Saturday, March 29, 2014

How did I get myself into this mess?!

I was sleeping away, dreading getting out of bed.... it was after 3:30 when the phone called.... it was my charge nurse asking where I was and why I wasn't working! HOLY SHIT BATMAN, I wasn't SUPPOSED to be working.... Hell I even double checked that since two weeks ago I went into work when I wasn't supposed to be working (OK with that because at least I'm not getting in shit for going in when I'm not supposed to)... so I made for SURE what I working this weekend. So much so that I printed out new schedules last week because I was paranoid about missing a shift or something.

So I told my charge nurse that I didn't have a problem coming in but that I would also bring my schedule to PROVE that the problem wasn't me this time!!!

So I brought my schedule in and even proved myself! What was her response?! Ya, make sure that you go into the scheduling system to ensure that you know your shifts, don't go by the print outs that SHE does!!!!! Grrrrrr...... Lady it's not like I'm available to work many shifts! We also called scheduling people to ask when the shift was accepted... turns out more than a week ago at 10:20 AAAAAAAMMMMMM - let me state this in VERY clear language - I LOVE MY SLEEP!!!! So when I drop my daughter at school, I go straight to bed... I do NOT pass go.... so I sure as hell wasn't answering the phone at that hour to accept a shift more than a week in advance!!!!

Plus, when I accept a shift, I get the scheduling people to send me an email indicating which shift I've accepted on which day so that when this sort of shit happens I can have proof or something.... well I certainly did NOT have an email from them indicating the "supposed" shift I picked up.

So off I went.... late - and it was the shift from HEEEEEEEEEEELLLLLLLLLLLLLLLLLLLL - it was like it was fucking payback for not knowing I was supposed to be working or something.

Pt 1 - CVA, lang barrier - on the call bell ALLLLLLLLLLLLLL the time - which I don't understand half the time what the pt wants... so that was fun - oh and a diabetic so you have all the extra work that goes along with that.... plus she's incontinent.

Pt 2 - non formed but has a security guard - because he's hallucinating - that snakes are crawling all over him - turns out it's actually illusions which still suck majorly but the pt KNOWS that what he's experiencing isn't real but still it traumatized and wants it to end! Plus he's a double amputee who's also a diabetic - and is newly admitted and the chart hasn't been checked yet by a nurse (so that "fun" job lands on my shoulders - which has to be checked BEFORE I can do meds or diabetic stuff) - and he doesn't want to be in his bed (because he thinks that the bedding is snakes (don't blame him for that one) and so he's very anxious and needs a LOT of hand holding and reassurance.... plus psych came and saw him so I got even MORE orders (at least these should stop his illusions - we hope!)

Pt 3 - trached, MORBIDLY obese, basilar stroke (AKA VERY BAD), legally blind and because of the stroke can't talk - but she CAN hear and DOES understand - (man that would suck!) and she's in pain and for some reason thinks she's going to fall out of bed so ANY kind of movement makes her startle and drip the side rails for dear life. She's incontinent so it takes several of us to change her (which causes more work because you have to go FIND the other people to assist). Has a PEG tube which means that you have to crush the meds and dissolve them and THEN administer them.... which means lots of work. Oh the fact that there's a trach insitu means that you have to suction so there's more work for you there - I had to do so 4 times in my shift... and when you suction it has to be sterile so there's more work there. She's on 2 different antibiotics that you have to go into our med room for - so more work for that. And she's diabetic - so more work for that one.... oh and when I came on she was tachycardic at >145 bpm - but BP was JUST FINE - so I had to call the doc about that one - administer that med..... which didn't really bring the pulse down so after about 4 hours I had to call on-call doc and get ANOTHER med ordered.... and that all takes work because you have to transcribe the med, get the med co signed - then go give it..... and an hour later recheck vitals and an hour later recheck again. Good thing was was that she wasn't symptomatic - she wasn't having trouble breathing and her BP was good.... it was just that her heart was racing. The other part of lots of work has to do with her tube feeding - you have to make sure that you only put one can in at a time because this reduces reflux and the risk of aspiration (forget why but as long as it work it's cool with me!) but you have to still take the time to fiddle with the stuff... and when you give meds you have put them through that which can be a pain in the butt..... FYI pantoprazole is NOT a good med for PEGs or G/J tubes - it clogs them regardless of what you do. And I have told our pharmacist to ensure that autosubbing is done for this stupid med but I am ALWAYS the one bringing it to his attention.

Pt 4 - my ONLY independent pt - did NOT know that he had a urostomy until like 2000hrs when the daughter went looking for me because his urostomy was leaking!!! So off I went to find supplies to change it out - which THANKFULLY we actually had on unit! And of course THAT takes more time away that I just don't have.... he had an IV and two antibiotics - quite a bit of work for that one because I had to prime two lines (incompatible with each other) because he's a new patient.... Other than that he was simple! Poor guy got ignored otherwise. Such is the life though!

Ya it was nuts to say the least. I have 2 more night shifts to go for this weekend - I hope they're better than tonites shift! Though I know who'll be working with me tomorrow and when this one gal and I work together it seems like the floor goes crazy - honestly, the last time we worked we had to restrain FOUR patients, and other patient had a grand mal seizure for like 3 minutes! Insanity! So ya, it should be interesting!

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