Today was one of the crazy days on the unit, I feel like those are the days I enjoy work the most. Usually. I didn't have anyone standing over me today. I precepted with the charge nurse and we were short a nurse, and we were down one more after noon when one float pool nurse had to leave because of a sick kid.
As I sit here I am hearing the tube feeding alarms going off in my head.
Today I felt like I was on my own, even though I did get help a few times and was clueless more than a few times. I managed to figure out a few things for myself since there was no help, and I hope I got things right. For example, dealing with a PCA pump was a challenge, even though it is one of the so-called "smart pumps" where it is supposed to be idiot-proof (smarter than the average nurse, I guess!)
I had four different patients all day. I almost got 5. I started out with two day 2 post-ops, one craniotomy and one colon resection. I thought only one would be transferring out but as it turned out both did. I got both of them going, and as I was waiting for transport to come get the second one, I overheard the charge nurse talking with the float pool nurse who had to leave. They were trying to figure out how to manage staffing and being down two nurses.
The unit educator came in and helped, and our director came to the floor to help. She was wearing a mask because she is sick and didn't want to spread her crud around! We were so short we needed all the help we could get. No one had time to stop, none of us took lunch. She ended up buying us pizza, which I scarfed down in between calling report on transfers and taking report on new patients.
I ended up taking two more patients while we waited an hour and a half for the next 8 hour shift nurse to come on. One was a transfer, and at that point I had three patients and I felt a little over my head so I asked the charge nurse to help me watch the one sick patient while I got the other two transferred out.
Transport was short staffed too so it took forever for the new transporter to get her act together to get the third patient out. Finally we got done and the new nurse came on, and I took over another patient from someone else.
This guy has been on the unit for over a month, he was a trauma. He is recovering well but has some frontal lobe damage and is more of a handful every day as he recovers physically. Last week I took care of him one day with my preceptor and I felt he needed tobe a 1:1, where there is someone in the room with him at all times, usually an aide. He is climbing out of bed, out of the wheelchair, he's impulsive, and he's a big, strong guy.
He was also talking to some woman, having a conversation with her. Someone named Jen. I have no idea who he was talking to, I asked him. He started going on about how great I was, how beautiful I was, what a wonderful person I am (I am sure he was talking to Jen but he kept addressing me) He apologized for being a jerk. I kept up a conversation with him, just to entertain myself, in between telling him to settle down and lie back and not to climb out of bed.
Today he was getting agitated and I finally decided to give him some Ativan, I couldn't control him myself and there was little help. We had a traveler and one of our staff nurses who had a student with her, and the more experienced nurses were down at the other end of the hall, so I felt like I didn't have much backup. The traveler is lazy and the other float pool nurse was over her head, I was answering her questions all day. The other nurse who had the student, I've been with her before and she's not so helpful, and passive aggressive to boot.
The aides on the floor were all being used as 1:1s in other rooms. Lately our unit has felt like the detox unit- we've had at least 3 different alcohol withdrawal patients, all DTing at the same time. My patient isn't in alcohol withdrawal but he was more agitated than any of them have been lately, except for the crazy guy the week before last who was giving me the finger underneath the sheets while he was restrained and vented right after a major abdominal surgery, thrashing around in bed even on a heavy dose of propofol and an epidural!
Once my patient had the Ativan he settled down a little but as soon as any noise woke him up he's start climbing out of bed again. His blood pressure was up and it was a while since his last pain medication so I gave him some in his PEG tube thinking it might help. It did, and by shift change he had settled down enough that I could get away from the room and go to the bathroom, check the orders, and waste meds, among other things before giving report.
And as I sit here typing I hear sirens on the way to the hospital. I guess it's job security, but the night crew was already short staffed and they are probably getting a trauma or something that we will end up with. Glad I have the next two days off.
After four different patients and running around all day, once my last patient settled down I had about twenty minutes of quiet time before shift change. I didn't stop and get centered all day, but I finally had a chance to think and feel things.
I felt pretty good about being able to take on things on short notice and be flexible with the assignment, I know I missed a few things with all the transfers, like forgetting the MARS to go with the chart on the first one, forgetting to wrap up some computer stuff on the second one, and forgetting to check over everything the float pool nurse did before I got the last patient transferred since she left me with huge gaps in medications, charting, and information in general.
I'm not bothered as much by coworkers who are insensitive, rude, controlling or just plain mean. I understand the personalities a lot better. Somehow this past month I've pieced together a lot of small things like figuring out personalities, that helps a huge amount when I feel like I need help. It's amazing the things you learn that you never thought had anything to do with learning how to do your job.
I feel like I am now getting the hang of who I can ask for help and who to avoid except when I'm desperate. I want to socialize with a few of my coworkers outside of work, I think it would be fun to do other things- go hiking, mountain biking, snowshoeing, or drink beer. So far there are only a few, maybe three or four in that category. And then there are a few I'm hoping will quit so I don't have to put up with them for too long!
I finally got some food down- I reheated my lunch that I never ate, and now I'm going to bed. My eyes are burning and I feel like I might be getting the crud too. I need sleep. Two blissful days off- ya right! and then it's back to it for three more.
If only I could get that stupid tube feed alarm to shut up.
Peace, love & medication restraint bliss,
Towanda, ICU RN
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