial by fire.

TriciaJ, RN · Sep 8, 2016

Someone says "wow, it's really quiet tonight...".

Grrrrr! I hate that!

CardiacDork, MSN, RN · Sep 8, 2016

Grrrrr! I hate that!

Tell me about it and it tends to be nursing students or visitors that say this--- although it seems like nursing students eventually become well informed and warned that if they say quiet around me .. I'll eat them sunny side up.

carolinapooh, BSN, RN · Sep 8, 2016

Tell me about it and it tends to be nursing students or visitors that say this--- although it seems like nursing students eventually become well informed and warned that if they say quiet around me .. I'll eat them sunny side up.

I don't like eggs.

I'll eat them medium. :)

saraaileen76 · Sep 8, 2016

When night shift is staying over for a double shift because we don't have enough staff.

BeenThere2012, ASN, RN · Sep 8, 2016

When you are work acute dialysis and assigned ICU for the day. You have an assignment of 3 patients on CVVHD, have 3 add ons, your tech is sitting a 8 hour SLED on an acidotic vented patient. You get told that there is a tylenol OD that needs a 12 hour SLED stat. A coworker assigned med surg dialysis gets that started ( leaving med surg dialysis short), and then find out that life flight is bringing in an cardiovascularly unstable pt with a potassium of 7.5 that needs a SLED, but every dialysis machine in the hospital has a patient on it, and the ED has a patient in volume overload on Bipap who needs urgent dialysis also.

I'm getting an anxiety attack just reading this!

Here.I.Stand, BSN, RN · Sep 8, 2016

When you have to travel with a newly graduated MD to MRI with your unstable patient (because policy says an MD has to come even though it always ends up being the new doc anyway so it makes little difference) on vasoactive drips/vented and labile MAPs and you know if shi-- goes down you gotta step in and it's you and RT running the code either in the hallway en route or in the hallway of the MRI room (no codes allowed in the MRI room because of the metals and the crowds that come in) until the code team get there.
MRI is the scariest place to be at as an ICU Nurse. So if pressures start tanking you have to be ready to act. It's scary and I'm not afraid to admit it :) We are far away from the ICU nurses, from the fellows, minutes away and in minutes a lot can happen. So your initial interventions will make that difference.

The other night (while safely in the ICU) I heard a code called to MRI. My blood ran cold. :nailbiting:

We generally don't get MRIs on unstable pts where I work -- stuff that truly can't wait is usually visible on CT -- but as you know, **** can happen fast.