My goodness....the hospital has been non-stop busy, busy, busy. As soon as someone is discharged, there is another person waiting to be admitted. Actually...it's more than just waiting...it's being held in the ER until a bed opens up. For those of us that thought it would be a slow season, we were wrong.
Sunday night wasn't too bad. I sat down for report & the nurse immediately says to me "This patient is discharged, but let me give you report on her." Ummm...whoaaaa....no. If she's discharged, then do the discharge paperwork & send her home. So I ask how many prescriptions are written....we look...there's only 2. I then suggest "rather than taking the time to give report to me, why don't you just do the discharge paperwork so the patient can get out of here." Makes sense, doesn't it? As I have 4 other patients to still get report on & if you leave the discharge to me...the patient is there for at least another hour or more. The nurse agrees....but later tells my clinical leader that I refused to take the patient. It ends up taking the nurse another 90 min to discharge the patient because she is so slow. Normally if the discharge orders just came in around shift change, I would have done it myself....but they knew this patient was being discharged all day. She didn't even have the heart monitor on when I was there at 6:30. So for this nurse to hold off on discharging the patient until shift change....and then having to stay an extra 90 min, well...as far as I'm concerned...that was her problem. She should have discharged the patient at 3:30 when the doctor filled out the discharge paperwork.
Ok....so the rest of that night went fairly well. Monday was a different story. I only had 4 patients that night....3 who were stable...thankfully. But that 4th one...I spent the first 5 hours of the shift trying to stabilize her. She was 92, had a lap chole (gallbladder surgery) on Saturday....went into respiratory distress that morning....but by 3 pm, the doctor had written discharge orders. What???????? She could barely breathe this morning & he's ready to send her home? What?????? Then he changes his mind and decides she should be downgraded to med/surg status. The cardiologist agrees. What??????? Hello, she could barely breathe this morning. And on top of that...they give her 40 mg of IV Lasix with a potassium level of 3.3 & no replacement.
So I show up & her heart rate is in the 140's. I'm told it's because her family is there agitating her. Ok, that happens sometimes. Only it was still happening after the family left. This patient won't stay in bed either & she only speaks spanish. Not a single word of english. I decide a posey vest would be best to avoid her falling on the floor. She wasn't crazy about the idea....but I knew if I didn't do that, she would end up on the floor. I kept hoping she'd calm down, get some rest & her heart rate would get back to a normal rate. That was wishful thinking, but didn't happen. I check her oxygen sat & it's about 84% on 5 liters. Ugh...not good.
I call our respiratory tech....I don't know why I keep hoping that one day one of them will stop & take the time with the patients to make sure their O2 sat rate is ok....even though it never seems to happen. So she walks in, checks the rate...it's still 84%, she bumps the oxygen up to 6 liters & leaves. Ummm...are you going to come back & recheck her????
Even though I have the posey vest on my patient...she weighs like 70 lbs total & is like Houdini Jr. Somehow she was able to get to her hands & knees in bed....this is not supposed to be possible with a posey vest on. She wanted to get up & walk around. These are all big clues that something is really wrong...the confusion & restlessness. At this point it's a little after 10 pm & I put a call out to the cardiologist because the heart rate has now gone from sinus tach to a-fib......new onset of a-fib that is. I wait 20 min, call the cardiologist's answering service again because I haven't heard back from the cardiologist. I wait another 20 min & still no call back. I call again. By this point...I'm ordering things I think are necessary - even though at this time I have yet to get the official orders. I got an EKG, the potassium level...which dropped to 2.3 and ABG's. It takes the nursing supervisor calling the cardiologist to get her to call me. She finally does & I give her all of the info. She starts the patient on Cardizem & starts to give me orders to titrate. I was like "yessssssssssss".....because we are not allowed to titrate Cardizem on PCU & that means she has to be moved to ICU. So I tell the doctor this & she gives me the order to ICU......only my clinical leader is right there whispering to me "We have no beds available in ICU." What????????? So I tell the doctor this & she tells me not to titrate the Cardizem, just keep it at 5 mg/hr. Darn it! She also tells me to call the ABG results to the pulmonologist because they are so crappy. I also start to replace the potassium. I had a feeling the low potassium level was the reason for the a-fib.
My clinical leader makes the ICU clinical leader aware of the situation. They both come in & assess my patient & decide she needs to be moved to ICU. They did have a bed available...the "code bed".....but decide it's better to move this patient before she codes. It's at this time also that she is switched from nasal cannula to 100% non-rebreather as her PO2 level is 45 on 6 liters.
The only bad thing though...I don't have an order for ICU because I was told we have no ICU beds available. I'm confident the pulmonologist will give me the order...if/when he calls me back. I wait 30 min after my first call....on the second call I don't even mess around. I say "Can you connect me directly with him?" Luckily that happened. I don't like calling this particular doctor as he can be rather snotty....but it was my lucky night as he had no attitude with me at all. I got the order for ICU along with a bunch of other orders. I gave report to ICU & got my patient over there by 1 am.
Now I had not done any charting at this point except on the patient I transferred. My clinical leader was understanding & told me....go chart & let me know when you are caught up. Two hours later she is calling me. I told her I was caught up, but I would like to take a break. She said that was fine, but I'd be getting an admission when I got back. I figured as much. I don't usually even take breaks, but I definitely needed one that night. All I wanted was a few minutes to drink a coke & to finish the chicken nuggets I bought at Chick-fil-a earlier in the evening.
I go into the breakroom & notice that my Chick-fil-a bag is not on top of the fridge where I left it. Hmmmm...not good. I think "Ok, maybe someone thought it was from dayshift & thru it away." I glance over at the garbage can & to my dismay....I see my Chick-fil-a bag and the container of my chicken nuggets....open & gone. Someone ate my food!!!!!!!!!! Who does stuff like this? I was so irritated. I mean really.....if you want chicken nuggets...buy your own! I told my co-workers about it & they all started coming out with stories about how they've had food that was taken too....didn't matter if it was all wrapped up & had their name on it...the food thief came along & ate it. What is wrong with people that they have to steal other people's food at work?
The rest of my night went ok. My new admission was easy to care for. I was able to leave work on time. Tuesday night I was floated to a different floor & it was me working with four other nurses....who were all males. That was different. My night was pretty good. I kept busy, but at least nothing critical was going on.
On a good note...I taught my dog Shay how to speak on command last night. She is a fast learner. She has taught me that she will only speak on command when I have a dog cookie in my hand. Ahhhhhhh! Smart dog!