Nursing

Disclaimer: facts changed to protect patient confidentiality.

Start of shift 1900, no resource RN this shift, no CNA’s on the floor.

SBAR patient 1: admitted to floor at 1730: 89 YOM, full code, NKA. PMH: COPD, DM, HTN, AFIB on Eliquis, CAD, CHF, dementia. BIBM with c/o CP & SOB. CBG 450’s, no ketones in urine, K 7.4. Code Blue in ED-PEA arrest. ROSC achieved after 2 min CPR. Pt. intubated, on milk of Michael at 35, fentanyl 50, Versed 2. Insulin gtt, q1hr CBG’s, NE at 12. “Family wants patient to remain full code until family from out of town can come to say goodbye.”

Shit.

Bed 2: Patient coming from ED post new-onset seizures and SDH, in cervical collar, no report called yet.

I immediately called charge to express my concern for the assignment I was given. My concerns were not met with understanding or compassion. I was told “there’s nothing I can do about it.” I knew for a fucking fact that there was something they could have done about it. I was the LEAST experienced nurse on the floor that night. There were 5 nurses around me who would have been better served to take this shit show, let alone the 16 other nurses on the floor. I couldn’t call the resource, there was none. I had to put on my big girl panties and suck it up.

I was nervous, and very anxious.

I first went to the post code to check on everything, make sure my drips looked good, the alarms were all set, I had emergency equipment, etc. I did a quick physical assessment, emptied the urometer, made mental notes of vital signs, respiratory status, temperature. Everything looked fine at the moment. I went to my empty room to make sure it was set up for the new admit. By the time I left the room, my phone was ringing for report. I took report, everything sounded ok, really just needed monitoring, q1hr neuro checks and repeat CTH in the AM.

2000 CBG 220, Start D5 1/2 NS

Admit arrives 2045, CHG bath done, weight checked, VSS. Pt. lethargic, anxious, attempting to bed exit, c/o Headache.

2100 CBG 195

2130 time for rounds. Updates given, new orders placed.

2200 CBG 186, Draw BMP.

2300 CBG 175, K 4.7-normalized. AG: 17

0000: assessments. CBG 162.

0100: CBG 161.

0200: CBG 165. Draw BMP. Off to CT with patient 2

0300: CBG 158. BMP results AG closed, K 4.2. Provider paged, orders for SQ insulin ordered. BP Labile, needing frequent NE titrations.

0400: SDH stable. CBG 138

0500: CBG 122

0630: Patient 1: no cough/gag reflex. Pupils 4, nonreactive. No pain response. BP labile from 170’s systolic to SBP 70’s. Code stroke called. Sedation turned off. RRN and MD arrived to bedside. CTH ordered. The RRN and CCT transported pt. to CT.

Tears…

0700: Day shift arriving. SBAR to Day RN

0710: Pt back to room from CT. Report from RRN as follows…CBG in CT 52, 1/2 amp D50 given. Repeat CBG 136. Pt responsive to painful stimuli, cough/gag reflex present. PERRL 3/2.

WTF. I left, not wanting to ever show my face again. I was mortified, embarrassed, pissed, mad, angry.

I should NOT have had that assignment. Driving home I cried and called my mom (who’s a nurse), to tell her everything and to get justification for my feelings. She agreed, I should not have had that assignment.

As much as I didn’t want to come back, I forced myself to. I knew that the plan was for the patient to go comfort care that day and to pull the ETT. My naïve brain told me everything would be fine. It wasn’t.