Friday, January 30, 2009

12+ hour downtime

Let me start by saying...Sunday & Monday night at work was pleasant....maybe even enjoyable. It's hard to recall specifics...but I remember not being stressed one bit & I was able to finish up the 3rd book of the Twilight series.

That all changed on Tuesday night. You see...Tuesday night was our night that the computers would be down for an upgrade. This was not sudden news......we've known about it for at least a month. Silly for me to go in expecting things to be organized...or at least moderately prepared. Ha! I must have still been sleeping because it was totally a dream to think the administration would prepare us for a downtime scheduled for 10 hours. We all knew it would be longer than 10 hours, but for some reason, that was what they told us. We've learned in the past not to believe anything they say when it comes to downtime.

I don't know who the wise person was that decided downtime should begin at shift change...but whoever they are...they obviously never worked a day on the floor. I strolled in later than usual.....7 pm. The same time the computers would be down. I already knew it would be of no advantage to start earlier, but I was hoping that we'd at least have our downtime packets ready & waiting as well as our MAR's (medications sheets for each patient). Ha! Once again, I must have been off in fantasyland. Nothing was ready. Nothing was prepared. No one knew what we were supposed to do. We had no way of redlining any of the orders of the day because the computers were down at shift change. And to top it all off......we get this pleasant email saying something like "We are off to a smooth downtime process this evening. Everything went exactly as planned." Huh?????? What kind of drugs is the person that wrote that email on? I highly doubt their plan was to leave the nightstaff hanging as everyone from days rushed out of the building to avoid the chaos & the complaints of nightstaff.....BUT if that was the plan, then it did go off smoothly.

I started the night with all new patients. I had been there the past 2 nights...why I didn't get my same patients back...who knows? The other nurse had already started report & I wasn't going to steal them back for her. So I get report on my new patients from an ICU nurse. Now I am not knocking ICU nurses at all....I think a majority of them know what they are talking about & are far more experienced than me when it comes to patient's conditions. However, when you double the amount of patients they are used to taking care of.....they seem to fall apart. I expected the report to be thorough & complete.......instead I got like 2 facts on each patient & that was about it. Not to mention, we also had a direct admit.

I'm beginning to think direct admits should not even be allowed. Why? Because they are usually very sick - hence the reason the doctor is sending them directly to the hospital to be admitted.....but they are coming directly to the floor with no work-up from the ER. They are being thrown into the mix of an already chaotic floor with absolutely nothing known about them other than the doctor thinks they are so sick that they need to be in the hospital with a heart monitor. I don't like not knowing what their labs are or if they need tests done or medications, etc. They usually need all 3 stat. Only when they arrive to a floor out of the blue, stat is more like slow motion. It causes anxiety for everyone involved & when you already have 4 other patients....throwing another one in that has extremely high needs at the moment is very stressful & frustrating.

My direct admit was neutropenic & having abdominal pain. The doctor wanted her to have a CT of the she had to drink oral contrast. While this potion smells somewhat good (fruity), by the reaction on her didn't taste nearly as good as it smelled. She immediately began dry heaving. So I call the doctor & he says "If she can't drink it, put in an NG tube & get the contrast into her." I'm not crazy about NG tubes...especially on people that are alert & oriented...but I share this news with her & suddenly she is able to drink the contrast. She got most of one bottle down, but gave up on the second bottle. I chatted with the CT scan tech & she said we can wait a few hours & have her drink the second bottle & it should be fine. So I tell her she has a 5 hr reprieve until the drinking will begin again.

It's about this time that I begin wondering what her lab results are...because as I mentioned before....our computers are down & we have no access to any results. So my clinical leader calls the lab dept & they also state they have no access to any results. Hmmm...this doesn't sound right. They hemmed & hawed (are those words?) & eventually got me the results. Her platelet level was 13. As the doctor replied to me when I told him the news..."Not good." Uhhh, yeah, more like critical. Her white blood cell count was 0.4. She had just been thru a round of chemo a few days earlier & that is why she was doing as poorly as she was. Her Magnesium level was low too. I manage to transfuse some platelets, supplement her with Mag, admit 2 more patients & while I was still breathing - I was sooooooooooooo frustrated.

On all the nights that we could have used an admitting nurse...did we have one that night? No. It makes no sense to me whatsoever. The only good thing about that night is that it went by quickly. I kept meeting up with another nurse & we had like 1 minute venting sessions with one another....just to make each other smile, because I seriously could have beat someone up that night.....that's how frustrated I was by how administration left us hanging with the downtime. I am usually a very easy going, calm person......but that night really stressed me out. To top it relief nurse the next morning showed up TWENTY-FIVE MINUTES late!!!!!!!!

I had to keep reminding myself to take deep breaths & think pleasant thoughts. The only good thing about the still was not up at shift change, so I was not redlining a single thing. In fact, I didn't care whether the orders were even correct on the chart. I didn't have the time to care about that stuff. While I hate dumping anything onto the next nurse, they left us in that position & frustrated me also. And on top of that....I saw another email went out saying how everything ran perfect, we had no problems whatsoever. Ughhhhhhhhhhh....I wanted to reply "You are a liar, it was miserable...ask anyone that worked that night." But I figured it was better to stay silent so I could keep my job.

Ok, I'm done venting. If the above makes no sense to anyone...I apologize. I went out last night with my friends.....who happened to also be my best friends in high school. I love getting together with them....partly because they make me laugh & partly because it takes me back about 25 yrs to when we would hang out all the time while in high school. I lucked out in the friend category...that's for sure.

After dinner my friend Maria (hi Maria!) & I went to see Underworld: Rise of the Lycans. I blame it on Twilight for wanting me to see another vampire was brutal. And I didn't know it was part 3 of some Underworld series. While it was not boring, it left me wondering what it all meant at the end. There is no way I'm watching the first 2 in order to understand this one. I'll go back to only seeing chick flicks that don't require much thought at all.

Speaking of Twilight...I'm finally starting the 4th book. I still have yet to understand the desire of this series. While I liked the movie, I just don't understand how anyone can read all 4 books in like 4 days...or even 4 weeks. I will finish the book though...since I've come this far. Only something like 750 more pages to go....woo hoo. Hopefully I'll be done by spring.

Want to hear something funny? I have a nephew that is turning 10 in February. As a gift, his mother decided she will let her boyfriend take him snowboarding in North Carolina for a couple of days. When I picked him up the other day...he said "My mom says you can buy me a snowboard for my trip. It will cost $200." He was dead serious. Who in the world does she think she is? And she implied to him that if I don't do it....that I must not love him enough. Ugh! Luckily he is smart enough to realize that buying him things or not buying him things has nothing to do with the love I have for him. I also explained to him that I don't ask her to pay for things when I take him on trips, so she should not be expecting/demanding I pay for things when he goes on trips with them. She really annoys me...but that's another story all in itself & something I'm not going to go into.

Hope everyone has a good weekend.....stay warm.....stay safe & enjoy the Superbowl!!!!!!! Go Cardinals (I always have to pick the team with the warmest's the


Julie said...

It made perfect sense to me. Direct admits, hate them. Downtime....hate it, LOL

Pamela said...

I understood it all. And...I cringed through it all. I hated direct admits, and downtime. The higher ups sure don't make it easy, do they?
Hope you enjoyed the game.