Thursday, March 1, 2012

Lost It. Sigh.

I officially lost work that is. Last night was a combination of pms + disrespect + work overload + whiny drug addicted patients = me crying at work. :( It is pretty safe to say that I am approaching that dreaded nursing burnout phase. Sigh.

I can't change seems as I get older, the symptoms get worse...especially the crying & hot flashes & sweating. Ugh. It isn't pretty & the 40's definitely are NOT better. Sigh.

Disrespect....that came from an idiot cardiologist. We are required to report all critical lab values....doesn't matter what time it is. Well, last night I had a critical Troponin to report. The patient is renal & I have learned at this hospital that if a patient has renal issues....the doctors really disregard the Troponin results. Leaves me to wonder why they even order it then, but anyways.........our normal value is below 0.03, my patient's result was 0.5. It wasn't extremely high, but comes up as a critical value. So I call it to the cardiologist who immediately gives me attitude. "Why are you waking me up for this?" Because the hospital requires me to report all critical lab values. "This is ridiculous. You call & wake me up to report something you already know will be elevated?????????" Yes, the hospital requires me to do so. "This is INSANITY!!!!!!!!!!!!!!!!" At this point, I wanted to hang up...but I didn't. Next time I think I will. I'm the messenger, dude. I didn't create the problem, I am just doing what I am required to do. This isn't anything new. The doctors know this & they know not to be rude to us. While I may agree with him & I really didn't want to call had to be done. A simple "thank you" & hang up would have sufficed. Sigh.

I had two new admissions who were begging for pain medication. By begging, I mean screaming as loud as they could & continuously begging/whining. One I was able to meet his needs. His blood pressure was good, I managed to talk the physician assistant on call to give me some options to work with because I was not going to let my patient scream out in pain all night. It was my third shift in a row & I'm pms'ing = no tolerance. Gave him 1 mg of Morphine & everything was good for about 6 hours with him. Thank goodness. Sigh.

My other patient....not the same story. She is a frequent flyer & while she does have back issues that no doubt cause her pain, I prefer her to be alive with pain than to be dead with no pain. 10 days ago at one of our other hospitals her heart stopped because they gave her too much pain medication. Somehow they managed to save her (she coded 3 times) & she had zero brain damage in the process. I'll never understand that. Anyways, the good ol' ER nurse promised her that I would give her whatever pain medication she needed when she got to the floor. Not a good sign. Her blood pressure when she got to my floor was in the 70's as was her 02 sat as she didn't feel like wearing oxygen anymore & they said ok. Sigh. All she's doing is begging for Morphine. I explain to her that until she's stable, NO PAIN MEDICATION. After about an hour, her blood pressure was back up to about 116/70 and her 02 sat on 3L was 95%. Ok, here you go....1 mg of IV Morphine. Not super strong, but like I said earlier - I prefer my patients to stay alive. Amazingly the doctor came by around midnight & was able to order me the things I needed.....nebulizer treatments, Tylenol (for fever), pt's home meds. She asks him to increase her Morphine dose...which he does to 2 mg. She's happy, until I recheck her BP & now she's in the low 90's. Sorry, more pain medication for you. She's crying that she wants to go home if this is how I'm going to treat her. Sigh. It's so great to be a nurse!

Every half hour she's asking me to recheck her blood pressure, which never makes it above 99 systolic. She finally stops asking when it reaches 89/44. Well, she stops asking me to check her blood pressure, but it doesn't stop her screaming out for pain medication & how awful I'm treating her. So much for patient satisfaction. I guarantee our scores next month will be awful with patients like these. I go in at 6:45 am to empty her foley cath & draw blood out of her central line. She asks again about checking her blood pressure & I tell her we are just about to go into shift change & her next nurse will have to assess her first. Now if this were a normal patient with a normal blood pressure.......I would have given her pain medication. But knowing 10 days ago she coded from pain medication....I wasn't about to medicate her & then go into shift change for 20-30 min with no one checking on her. That's why I deferred it to the day nurse. My patient again started demanding to go home.......saying what is the purpose of being here. I don't think this lady could stand on her own two feet at this point, so I don't know how she was planning to get up & leave. Didn't matter, by this point...I was mentally checked out. Sigh.

