unapologeticalyme-blog

[unapologeticalyme-blog]

Nursing gone wrong

Starting my day at work 

A typical day 

I come into work an hour early so that i’m able to actually read through my patients’ charts and write down all the meds they are going to need because once I clock in, it’s going to be a rat race.  It’s  now 7 AM and I am looking for the nurses who had my patients the night before so that we are able to do bed side report. They are nowhere to be found. They are finishing up med passes that were due at 4 AM but they didn’t have time because they had 4 people  admitted from the ER between 1 and 3 in the morning and they are trying to find out what kind of diet these people are supposed to be on, what fall risk they are, what medications they take at home and the last time they took them, and their history. As i’m walking down the hall looking for someone, I hear a patient yell “help me.” I go in and they have slid off their bed pan and have a mess in their bed. I slip on gloves, look for their wipes only to realize they don’t have any. So I take the bed pan off them, slip off my gloves, run down the hall to get into the supply room, and grab the wipes. Now I have to get them fresh sheets and a new gown. As i’m heading back to their room, two nurses are waiting for me so that they can give me report and go home. I know this patient isn’t going to die from dirty sheets. So I go in and explain to them that I will be back in to clean them up in a short while. I wipe them up and remove the dirty chuck pad underneath them so that they won’t be uncomfortable. They then tell me they need fresh water as well. --so I think “ok, I need to get report, change these sheets, and get fresh water.. check” 

I get a patient report on one person and they tell me that they have not been walked and want to get up and stretch their legs. -- I write it on my sheet and think, “ok, so I need to change sheets in room 910, get her fresh water, and then I need to pass my morning meds, do my assessments, look at my telemetry reading at 8 for my four patients and make sure their heart rates aren’t doing anything whacky, chart that info, and then i’ll come back around and hopefully the techs will have vitals done and be starting on the bed baths..after that is done, I will get up and walk this patient.”  

I walk down the hall and a bed alarm goes on. I go running and a patient down the hall in room 915 has now gotten up and knocked their entire bedside table over and there is water all over the floor and they have ripped off their telemetry monitor. I put them back in bed, call telemetry to tell them that this patient is ok, and go to put their monitor back on and realize that they have taken their chest pads off as well and there are none in the room. Back to the supply room I go. I  I walk by the nurses station and hear the phone ringing and call lights going off but I just ignore it and get packs of telemetry pads and go back to attach the monitor to them. 

I walk past two rooms with IV alarms going off. I will come back and check them or someone else will. 

It’s now close to 8 and I haven’t been back in patient 901′s room to change their sheets yet. I’ll just have the patient care tech do it because they will be going around doing vitals, checking blood sugars, and asking the patients if they want their baths. 

Next report taken, this patient is a stroke patient and requires neuro checks every 2 hours and must have blood pressure checked manually on the hour to make sure it is controlled because they have a bleed that is currently being controlled. They are on a nectar thick/pureed diet and can only be fed by staff. They are bed bound as well.

---Ok so now four of my patients are all accu-checks- which means I have to make sure their blood sugars are tested when they order breakfast. If it is high, I have to cover them with insulin when their tray comes. One of them, I have to feed or have the tech feed them and I have to make sure I stay on top their blood pressure every hour and check their neuro status every 2 hours. 

It’s 8:15. I haven’t seen a tech yet, patient in room 910 is still dirty, I still have a mess on the floor in 915, and I have to go look at the telemetry screens and chart their current rhythm and rate, which is already 15 min late. We chart rates every two hours. 

I still haven’t seen a tech. Four alarms are going off, nobody is at the nurse’s station, and the phone is ringing. My pocket is ringing and it’s dietary, telling me that two of my patients now have their breakfast trays and I look on the board and none of their sugars have been checked. 

I find out we don’t have a tech. I am now responsible for my vitals, which are to be taken every four hours (except for my one patient, who I have to do manually every hour), my own accu-checks, administering insulin to cover them, giving my own bed baths, walking my patients that do not have an order for PT, checking my telemetry screens every two hours and charting, completing all assessments and charting,  rounding with physicians, and checking charts to see if any new orders have been put in or if lab results have came in. 

Lab results are in- 2 of my patients have low potassium, nothing in their med rec shows they have potassium ordered. I have to page the doctor. 

Room 910 is still laying in a dirty bed. 

