Monday night I was bored. I had two patients who didn't need much of anything. I took it for granted. I thought in my head 'this SUCKS. I'm not learning, I'm not challenged.'
So we all know what's going to happen, as soon as you start thinking that way. Tuesday I came in, and my admit came rolling through the door before I was done with report. Not a good way to start. I had to untangle two chest tubes, the oxygen, the SCDs, the IV lines, the PCA and epidural and get them all on a pole, which got me behind to start out with.
Then another patient, an adult failure to thrive post-gastrectomy, needed albumin. He was supposed to have a PICC line placed in radiology while his dophoff tube was being placed, but they sent him back up without putting it in. Now guess what, he has no IV access because his peripheral had stopped working. He was supposed to go back down at 2:30. At 3:30, he still hadn't gone. At 4:30, I started trying to figure it out. I got on the phone with the vascular access team, who said they had nothing to do with it and don't put in STAT PICCs. I talked to his SGI service (his docs), who told me to call radiology. Radiology said he wasn't on their list. I told them, I'm staring at the order right now, how is it that you don't see it? Sorry, was all they said, we can't do it. Re-submit the order. So I resubmit the order. Still nothing, they say they don't have time.
By this time I'd given up on the PICC. I decided to just go with a STAT peripheral for the time being. I page the STAT vascular team. They don't show up. I page out to the floor and get two people on our unit to try. They have a hard time because both of the guys arms are so swollen, they are third-spacing and weeping and he's dry as a bone. Finally, vascular access shows up. The first guy has no luck. The second woman who comes brings an ultrasound, and she can't get it with that. By this time, it's 10pm. I tell service, sorry, no go. What do you want to do? Charge nurse is saying that an MD has to do it. I can see that the MDs aren't going for that. We're basically just SOL until morning when they do the PICC.
While all of this is happening, I'm frantically trying to do my vitals, because my tech? She apparently didn't feel the need to do anything last night. I try to get meds out at least an hour after they're due. I have to restart this guy's tube feeds, and there is no order to use the dophoff. Finally I say, fuck it, he's got no IV access and he needs pain meds, so I use the dophoff, which luckily didn't become an issue later. Now he's got to get this aluminum gunk down the dophoff and it keeps clogging it, but luckily I get it all in and flushed.
My first patient, the new admit, keeps calling for little things and is being whiny. I simply don't have time to be a waitress that day. I have a tech page lift team to boost her up in bed. My friend K, a new nurse, went to help me and oversee lift team. The guy from lift team is a total jerk and says he won't boost her because she's going to slide right down. K tells the tech she'll take care of, to leave me alone because I'm busy. The tech runs right into the med room, with the lift team guy behind her, and both of them stand there telling me they aren't going to boost the patient. All of the other nurses in the med room are just staring at them, and looking at me in disbelief. We've never had issues like this with lift team. Yeah, she's going to slide down again, eventually, just do your fucking job and BOOST her UP! But the guy continues to give me attitude, and we all tell him to get out then and forget it.
Meanwhile, a million other things are flying at me and I feel tears come to my eyes. I'm hungry, tired, and way behind. I don't want to cry though. By the way, I have a third patient who has an LVAD that's not working properly and I haven't given her any attention. Her docs are also trying to find me, so is pain service who wants me to order toradol for my first patient. I have call backs waiting for me and docs who are pissed that I'm not standing by the phone. It all gets very overwhelming and I'm still pissed about lift team.
The end of the night does not let up. My LVAD patient needs two units of fresh frozen plasma. I ruin the first bag they send because I don't clamp the saline, and the whole thing has to be re-done. The other nurses are so nice to me about it though, they tell me they also ruined their first bag. The patient is nice too, luckily. She has been teary all day because she wasn't expecting to need her LVAD replaced, and I feel bad that I have no time to give her any emotional support. My no-IV-access patient has been nauseous, and I basically have to tell him, nicely, to deal with it because we can't give him nausea meds. We asked service about something IM, but they said no.
My last 45 minutes I do all of the stuff no one else would probably bother to do on this kind of day. I post my strips (which I usually do first on my shift), I do my SOAP notes, my care plans, the admit's paperwork. I review my charting. The only thing I didn't do that day was read my patients' histories and labs. I hate that I couldn't do that. I have a headache, my feet ache, and I want to go home.
I guess I did as well as anyone could have, under the circumstances, but if every day was like this one, I'd quit.