Wednesday, April 22, 2009

I'm not gonna lie.

Sigh. This is where I show my humanity, I guess. Lame. I am getting my ass handed to me at this place. Like, in a big way. As in, I'm not sure I can do this. It's all really dependent on several factors. We're supposed to have 4 patients, sometimes it's more- I haven't had more than that yet, though. This job is a breeze depending 0n the doctor- some of them are very no nonsense and don't make you draw a bunch of unnecessary labs or do a bunch of stupid crap, and other are less that way. Sometimes you have nurse externs and paramedics or students to help- other days you have no one. Sometimes the patients are horribly sick and require lots of meds and care, other times, less so. Sometimes all of those factors come together into a perfect storm of you being totally fucked. Yesterday was one of those days for me. I was on top of stuff- I got a lot of my lines in before the doctors saw the patients, I was writing all this stuff down on my little task lists that I make, I was delegating when I could, but as my day went on, I got more and more behind. My first patient I got from the waiting room ended up not only having a small bowel obstruction, but also ended up being in DKA (this is seriously, like, my sixth or seventh patient with that. They FIND me)- so I ended up having to spend a ton of time with her- she had to have labs, urine, blood cultures later on, an NG tube, multiple doses of pain medicine, an insulin drip, antibiotics, fluids- i had about 4 lines going in at once- she was super hard to stick and i had to start a second IV for all the crap we had to dump in her- plus hourly blood sugars, and very nice but somewhat demanding family- that alone was a lot. Plus the doctor that day was discharging people before their treatments were even done, which sucks, because you have no grace period whatsoever- you have to work to get the discharge crap done and immediately end up working up a new person, which takes lots of time. So the whole morning it was in and out treatments and discharges with an ICU patient, and I was just scrambling to try and keep up with all the paperwork- as soon as one of my rooms opened up for 10 minutes they filled it with an ambulance patient with altered mental status and a blood sugar of 686 who did nothing but demand we bring him a sandwich (i'm not exaggerating when I say he asked me about 25 times- um, no, sorry, you can barely stay awake and have that blood sugar, you're not eating right now).
As soon as I caught up on that, my ICU lady got a bed, so I had to transport her myself because she needed constant monitoring. I finally ate lunch after that since I was about to pass out, and when I got back they had filled my rooms with people, one of whom spoke only spanish and another who was in a hypertensive crisis- naturally right then, my cranky hyperglycemic had gotten a bed, another patient needed to be discharged, and as soon as she left they put a woman in excruicating pelvic pain in the room without telling me. By that time our charge nurse had sent our only remaining extern to the floor to sit for a suicidal patient, my three patients needed meds and IVs and EKGs and the doctor was ordering more stuff, my hyperglycemic was now yelling and trying to get out of the bed with his monitoring equipment and demanding pain medicine for his toothache. I felt completely overwhelmed. It's times like this I screw up and start doing things wrong- I accidentally left a vial of labetalol in a patient's room and I gave morphine to my pelvic pain lady who was crying in pain before taking vitals because she'd gotten recent vitals in triage, I kept forgetting to put in orders- if I hadn't had my preceptor with me, I have no idea how I would have ever caught up.
I know there's going to be days like this that I don't have help. And I have no idea how I can practice safely. It seems I'm either cutting corners and playing with fire or delaying things that are really important. Everyone else seems to be able to handle it, and I have no idea how or why I can't seem to catch on. I'm naturally super disorganized and that all comes out when I get swamped and start panicking. It just sucks, because I work as hard or even harder than everyone else and I still feel like I'm so behind. The other interns in my group seem to have their shit together, I don't know why I can't seem to handle it. It just makes me wonder if I'm trying to break into this too early. I did really, really well in school, but I never worked as a tech or an extern or anything like that. I just wonder if I'm not ready, or whether my lack of self confidence is just screwing me. Ugh. More to come. Time will tell in the next couple of weeks, I suppose. This may end up as new nurse on a telemetry floor, however. I'm trying pretty hard not to give up.


  1. No matter where you can be overwhelming. The part I don't like about that sometimes you get dumped in your lap a handful of very sick people and you're expected to take care of them completely. It's like survival mode & in the back of my mind just repeating..."I wish it was 7:15 so I can be done with this." So much for protecting your nursing license & being able to provide safe care. We have no choice in the matter as to who they assign us & it really can be unfair & overwhelming. I hate when news shows or Oprah highlight all the medical mistakes that go on in hospitals, but never address the reason as to why they happen....overworked & understaffed. Implement safer nurse to patient ratios & I guarantee the medical mistakes will decrease.

    ER is fast paced & unpredictable..that's why I chose PCU/tele. We still have our nights of craziness...especially at change of shift, but at least there are hopefully some co-workers around to help out if things get really well as transferring a critical patient to ICU.

    It's something to think about...but don't doubt yourself. It sounds like they don't give a crap about you & often times they will give the annoying patients to the newbie's. The answer will come to you eventually as to whether to continue in the ER or move to the floor. I don't think you lose either'll be gaining experience & that's the best because it builds your confidence. You may be working in a crappy ER, but love it in another ER where they have their stuff together. Then again, you may prefer the different pace of working on the floor. Good luck in your decision making.

  2. Hey, hoodnurse, I hope you get notified of new comments, because I want you to reread this post and say, "Holy shit, just three years ago I felt like this? And now I totally kick ass, even if I'm alone with 10 patients and the worst charge on the planet? Go me!"

    Because you do. Kick ass, that is.

    1. I do. Thank you, sweet anonymous reader. I still get overwhelmed but it's nice to look back and see the change. Especially when you're getting slapped in the face with the foolishness daily and can't see the forest through the trees. Thanks for bringing a smile to my face.