Monday, July 6, 2009

Assignment Despite Objection

A Day Shift RN filled out a form that documented her objection to her pt load, because it was unsafe. She encouraged me to do the same.

My load was way too heavy. I cried for the first time in a month or two. Sigh.

One pt was here on suicide watch. No reason for her to be here. Heart is just fine, needs to be in a psych facility. She has a sitter for 1:1 observation. Waste of a sitter. Very tearful, but not very demanding. Not really a problem.

One pt was here for an possible infection in a dialysis port. He's mostly healthy and wants to go home. But he's on a heparin drip, which is a high-alert medication that also requires monitoring thru frequent labs. And he's been bleeding. One of his IVs yesterday, and his dialysis catheter today. And one of his IVs was starting to annoy him, and it had to be DC'd and replaced.

One pt came from ICU th'other day. Part of her intestine ruptured, so she had surgery to clean it out and make a colostomy. She has a colostomy bag, a line of staples (which were removed too early by a med student) and a few drains. She was in ICU for respiratory arrest, and is on high-flo O2. She hasn't been eating, so she's on CPN, food thru the veins. This means fingersticks q6hrs. She also doesn't swallow well, requiring meds to be crushed in applesauce. Her family is concerned about her recent mental fuzziness. She has a PICC line. All labs are RN drawn

One pt was also in ICU in the past for respiratory arrest. He had a PEG tube placed, which he pulled out a few days back. This means there is a hole in his stomach and abdomen. To prevent infection, there is an NG tube to suction to make sure nothing stays in his stomach. He has been pulling his tube out at least once a day every day. He's been on restraints, but his day shift nurse decided he was doing okay enough to have them off. Not the brightest of ideas. He also has CPN, requiring fingersticks. He has a PICC line, and I got orders at the beginning of shift to hang 5 extra bags of medication, which I have to juggle with his ABx and anti-seizure meds. He was doing ok until 1900, when (surprise surprise) he pulled his NG tube. The Dr has now said that *no one* is to take off his restraints for at least 3 days, because repeatedly jamming a tube down his nose is rather bad for the tissue. He's also on contact precautions.

I know on paper it doesn't seem so bad. But it's too much for a person to handle. I only survived because my resource did a bunch of meds and lab draws for me, and because one of the RNs who wasn't even supposed to be doing pt care did meds for me.

I barely had time to assess my patients before having to work on the meds.

I tried not to get overwhelmed but I couldn't stop it.

Hooray for crying in the breakroom. And bathroom. And almost on the floor.

I am so glad I have the next 2 days off. If not I'd probably call in sick.

1 comment:

  1. Yikes. I get where you are coming from. How are we supposed to handle our pt load effectively when they keep doing nurse:patient so high? I am an LPN student and we do one pt at a time. That is so not preparing us for the real world.

    In a psych facility now. They all have psychiatric issues along with major medical issues. 20 meds. No problem. I am superman and can leap difficult pts in a single bound.

    Hope you have a terrific 2 days off!!!!