I’ve just started a 6-week stint on night shift to fill in for one of our night nurses who is gone on maternity leave.
Its the first night. I arrive to the floor and look at the board for assignments. Great, I thought, my fifth patient is a new admit. I grab my organizational sheet and go to receive report.
Patient 1 is a little lady who is completely bedridden. She’ll be going home on hospice in couple days.
Patient 2 came in with an INR of 7.4 but is doing much better now. He’s very needy and always wants you to be there to get him things. He said he fell last night and so is now on a bed alarm. Though he will take it off himself when gets up for the bathroom so watch it.
Patient 3 came in with a heart attack 2 days ago. He’s going for a cardiac cath in 2 days.
Patient 4 has a lot going on with her. Came in with chest pain. They ruled out cardiac and are sending her for an EGD in the morning. She’s NPO after midnight. Her catheter must of gotten snagged today because its all really bloody. Just keep watching it.
Patient 5 arrived to the floor in the middle of report. Elderly lady with chest pain.
After making my new admit comfortable, I run to assess everyone else before I process her. Starting with patient 1 I walk into the room. “Hi!” a little 5-year-old boy yells out, “What’s your name? Hey that’s a cool pen, I LOVE pens like that. Hey, can I have a green wrist band like my cousin got, you know those green things that go around your wrist. My cousin got one of those, I want one those, can you get me one? What are you going to do? What are you listening for? Can I hold that?” The barrage of questions and chatter never ceases as I vainly attempt to hear the garbled breath sounds and hypoactive bowel sounds.
“Honey, I’m going to need the bedpan. When I need it I need it fast.” My 85 pound patient informed me. As the family and little boy chatter stepped outside the door, I slipped the bedpan in place and proceeded checking pulses and writing on the rounding log. “Honey, I think I’m through. I guess I can’t have a bowel movement.” She said sadly, “Its been several days.” With bowel movement in my thoughts, I jumped to the conclusion that she hadn’t needed the bedpan after all. I deftly slid out the pan with thoughts of my next patient needing to be assessed. To my chagrin, I realized too late that the bed pan had been filled… just not with a bowel movement. I righted the pan only after half the contents had been poured into the bed. Oh no, I groaned, I don’t have time for this. “I’m sorry,” I started, feeling rather foolish, “Don’t worry, I’ll get you all cleaned up and a nice fresh bed while we’re at it.” I gave a reassuring smile, mostly for myself.
I page a tech and run out the door to get some supplies only to be attacked by my now forgotten chatterbox. “Hey, did you know you can see Grandma’s house from that window over there? Its just right out there! Come look right now! Its the gray one! Come! Come! Come!” I barely squeak out a “That’s neat! I can’t come right now” when he grabs my arm with that insistent little boy feel and jumps back in with full force. “Have you heard of the purple candy lady? I like the purple candy lady. She dresses up in purple and always comes around…..” And that is when my multi-tasking failed me. I wanted to sit down and hear all about the purple candy lady, to go look out the window and have grandma’s house pointed out to me. But thoughts of his poor grandma sitting in a wet bed and my duty at hand drove me on.
I retreat back into the room as the tech comes to my aid. We begin the cleanup and bed change process, but in my nervous haste I bump the bedside table sending the water pitcher full of ice crashing to the floor. As Murphy would have it, the tightly snapped lid came decidedly unsnapped covering half the floor with ice chips. No, I groaned, I really don’t have time for this! Forcing on my quickly fading smile, I shove my way between bedside table, IV pole, call light cord, IV tubing, bed, and night stand to attempt fitting the too small fitted sheet on the too large mattress. Wielding all my strength from that awkward angle, I managed to pop the corner into place.
Whew! That’s over, I must get to my other patients, I thought with relief but not for long. I stepped out of the tangled mess with a seemingly quick, smooth motion, but not before my dangling hemostat snagged the IV tubing, pulling it rather violently. “Ouch!” I heard exclaimed as I looked back in horror to see blood oozing from where the tubing had been taped. “Is it supposed to be bloody like that?” she asked. “No,” I replied slowly. Mustering up that long lost smile I hastened on, “but don’t worry, I’ll get it all cleaned up and fixed for you.” Upon closer examination, to my utter consternation, I discovered that instead of just peeling the tape off the skin, the skin had peeled back off with the tape. Seeing the flap of paper-thin skin, 1 1/2 inches wide by 1 inch long, dangling by one end sent my stomach into one, tight, queasy flop. I felt the tears pressing against the backs of my eyeballs. But not having the time to stop for them, I gave one last fleeting look of utter helplessness and despair to the tech and hurried out the door to get more supplies.
I’ll spare you all the details of ripping skin while trying to untape it. Suffice it to say I managed to salvage the majority and leave a neat, clean dressing in place…. and escape the room without any more catastrophes.
Its 1940 and I still have 4 more patients to asses. I rushed through the rest of my assessments only to get stuck with my new admit who insisted on telling me her whole life story. With sudden urgency she informed me she needed to get to the bathroom. I quickly positioned myself and gently helped her to her feet. No more than two steps were taken before the flood gates opened. After finishing the trek to the bathroom and reassuring her that it was OK and that I was there for her, I calmly rushed out to get yet more supplies. Fortunately the tech was not too far outside and was able to rescue me yet again.
The night almost never ended. It was one thing after another. Patient 4 with the bloody catheter who was heading for an EGD in the morning had meds every couple hours with different antibiotics interspersed sporadically through the night. 2300 rolls around, “She’s had no urine output all evening,” the tech informed me. Well, I thought, we’ll give it a little more time. Surely somethings got to come out soon. I plowed on, attempting to chart but getting interrupted by so many different needs. 0300 comes, “There’s still no urine output.” I look at the tech helplessly. “Ok, I’ll call the doctor.” I don’t have time for this. Why am I here? I’m such incompetent nurse. I don’t deserve this job. Who even am I? I don’t even know what I’m supposed to do. I don’t know how to take care of these people. “500 mL Normal Saline bolus now.” came the order.
0500 arrived… the foley bag stood empty. Afraid the catheter might be out of place, I ask another nurse to come help me. The patient was complaining of needing to use the bathroom. With a new foley in place, we glance at the bag expectantly…. nothing. Another nurse runs to grab the bladder scanner… the bladder is empty. The tech came in to take routine vitals and discovers the blood pressure 67/45. A manual BP reveals 58/40. I ran to the nurses station frantic. I didn’t know what to do. A nurse runs in to place her in reverse trendelenburg position while I page the doctor. Another 500 ml bolus of NS is ordered. The house supervisor comes up and starts going through the chart and overseeing the interventions. Back in the room, my patient is alert and oriented. I watched the fluids rushing in and wondered where it was all going. As I stood their pondering everything but totally unsure of anything, the charge nurse came in, “The doctor is on his way up, he’s sending her to the unit.” By now, the shifts were changing. I called report and prepared for the transfer.
I spent the next 1 1/2 hours after shift change just trying to catch up on all my long forgotten charting. Is it worth it? I wondered, I’m not a good nurse, I’m not at all competent. And I still have two more nights this week.