I’ve Been a Bad Nurse…

I’ve Been a Bad Nurse…




8 hour-day shift in ER, starting at 7:30

 

7:20 Checked the assignment: monitored care area
Great, the day will go fast

Or so I thought…

Started with 4 patients (pts)
Ok, not too bad, we can handle that

Or so I thought…

9:15 Almost coffee break time
I’m already swamped.
I’m with a good team of nurses though
Some see I’m really busy.
So they offer to help
I think I can make it on time for my break
And by that, I mean 30 min post real break time

But at the same moment, a triage nurse yells
“I HAVE A NEW PATIENT FOR YOU DIDI
…It’s an easy one!”

Yea sure, they all say that…

I’m on my way to greet my new patient,
When one of my most stable patients walks up to the nursing station,
Saying he wants to get the hell outta this hellhole

I don’t blame him
I want to get the hell out too…

But I’m trying to keep my cool
It seems the more I try to reason with him
The more he gets frustrated

Must be the little remaining of EtOH he’s got in his blood

Or maybe just his personality

So I turn around and try to look for the ER MD

Off course he’s in the trauma room

At this point, I know my coffee break has vanished, or at least been further postponed
So I tell my buddy nurse that he can go on break,
That I’ll cover for him,
That I’ve got too much going on right now…

The matter is settled with the drunk pt: he can leave
He signed the leaving AMA paper
So he’s walking steadily towards the exit

I can now go see that new “easy'” pt of mine

Off course, the word “easy” is subjective: a febrile, confused, 80 years old gentleman.
Blood cultures, urine culture (I’m anticipating an In/Out or foley catheter insertion) regular cbc and chem7…EKG (because he’s tachycardic…probably from the fever, but still…) cardiac monitor… and done

I proceed to do an eye check on all patients

I see my buddy nurse
Already back?
“Yup, it’s been 30 minutes…your turn now”

“I’ve got Mr M who’s here for…

Mr S who’s here for…
And Mrs R who’s waiting for…
Oh and Mr P who just came in for…

So there shouldn’t be anything to do for my patients”

But I hear a loud noise from room 13 (my pt in the ISO room for bedbugs)
Sheshh… what’s going on with my drunk pt no.2?

I pray he’s alright

He’s standing in front of the bed…
Already that’s a bad sign
Because he was hooked to a cardiac monitor
And was also on IV fluids

…And he had a foley

“Crap Mr. S What did you do?”

Of course I don’t say that out loud
But I feel like exploding

Really? Like now?

I was already anticipating my feet elevated
With my bottle of water in hand
…Paradise in ER

But it’s all vanished… in the blink of an eye
I open the door

What a glorious vision

He’s standing there…
IV out
FOLEY OUT (I can see the tip with the inflated balloon on the floor)
Stools on the floor

He couldn’t make it to the bathroom

I’m paired with a good nurse though
“Go on break Didi, I got this”
“But-”
“It’s ok I told you, I got this”

So I go on break
11:15 Feeling bad about leaving this RN with a pt in such a mess
Even though I know he’s genuine and wants to help me
We usually tend not to leave anything for our fellow RNs while going to coffee break

They already have a lot on their plate

And I leave him with the exact opposite of “nothing”

I try to relax during my break
But I’m only anticipating the rest of the day

“It’s ok…it’s gonna get better”
In fact, it can’t get worse…

Said no ER nurse EVER…

In the blink of an eye,
My break is done

Gotta go back to the madness

Or the “hellhole”, as would say my drunk pt no 1 who left AMA

11:45 On arrival, I see 2 people arguing
Isn’t that my drunk pt no 1 with the internal medicine MD?
The pt who left AMA this AM?

Yes

He changed his mind, and accepts detox services
So he has to stay until he’s seen by the detox nurse (and that frustrates him too)

Great, I’m now with 5 patients…
Oops nope
6 patients since I got one during my break

It’s ok though…
6 patients is nothing special in ER
It’s every day life

So I go on
And on

13:00 my buddy nurse takes his break
No prob, it’s cool

I can handle 12 patients for 45 mins
Although I’m still over my head with things to do for my own peeps

13:45 Buddy nurse is back
But I’ve got so many things left to do
And with what happened this AM
I CANNOT leave not even one thing to do

Well, I could
But I don’t want to…guil
Because I feel guilty
Excessively guilty
For what happened this AM

The in-charge nurse is busy in the trauma room with 3 patients

Real trauma pt?
Traumettes? as we call the more stable ones
I don’t know
And I surely don’t have time to figure it out
So I carry on with my work

Until it’s
15:00
Already
“Didi you didn’t take your break!”

“I know, I know
It’s ok though I ate this AM
Could you watch over my patients for 15 min
I just want to check on my charts
Get to know my folks plan”
“Off course”

So I check my pt’s plans
And get prepped for report

My vision is blurred
My head is pounding
I manage to drink a 500 cc of water
The first 500cc of my shift

I’m now back in the zoo
Couple of more activities just popped up on my screen
15:25 I KNOW I have to delegate
But I can’t leave that many activities for the next RN
So I cut the pear in half
And go do some more blood tests on one of my patients
And administer another dose of Valium for my drunk patient no 2 who’s having heavy shakes

It’s been a busy day in ER
I’ve been a busy nurse today
I’ve been a bad nurse

A bad nurse because some will say I didn’t manage my time properly
A bad nurse because I missed my entire 45 minute break
A bad nurse because I didn’t reach for help when needed, or for such and such reason
Can you relate?

RN Didi

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