Thursday, October 23, 2008

Frazzled??? lol

I had a patient last week that reminded me of that story in one of my posts..."The Patient I Failed." My patient had come in with respiratory failure. She also was end-stage renal disease and on the verge of going on dialysis. When I got report, they had her on a bipap because she was having difficulty breathing. I was told that it was crazy during the day because the patient wanted to die and her husband was fighting her wishes to be a DNR. Three of her doctors were at bedside as well as her family. The patient was in her 70's, she was totally alert & oriented.....she was tired of having breathing problems. The slightest of movements tired her out. Her husband was not ready to say goodbye. The doctors took him into another room and tried to make him understand how his wife was feeling, but it didn't matter - he was not going to be a willing participant in her wishes to die. The grown children were on board - they understood their mother's last wish & agreed to do as she pleased. It sounded like a heartbreaking day. I never met the husband, but I felt for him.

When I took over, the patient's heart rate jumped up to the 150's. She had agreed to wear the bipap for the night, but wanted it off first thing in the morning. I didn't even think to ask her what she wanted to do about the heart rate....I just immediately called the cardiologist figuring he'd order Cardizem or Digoxin. I've never had to stop & think..."hmmm, does this patient even want us to treat the increased heart rate?" I got an order for a Cardizem bolus and drip. It was then that I realized she may very well refuse the medication since she had chosen to be a DNR. It's against my nature to just do nothing, so I went in there & started setting up the IV medication. I explained to her what her heart rate was & what this medication would do. Thankfully she was fine with it. She actually got quite a lot of sleep - most people don't with the bipap. It's a big gawky mask type thing that is tight on the face & it basically forces you to breathe.

About 5:00 in the morning I answered the phone. It was a man saying he was trying to call my patient & wasn't getting a response. My patient had already told me she was refusing all phone calls because it's pretty much impossible to have a conversation while wearing the bipap. I told him it was too early in the morning for phone calls to patient's rooms. He says to me in a desperate voice..."Is she still alive?" was heartbreaking. I knew instantly who he was - the husband of my DNR patient. I told him that she was. He replied "Are you sure?" I guess he figured she wouldn't be & was so elated to hear that she was. I told him yes & reassured him that if anything were to happen to her - he would definitely get a phone call. He went on to ask me more information, but I couldn't release it to him as he didn't remember what her password was. Darn HIPPA! Due to the privacy laws, we can't release information over the phone unless the person knows the password the patient set up. This man was elderly, he couldn't remember the password. I reassured him that she was stable and definitely alive. I don't think I'll ever forget his voice.

I never had that patient again, but I was told that the following day she was feeling better respiratory wise and didn't have to be on the bipap any longer. I believe she went home a few days later. At least her husband gets more time with her. I can't imagine what it's like to feel like you are about to lose the love of your life.

I worked last night & go back again the next 2 nights. When I got to work last night, it was chaos as usual. The day nurses refused to allow voicecare to come back...grrrr. They are the reason we need it. Change of shift report takes on average 60 to 90 minutes at night. That is ridiculous!!!! Anyways...I get there & see that I have 4 patients. I am waiting around 20 min just for the nurses to start report. One nurse has 3 of my patients & she's running around frantically. I see that one of my patients has her heart monitor off - so I go in to investigate. She's dressed & ready to leave. Tells me she's been waiting over a 1/2 hour for the discharge papers. I tell her I will work on it so we can get her home quickly. I find the nurse & she had no intention of discharging this patient herself. She wanted to give me report & let me take care of it. That alone will take at least another hour. So no...not gonna happen that way. I tell her to work on the discharge paperwork & I will get report from the other nurse. She wasn't happy...but seriously...the patient was ready to go. There was no reason to hold it up any longer. In the time it takes her to give me report, she could have the discharge finished.

So I get report on one of my problem. I come back to the other nurse & she has the discharge paperwork printed out. Yay! She then announces to me that another patient of mine has orders to be transferred to ICU. What??? And he's still here on PCU? Again - she wanted to give me report on him, then I could handle the transfer. Nope, not happening. I call the clinical leader & let her know we have a patient that needs to be transferred to ICU that she could arrange bed placement. I then tell the nurse to discharge the patient, I'll take her downstairs and she can call report to the ICU nurse while I'm downstairs. That makes sense, doesn't it? Again, she's not happy....but there's no sense in both of us being

I come back & report has been called, the clinical leader is transferring the patient and I am ready to get report on the only patient she has left. This patient should have been discharged. All she needed done was PFT's (pulmonary function test) that was ordered at 1:30 pm. It was never done & they don't do them at night. So this patient had to spend another entire night at the hospital as well as be billed an additional day waiting for this test. Ridiculous! The day nurse was frazzled (is that a word?).

Luckily, I had a great night. I had one admit - a gentleman with chest pain that was already telling me he was going home tomorrow. I've learned not to argue with them when they talk like this. I simply say "Ok, let your doctor know when he comes in to see you tomorrow."

I've got to go get ready for work. Maybe one day I'll win the lottery...ahhh....


Amanda said...

I HATE when other nurses leave things like that for me to do too! I am glad that you stuck up for yourself and made her finish her work though. We have been SO busy lately and the patients all seem so much heavier than usual.

Teresa said...

At one time in my life I worked in the medical field, I worked in the Medical Surgical Ward and the Cardiology portion too ~ The nurses had such a hard time even then, I remember the shift changes :( I hope things are very good for you this week. Blessings* Teresa