Several shifts ago, I walked in feeling good, feeling confident and generally feeling fine about the night. I put away my coat, got out my ID and stethoscope, greeted my coworkers and started walking on over to the assignment board. And that’s when I experienced a moment of asystole and then rapid tachycardia. My name wasn’t paired up with a preceptor. ‘Surely this must be a mistake – the ward clerk made a mistake. This HAS to be a mistake’, I thought in a panic. Unfortunately it was not a mistake. The charge nurse strolled over and told me that the unit was extremely short staffed and she thought I could take on the assignment by myself. Apparently 4 nurses called in sick. Damn flu season.
So I try to pull myself up by my bootstraps and head over to the fast track area (seems to be where I’m usually placed). I have 8 patients and a very worried day shift nurse waiting for me. Report sounds something like this;
‘Curtain 1 is a 33 year old guy came in with coffee ground vomiting. He’s got 2 boluses of fluid and needs a pantoloc infusion started along with another PIV. He’s due for another CBC in two hours and he’s waiting for a GI consult. Keep a close eye on him. Curtain 2 is HIV/HIT positive and came in for query pneumonia. Her sats are now in the low 80s. She’s gonna need help and lots of it. Oh she’s also isolation for ESBL precautions. Watch out – she’s kind of a bitch and may try to hit you or rip of your mask. Curtain 3 is a homeless lady, EtOH abuse, left elbow cellulitis and waiting for an ortho consult to rule out septic arthritis. Her morphine tolerance can rival that of a large baby elephant so keep on signing out as much as you need but keep an eye out for respiratory depression but you knew that hahaha! Curtain 4 is another homeless EtOH abuser and is VERY tremulous. He needs hourly IV diazepam. He’s to be discharged when he stops shaking. Curtain 5 is a lol who’s waiting for a bed in medicine. The resident wrote a shit load of orders for her. My advice would be to start her cipro, ancef and avelox and let the floor worry about everything else. Keep an eye out on her I&Os cuz the resident is really anal about it. Jerk. Curtain 6 is a perforated appendicitis but GI can’t take her right now because they’ve got 3 urgent cases lined up ahead of her. She’s got admission orders so start her antibiotics quickly. Oh and she’ll probably be spiking a fever soon. Do hourly vitals on her cuz she just doesn’t look right. Good luck hon – make sure you ask for help. Good night’.
When that report was finished I wanted to hide in the bathroom and cry. Turns out that between patient transfers to the floor, I went to the bathroom and experienced what could be my first ever panic attack. I was definitely tachy, diaphoretic and vomited. Had I been older, I would have thought I was having an MI. Not a good patient load to start of with when I'm still a newbie. I don’t know how I managed to survive that night – all I remember is that my priority was sticking on high flow oxygen to bitchy HIV lady, getting pantoloc to coffee grounds guy, antibiotics for old lady and perforated api woman while begging admitting to find beds for the ones who were waiting. When I finally got a bed for my perforated api lady, I realized that I forgot to give her Tylenol for her fever. Since Tylenol was not in her admission orders, the medical directive becomes void on the floor. The floor nurse made sure she bitched at me. Funny thing is that I had Tylenol in my pocket and was willing to sign on the chart for it but she wouldn’t let me. Her problem.
Not that I want a night like that again, but looking back on it I got a month’s worth of learning in 12 hours. Sure I needed a stiff drink after that but since it was morning time when I was finished I just crawled up in my bed and tried to forget that any of the night actually happened. My boss is telling me that she wants to test run another independent shift in a few days so I suppose I better I get my butt into gear and get ready. I don’t wanna!
So I try to pull myself up by my bootstraps and head over to the fast track area (seems to be where I’m usually placed). I have 8 patients and a very worried day shift nurse waiting for me. Report sounds something like this;
‘Curtain 1 is a 33 year old guy came in with coffee ground vomiting. He’s got 2 boluses of fluid and needs a pantoloc infusion started along with another PIV. He’s due for another CBC in two hours and he’s waiting for a GI consult. Keep a close eye on him. Curtain 2 is HIV/HIT positive and came in for query pneumonia. Her sats are now in the low 80s. She’s gonna need help and lots of it. Oh she’s also isolation for ESBL precautions. Watch out – she’s kind of a bitch and may try to hit you or rip of your mask. Curtain 3 is a homeless lady, EtOH abuse, left elbow cellulitis and waiting for an ortho consult to rule out septic arthritis. Her morphine tolerance can rival that of a large baby elephant so keep on signing out as much as you need but keep an eye out for respiratory depression but you knew that hahaha! Curtain 4 is another homeless EtOH abuser and is VERY tremulous. He needs hourly IV diazepam. He’s to be discharged when he stops shaking. Curtain 5 is a lol who’s waiting for a bed in medicine. The resident wrote a shit load of orders for her. My advice would be to start her cipro, ancef and avelox and let the floor worry about everything else. Keep an eye out on her I&Os cuz the resident is really anal about it. Jerk. Curtain 6 is a perforated appendicitis but GI can’t take her right now because they’ve got 3 urgent cases lined up ahead of her. She’s got admission orders so start her antibiotics quickly. Oh and she’ll probably be spiking a fever soon. Do hourly vitals on her cuz she just doesn’t look right. Good luck hon – make sure you ask for help. Good night’.
When that report was finished I wanted to hide in the bathroom and cry. Turns out that between patient transfers to the floor, I went to the bathroom and experienced what could be my first ever panic attack. I was definitely tachy, diaphoretic and vomited. Had I been older, I would have thought I was having an MI. Not a good patient load to start of with when I'm still a newbie. I don’t know how I managed to survive that night – all I remember is that my priority was sticking on high flow oxygen to bitchy HIV lady, getting pantoloc to coffee grounds guy, antibiotics for old lady and perforated api woman while begging admitting to find beds for the ones who were waiting. When I finally got a bed for my perforated api lady, I realized that I forgot to give her Tylenol for her fever. Since Tylenol was not in her admission orders, the medical directive becomes void on the floor. The floor nurse made sure she bitched at me. Funny thing is that I had Tylenol in my pocket and was willing to sign on the chart for it but she wouldn’t let me. Her problem.
Not that I want a night like that again, but looking back on it I got a month’s worth of learning in 12 hours. Sure I needed a stiff drink after that but since it was morning time when I was finished I just crawled up in my bed and tried to forget that any of the night actually happened. My boss is telling me that she wants to test run another independent shift in a few days so I suppose I better I get my butt into gear and get ready. I don’t wanna!
3 comments:
Congratulations on not shitting your pants! Seriously, I would have freaked, too, but you had your moment and then carried on.
And as a floor nurse I can advise you to just ignore the bitchy ones. I do. :)
Wow. Good job, you made it through, and will be better for it!
Thanks for the article, very helpful information.
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