Tonight may have been the worst 3-11 pm shift I have experienced in my nursing career in the lovely city of New York.
It was so bad, that I feel compelled to write about it and share it with the faithful Strangelands family. It took some time for me to decide whether I should post it in the Rant or Rent section, obviously one prevailed.
Anyway, I digress, back to the horrific night at this well-known and highly regarded skilled nursing facility.
I got the first inkling that things were going to be rough when I began to do the narcotic count at the start of the shift. For all of you readers not familiar with this procedure I will provide you with some boring details. When an oncoming nurse begins his/her shift the narcotics are counted for each patient and verified that what is written down by the previous nurse is correct. This is done to ensure that only the patients are receiving these drugs and to keep all involved honest.
Well, the drug count was a 20 minute affair. Normally it should take only half that time but considering the turn-over of residents this time of year and the administration's laissez-faire attitude about destroying the ones not in use it didn't. I found myself still counting pills and injections of assorted hards drugs of patients who had checked out of the facility and some out of this world 3-4 months ago.
After completing this frustrating task I moved on to the business of getting a verbal report from the day charge nurse on the condition of the residents I was to take charge of.
There was one phrase that sounded off warning bells and red lights and should never be taken lightly. This phrase is TWE till clear. In the medical profession this means tap water enema till clear. Yup, you guessed it, I had a severely compromised and impacted patient that obviously had not layed down coil in quite some time. Normally, I wouldn't bat an eyelash about performing this procedure (been there and done that too many times to count), but what burned me up is this nurse got this order at 8AM in the morning and had not carried it out. We are talking about too many hours of lag time here with one swollen and uncomfotable old woman laying in bed wondering what she did in her youth to deserve such a fate.
The kicker was when this same charge nurse told me not to worry if I didn't have time to do it tonight, she'd get to it in the morning.
HELLOOOOO! WHAT? To boot this lady's only source of nourishment came from a tube feeding attached inside her swollen abdomen and was scheduled to begin her feeding at 5pm. It is now 4pm and I haven't even started to pass out any medications or eyeball all of my 41 patients on the unit.
Normally, at this point I would have called my supervisor and begged for some back-up but as usual she was running late and had not showed up for work yet.
While I am still absorbing this tidbit of information another newly admitted patient is standing above me declaring that she's transferring to another facility in an hour and her friend was coming to pick her up. HUH?
Where's the paperwork on this one? Where's the doctor's order giving the thumbs up? BINGO, right again faithful readers, there is NONE. So now I need to stomp out this fire before everyone loses their patience. Doctors must be called, paperwork is filled out and one last set of vitals taken. Good enough she seems fit to travel and shortly thereafter she's on her way,
Back to the Constipation Express heading to the land of the Chocolate Way. Sorry, I am still feeling a little bitter. In a nutshell, the enema is a huge success and the swollen abdomen goes down and a collective sigh of relief is breathed. But, it doesn't end here folks the journey is just starting to get interesting. Another patient wheels her motorized chair up to me and declares "I don't feel well and I think I need Oxygen". A quick look told me she might need more then that and I calmly escorted her to her room and transferred her into the bed. Did I mention that during all this I am getting no cooperation from the nurse's aide assigned to her because she's still holding a grudge about the results of the enema leading to a major clean-up in the room next door. Now, I feel her pain but I also don't care at this point since my priority is trying to keep this patient from passing out due to a lack of oxygen to the brain and what was beginning to look like the beginning signs of a heart attack or something equally as ominous.
To wrap up this drama, after much monitoring and medication administering, the patient improved. No hospitalization was required and I am happy to report that at the end of my shift her vital signs stabilized and she told me she was feeling much better.
God, this post is getting way out of hand and I haven't even described the rest of the night. Needless to say, at some point in the evening I realized my sanity was hanging by a thread and the only thought coming into my head was I have to do this all over again tomorrow.
Fortunately being a per-diem nurse means you are never locked into anything. So, being the survivor I am I marched up to the no help, late arriving, lazy good for nothing supervisor and declared that I would not be able to work tomorrow and seeing there was extra nursing staff on it would not affect the care of the patients.
Of course, now in the comfort of my quiet cozy apartment I am feeling slightly guilty about being such a slacker. Perhaps I will need to go shopping tomorrow to assuage these sentiments :)