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The worst shift of my career
Jan. 20th, 2023 02:47 pmSometimes I need a reminder of what "worst shift ever" looks like...
Long ago and far away, I worked in the rehab unit of a long term care facility. Which was staffed at LTC levels, even with the higher acuity. Meaning, there was 1 nurse for up to 26 patients.
The worst shift of my career, and the memory that got me through the pandemic (because nothing in covid was as bad as this day):
26 patients.
One RN, 3 CNAs.
7 diabetics, and I can’t delegate blood sugar checks (a quirk about my state laws that still leaves me bewildered and furious).
Four on IV antibiotics.
One wound vac, one wound vac pending.
All the patients had at least six meds, and there were a total of six routes of administration represented on the unit.
Report at 06:30, and then we’re off to the races. Run seven blood sugar checks, start pulling meds. Oh, there’s no Pyxis, all the prescriptions are in bubble sheets from the pharmacy, OTC are in large bottles, and controlled substances are in a locked drawer of the med cart, and need to be tracked on a hand-written log.
I’m rushing along, trying to stay on top of things, when one of my aides comes out of a room and says “um, Gwywnnydd? She’s seizing!” I go in, and it’s my girl who is POD4 from burr holes to relieve a subdural hematoma. Right, put her in recovery position, call 911 to get her back to the hospital. Start looking through her chart to see if she’s DNR (she came in yesterday, so her chart is incomplete). Fuck it, can’t find it. OK, well, hand her off to the paramedics, accept that everyone’s meds are going to be late today, and push on.
I am just wrapping up the morning med pass, when the facility doctor finds me and says “I unwrapped the dressing in 8b, you’ll need to re-dress it”. Oh, the trans metatarsal amputation in 8b? The one who came in last night and I’m still trying to chase down his IV meds and wound vac? That patient? Great, fuck you too, doc. Go in, yep, doc has left this fresh amputation open to air. I have NO idea how to dress this thing. Wound care nurse isn’t due until tomorrow. Ask an aid to run to the other wing and ask the nurse there to come advise me. Wait 10 minutes, which felt like sixty as I’m staring at these five transected bones. Nurse comes, has no useful advice. Excellent! Ok, Xeroform and Kerlix it is.
Pushing on. The usual stuff, the entitled bitch in 2b who clock watches for her pain meds (and has a series of conflicts with her roommate [who is the sweetest lady ever], but this is already long enough), the guy in 28a who obsessively masturbates (and requires a male sitter cause he’s already molested two nurses and another resident), the total care in 5 who has pressure injuries on all his bony prominences (who refuses all food and meds, and refuses to let us reposition him), just standard stuff.
Get through lunch, midday med pass, when one of my aides comes to tell me the guy in 8b is complaining of chest pain. Bugger. I call down the hall to another aide to get a set of vitals, *just* as that patient’s family walks past me. Yay, great timing folks! Ok, call 911 again, turns out it’s the same crew as this morning. Hi guys! Yeah, it’s been a busy day.
After that, it was just typical stuff, but I was so far behind that I was still working on the 5pm med pass when my shift ended at 7.
Long ago and far away, I worked in the rehab unit of a long term care facility. Which was staffed at LTC levels, even with the higher acuity. Meaning, there was 1 nurse for up to 26 patients.
The worst shift of my career, and the memory that got me through the pandemic (because nothing in covid was as bad as this day):
26 patients.
One RN, 3 CNAs.
7 diabetics, and I can’t delegate blood sugar checks (a quirk about my state laws that still leaves me bewildered and furious).
Four on IV antibiotics.
One wound vac, one wound vac pending.
All the patients had at least six meds, and there were a total of six routes of administration represented on the unit.
Report at 06:30, and then we’re off to the races. Run seven blood sugar checks, start pulling meds. Oh, there’s no Pyxis, all the prescriptions are in bubble sheets from the pharmacy, OTC are in large bottles, and controlled substances are in a locked drawer of the med cart, and need to be tracked on a hand-written log.
I’m rushing along, trying to stay on top of things, when one of my aides comes out of a room and says “um, Gwywnnydd? She’s seizing!” I go in, and it’s my girl who is POD4 from burr holes to relieve a subdural hematoma. Right, put her in recovery position, call 911 to get her back to the hospital. Start looking through her chart to see if she’s DNR (she came in yesterday, so her chart is incomplete). Fuck it, can’t find it. OK, well, hand her off to the paramedics, accept that everyone’s meds are going to be late today, and push on.
I am just wrapping up the morning med pass, when the facility doctor finds me and says “I unwrapped the dressing in 8b, you’ll need to re-dress it”. Oh, the trans metatarsal amputation in 8b? The one who came in last night and I’m still trying to chase down his IV meds and wound vac? That patient? Great, fuck you too, doc. Go in, yep, doc has left this fresh amputation open to air. I have NO idea how to dress this thing. Wound care nurse isn’t due until tomorrow. Ask an aid to run to the other wing and ask the nurse there to come advise me. Wait 10 minutes, which felt like sixty as I’m staring at these five transected bones. Nurse comes, has no useful advice. Excellent! Ok, Xeroform and Kerlix it is.
Pushing on. The usual stuff, the entitled bitch in 2b who clock watches for her pain meds (and has a series of conflicts with her roommate [who is the sweetest lady ever], but this is already long enough), the guy in 28a who obsessively masturbates (and requires a male sitter cause he’s already molested two nurses and another resident), the total care in 5 who has pressure injuries on all his bony prominences (who refuses all food and meds, and refuses to let us reposition him), just standard stuff.
Get through lunch, midday med pass, when one of my aides comes to tell me the guy in 8b is complaining of chest pain. Bugger. I call down the hall to another aide to get a set of vitals, *just* as that patient’s family walks past me. Yay, great timing folks! Ok, call 911 again, turns out it’s the same crew as this morning. Hi guys! Yeah, it’s been a busy day.
After that, it was just typical stuff, but I was so far behind that I was still working on the 5pm med pass when my shift ended at 7.