I have a family for one of my patients wanting to know how their mother is doing today.. I don’t even know what to tell them.. I haven’t assessed her yet. When they say her name I don’t even know who she is, give me a room number.

Two doctors have just arrived to round with me on my patients. 

Two of my patients have eaten breakfast and have not received their insulin. 

My patient keeps calling wanting to know when he can get up and walk. 

My other patient calls and wants their bath in the next half hour because their family is coming up. 

I haven’t charted anything. 

My 8 oclock meds are 45 minutes late. 

I page the doctors again about my lab results

I call pharmacy twice because my patient’s levemir isn’t in their bin and it was due a half hour ago. 

One of my patients has to go for dialysis and they are ready. Did they get their bath? I have no idea.  

We have two more admits coming from the ER. Now each nurse will have 5 patients. 

One of my patients needs a blood transfusion. 

910 is still dirty, at least I think they are. Someone may have cleaned them up, I haven’t been back. 

I’m passing meds and my patient starts talking about his love of camping and telling me about all the trips he and his wife go on. He is answered back with,  “how exciting” .. I honestly haven’t heard everything because I see in his chart he’s tested positive for influenza and we have no precautions set up. Everyone is going to need masks for his room now. I don’t have time to talk to him. I need to go page the Doctor to make sure they are aware of his results. His wife starts asking questions about when I think he’s going to be discharged. 

I can’t even remember why he was admitted or what he is here for. 

910 is still dirty. I haven’t charted anything. 

My patient in room 918, who was just admitted an our before shift change, has a heart rate of 165 and radiology is trying to take her for a cat scan so I have to run and stop them. I look on her chart, nobody has reconciled her meds so nothing is ordered. Radiology is pissed at me. I don’t care. She’s not going anywhere.  I page her doctor. I call his office and find out he is out of town. I call the doctor who is handling her doctor’s patients.. no answer. I page him.I tell radiology she’s not going to have the scan until her heart rate is controlled, she is going to be having a pacemaker put in tomorrow but I refuse to send her because she needs to take her amniodarone that she should have had but she forgot to take it last night. I know she’s drank all the contrast for her scan and is on limited time but her HR is now 180. The physician calls me back. I am going to give her a cardizem bolus of 10 mg  and run a drip. If that works I  can call radiology and let them know they can come back and get her. It works. her heart rate is now 110, going down.  The Doctor tells me to update her entire med list, that means I have to go through and put in each medicine and order it through pharmacy for him. I can fight him on it but I don’t because it needs to be done and i can’t be sure he’ll do it right away. 

Shit, I am a half hour late on my blood pressure check for my stroke patient and guess what? 910 is still dirty. 

My mouth is so dry and I have to pee.. keep moving. 

The cardiologist is here to round and I have a nurse run up to me telling me that pharmacy is on hold for me and case management wants to know if one of my patients is ready to go home.  Oh, and my patient who had the stroke’s family is all in the room wanting to see me because he hasn’t had his bath yet and his food is just sitting there because nobody has fed him. 

I hear a nurse getting yelled at by a doctor for not knowing that the patient had converted back to a-fib. 

Shit, I need to check my telemetry. 

I need to check blood sugars because lunch is coming up. 

Who had the crackles in their lungs? Was it 903 or 904? 

Another nurse stops me, 905 needs their catheter emptied and needs fresh water. She has to get her patient ready for his heart cath so she doesn’t have time to do it. She’s super sorry. 

My phone continuously vibrates in my pocket. I am told by the charge  nurse I need to take a lunch. 910 is still dirty. I tell her I’ll take my lunch later, let someone else go... knowing I won’t eat lunch until 3 and it will probably be nothing more than a snicker bar and milk. My urge to pee has passed, I’ll slip in the dietary area and get a small drink of water when I go to get fresh water for a a patient. 

I still haven’t charted. I hope 910 isn’t still dirty. Surely her nurse took care of it . 

This is every day. I did not sign up for this. I became a nurse because I truly love people and wanted to help and make a real difference in this world. If I take the time to talk to my patients, I am late doing something that could effect the outcome for another patient. There are times I can’t even remember what patient is what or what they were even here for. All through nursing school, we are told that our job is to be advocates for our patients and tend to their needs, not only medical but spiritual as well. I can’t advocate for my patients when I don’t even have time to talk to them.