When you finished your shift and you felt terrible because you think that you did not do your job well.Oh did I document the medications that I gave?.Did I chart on my patients?.What about the orders that the doctor gave me?.Was it entered?.Did I do my pin care?.What about the dressing change on Mr.Smith?.You kept beating yourself. Well you are not alone. Check this out.
The evening shift starts at 3pm in my facility.
At 3:15pm the supervisor called the floor,two Registered nurses called in sick she said.You just have to work with what you have.I replied we are full and the acuity is very heavy. She did not listen ,so I handed the phone over to the charge nurse.The charge nurse turned around and started to ask some of the day shift nurses to see if someone can stay to assist us.
Do you want to stay to help us out she asked?.
I joined in the plead,please help us .
We will buy you dinner I said with a smile.
Nobody volunteered to stay.
We have 51patients ,4 discharges.Emergency room is code green. That means that the Emergency room is full. Nine Registered nurses, one Certified nursing assistant.
I have seven patients two of them were discharges.It is assumed by the day shift Charge nurse that the patients were already gone.No they were not.One patient was waiting for his daughter to pick him up at 6pm and the other was waiting for her medications. They were sent to the discharge lounge at 5pm and were later picked up by family members.
I was now left with five patients, two of them are confused and the sitter room is full.So placed the two patients in one room and do all my work from their room.They attempted to get out bed.Placed them on low bed ,and gave them their medication at 1800,and 2100pm,called CNA to monitor while I hang my TPN on another patient, and admit my trauma patient. Completed my assessment in ten minutes,took his vital signs ,document my findings, hang his intravenous fluid gave pain medication. Run back to room 13022 for my two confused patients.
I was lucky to urinate one time during my eight hours shift .While I was in my patient room the doctor called and gave me some orders.
I could hear our new manager barked at one of the nurses,he quickly barked back. He has had enough and was ready to turn in his badge.
Manager : Why are you not answering your calls?.
Mr.XYZ replied ,I am in isolation room so I can’t put my hand into my pocket to answer my phone. But I told the charge nurse and the resource nurse that I am in Isolation room to change patient dressings(patient has multiple chronic wounds)And they are covering for me.
Manager: I don’t care where you are or what you are doing. When I call or your patient calls you must pick up the phone if you want to continue to work here.
Mr.XYZ : You know what ,you have never been a nurse so you don’t understand. What are you going to do?.Fire me?.Go ahead. And he walked away.
The charge nurse called me and said that the doctor wants to place chest tube at the bedside on one of your patients (Ruben 13024)and that I should gather all the supplies including the chest tube cart, the syringes, needles 23guage,I gathered from size 16guage to 23g.And he will be coming back in one hour to place the chest tube.
I asked the charge nurse for help she declined, talked to the resource nurse she refused and said that she is extremely very busy .I got sitter orders for my two confused patients. One of the nursing assistant from another floor became as a sitter for my two patients,then I went to assist the doctor for chest tube placement. Patient was medicated before the procedure. I can tell that he was still in so much pain.There was no time for dinner I said to myself. The charge nurse said that I must go for dinner I told her that I already took my dinner. She asked at what time,I replied 19:30pm.She knew that I didn’t take my dinner. But with California law it must be documented. Here are slight pictures of my patients.
Patient number 1.
A 62years old female S/p Pneumonia, Pleural effusion ,mentally retarded who came from Boarding Care.Stage 1V lung cancer,none squamous cell carcinoma versus adenocarcinoma .History of left lung thoracentesis.Consent signed for genetic studies for mutations.( It was signed over the phone with patient caretaker and two Registered nurses) Procedures site at the middle of the back. Bilateral redness to buttocks, nonblanchable, redness anterior bilateral breast. Stage 11 bedsores to the coccyx area,nonambulatory.Reposition patient Q2hours .Dressing change qshift.Blind partially,nonverbal but makes incomprehensive sounds, lungs diminished, 02 at 2 liters nasal cannula. Left forearm saline lock. History of constantly pull out her saline lock.She pulled her saline lock twice and was replaced. Feeder,confusion, make sounds all the time.
Patient number 2.
54years old female. S/p left foot infection,Sepsis, swelling, incision and drainage done,dressing with kerlix and cuban intact. History of poly substance abuse, history of meth use,homeless and some confusion.Wound culture to the left foot done.Transfer to SNF when bed is available. Intravenous antibiotics long term.
Zyvox 600mg if Q24hours for 14days.
Unasyn 3.375gm IV Q8hrs × 4weeks, right upper arm middle line,bedpan,Bedrest, Kerlix roll and cuban dressing QOD.
Patient is able to wriggle her toes.
Patient number 3.
New chest tube inserted with the doctor at the bedside.Patient is resting quietly.
Patient number 4.
New onset Diabetes mellitus. Diabetes education done.Nutrition consult ordered for follow up with diabetes education. Patient demonstrated understanding. He said that his parents are diabetic. Ordered diabetic supplies ( accucheck machine, diabetic syringes etc) He calls frequently for pain medication,dilaudid 1mg IV Q3hours, percocet 2tablets Q4hours prn pain,and was medicated as ordered by the doctor. Xanax 1mg po Q6hours prn anxiety.
Patient number 5.
Trauma patient from Emergency room due to multiple stab wounds to chest, shoulders, abdomen and back.
Two patients were discharged and send to discharge lounge.
I gave report at 2300,clocked out at midnight.
And drove home with a song on my lip.
Oh God I feel resentful.
Remove my resentment.
Then I started singing.
I love nursing and nursing love me.
Some days are good and some days are bad.
Suddenly ,I heard police sirens ordering me to move to the side and stopped.
I stop as ordered, the officer came and asked for my driver license. I gave it to him.
Lady did you have too much to drink tonight?.
I smiled hysterically why I asked.
He said because you are driving too slow.
I replied officer, I had a terrible shift so I was trying to reflect back to make sure that I did my work competently and documentation done correctly.
He said,that is too dangerous because a speedy car can ran into you.Where are you going?.I pointed.He replied you are almost there increase your speed a little bit.So I did.He waved good night to me.And I waved back.
When I got home I could not sleep. I cried,I talked to myself. I tried to talk to my husband but he has already gone to sleep.
The next day ,I called off from work not because of my terrible assignment but because of my encounter with the officer. I know that the next day assignment will be better but I was mentally exhausted. Moreover, I was the charge nurse the next day but cannot be there.For me to be late or miss work is the worst thing that can happen to me. However patients safety is the top most priority. I love nursing.It is a noble profession. It is flexible, be knowledgeable and willing to serve. I was tired but it is what it is.