I broke down around 12:30 am. I literally had not sat down since 7 pm except to chart my patient's vital signs. Nothing else was done. None of the admission stuff, none of the assessments, none of the plan of cares...nothing. I pictured I would be there till 10 am doing all this stuff & after being yelled at by the cardiologist.....I went into the bathroom & just started crying. :( I couldn't help. Jeez. I could cry right now...which makes me even more aware that it is pms & stress & not directly related to any one incident. Luckily, my good friend was the charge nurse last night & helped me quite a bit as far as she got my patient's vital signs at midnight and another nurse checked a blood sugar for me so I could just sit & catch up on charting. She also gave me a hug, which made me cry more. She gets it though. She & I were the ones that left our old hospital first because we were fed up with the stress & just recently she has been wanting me to get on board with going back to the old hospital together. I was hesitant, but after last night & the last month/year........I am just about to re-apply to the old hospital. Cause even though administration sucked over there, the patient load was not this bad. Sigh.

I am soooooooooo sick of primary nursing. We, nurses, need help. I shouldn't be doing respiratory treatments or emptying trash or cleaning up the patient's rooms or reminding doctor's to do their part or making sure lab is on time or putting in orders. Just because "I can" doesn't mean "I should be required to do everyone else's job." I am all for taking care of my patients, but it has to be balanced with all the charting we have to do. And lately with all the emphasis on patient satisfaction, it is taking away from our ability to be nurses & to use our critical thinking skills. Even last night as my patient is begging to be overdosed on pain meds, in the back of my mind I'm thinking "our hcahps scores are gonna suck next month"........I shouldn't have to think about that crap. I have been so forgetful lately that I thought it was all just a part of aging or I'm beginning early Alzheimer's..........but I totally think I am just overwhelmed at work. And all we hear back is that we aren't doing enough....the patients must be "ALWAYS" satisfied. That is impossible. Who is ALWAYS satisfied with everything...especially in a hospital? Correction...a purposely understaffed hospital? We floated our nurses to another floor because they were short.......which left our floor short. Is that fair?????????? Sigh.

And one more thing to vent.........we have no patient care techs. So our patient ratio is supposed to be 3 patients to 1 nurse. Mind you, these are usually total care type patients with multiple don't think having only 3 patients is a breeze. It's doable, but it isn't easy without any help. They told us "occasionally" you might have to take a 4th patient. By "occasionally" they mean just about every shift you work as well as every other nurse on the floor will have to do that too. So now we have 4 total care patients & no help. It's too much. And then they tell us we still have to do more to make the patient's and their families happy because 60% of our patient satisfaction surveys are filled out by a family member. WTF? How can they judge patient satisfaction if they aren't the patient? That should not be allowed!!!!!!! Sigh.

I don't know that going back to the old hospital is the best option, but it is pretty much my only option - if they'll even have me back. All I know is that they do have patient care techs and the nurses are not doing the respiratory techs jobs either. I'm also wondering if nursing is something I'll be able to do the rest of my working life. Not if this is what it's going to be like. I don't thrive off stress. My mind is worn out & my body physically aches. I'm moody, I complain. This is not me. I'm usually the easiest going person in the world & full of smiles. Now I absolutely dread going to work & count the hours until I can go home. I love my co-workers, but it isn't enough to survive. Wish I could work from home. Sigh.

1 comment:

hoodnurse said...

No shame, girl. I have cried out of frustration probably more times than I can count at work. It's really tough feeling like you are working your ass off and your efforts are not only ignored, but you're constantly getting shit about how you aren't doing enough. I had a patient like this- I bent over backwards for this lady, went the extra mile to get her whatever she needed to make her more comfortable, and she and her friends did nothing but bitch and threaten to leave AMA because she wasn't getting a bed fast enough. I seriously had to just go back in the break room and cry because I was so pissed off. I hope you take some comfort in the fact that you are obviously a rad nurse, despite what some clueless autocrat upper managements losers or manipulative frequent flyers say. Drink an extra margarita on your cruise for me sister.