Horror Stories -- working short staffed

[redrosegal]

Dear Dixie,
I hear your pain. Having been a nurse for 32 years now, I have my share of horror stories. One in particular comes to mind similar to yours where a 46 year old man, husband and father, brother and son came into the ER with SOB. Was turfed too soon to our large medical unit that was staffed by 3 new grads. Me an ADN, a diploma grad and a BSN grad all green with the newest of us only out of school a month ago and the oldest out 3 months. The man was in pulmonary edema, even I knew that, and it was the month that all the new interns were on. It was late PM shift. The man should have been given Lasix in the ER before transfer, but did not. He was going downhill, and we were waiting for the Intern to come to the floor. We had RT there, we had the crash cart there, I even had the Lasix out and draw, we called down the nursing supervisor, but no Intern. We called him stat 3 times. I begged the supervisor to give me permission to give the Lasix. She refused. Back then, nurses could not ever take it upon themselves to push any kind of med without the docs permission. The intern finally came, the man was purple and now almost too worn out to breath, and the Intern did not know what to do and would not let me give the Lasix until her checked with the Medical Resident on call. Then he still waited for the Resident to come to the floor. Seconds before the Resident arrived, the man coded and we lost him. That was 32 years ago, and I still can see the man and the fear in his eyes. Today, I push meds without the doctor there. I wish I had been a seasoned nurse back then and had the "balls" to do what was right for that man. I also have only told this story to other nurses, not even my then husband, I have told my firefighter son, because as a paramedic, we share our stories. This man should not have died. The ER failed him, and the docs failed him, and I still feel that the nurses failed him because we were all new grads and had never experienced this before. It still makes me sad to think about him, but I use that knowledge I gained from this experience to help other patients to this day.

[cin3]

THE WORST ASSISNMENT I HAD WAS ONE IN FLORIDA WITH A NURSE PT RATIO OF 8-9/1..I DIDN'T REALIZE I HAD IT SO GOOD AT MY OLD JOB WITH 4-5/1!!!!

[nursinghumor]

The worst for me is working 3-11 and then getting a phone call or having the supervisor ask if I want to work 11-7 because the night nurse called out or won't be able to make it. Happens with increasing frequency these days.

Knowing I'm tired already and that they want me to try and make it through the night as well.

I'm not above telling the Nursing Supervisor to take the keys and count me out. Have left more than one job for that reason. Some places seem to have terminal staffing issues these days and I've gotten tired of getting stuck.

Management doesn't seem to care if you have to take care of a child the next day or have family obligations.

Been threatened with "abandonment" on more than one occasion. I was happy to learn from the state board, that unless you accept the assignment, you have no obligation to stay. The facility may end up firing you for leaving, but they cannot take action against your license for not agreeing to stay.

The New Jersey state board told me that was an "employer/employee" issue and they wouldn't get involved.

Andrew Lopez, RN
http://www.4nursing.com

[michigancna]

In Michigan it seems to happen due to immature CNA and Nurses. I expect call offs and no calls to happen in other job fields like factory or office work, but lack of teamwork in a health field is just plain careless.

[RNsRock]

For Dixiedi- thanks for sharing your story. It truly is horrible that you have had to carry that burden. Unfortunately, our profession is life and death and we all have seen/experienced tragedy.
One thing I just have to say in relation to staffing shortage- We know it's going to get worse! Agency has a bad name but it really is becoming more necessary to get those experienced PRN/travel staff into our facilities! Who would you rather have- new grad "helping" on your floor, or a nurse with 15 years experience in your specialty who happens to be at your facility for the first time? I'm bringing this up because it's kind of my thing. I am working at a travel/staffing company now and I love it. Sometimes I work PRN and sometimes I do contracts and either way, I have walked into some facilities who are in dire straights. I know this role isn't for everyone but having agency staff can really help abate some of the "horror" that could go on. Ok. Sorry. That's my soapbox! Nurses Rule!!!

[TheCruiseAcademy]

In most cases, I'd take the seasoned nurse for sure. I have nothing against new nurses - Heck I was even one at one time
Sometimes of course, it is annoying to have to keep orienting a new nurse to your unit, but in a case like OP talked about, it can mean someone's life.

When I was a fairly new nurse, sometime in year 1 or 2 I think, I took care of a woman, mid forties, who had the most god awful colostomy. None of the nurses had ever seen anything like it. It was an emergency surgery - she had a bowel obstruction due to a tumor of some sort and it was a VERY dirty surgery. Colostomy looked like she got shot in the gut... largest flange barely fit... Unfortunatly she got the surgeon on-call who was the worst surgeon ever...
Anyway, dirty surgery, no iv abx after... DUH! Idiot Dr should have been shot.
Anyway, I come in for my 11-7 shift and 'Betsy' a rather inexperienced nurse, who returned to nursing after being out raising kids or something... is giving me report on all the patients.
She gets to this woman and makes some comment about how she only put out about 125 cc of dark urine, and you know, wow, her pulse has been running kind of fast, and I had a real hard time getting her blood pressure...
I'm like WHAT???

I almost say to her, Are you f***ing stupid? I flew into the room, and sure enough, no urine in her bag, she's diaphoretic, weak rapid pulse and of course I can't get a BP on her...

I call a code (we didn't have RRTs) and of course she ends up in ICU, septic and on a vent and eventually dies over the course of a few days.
It was so awful; I just cried when I heard. I wanted to kill that idiot nurse for being so stupid and letting a young woman die needlessly.
It was devastating; her husband was devastated. They had met later in life and married; was just them and no kids.
I still think about it today.

Needless to say, Betsy was not seen again. Don't know what happened to her, fired I imagine.
If you don't know your stuff, you shouldn't be learning on really sick people without proper supervision. It can mean someone's life. :cry_smile:

[sunnijudi]

..isn't working 24 hrs. illegal?......just wondering.

peace...be well.
judi

[cougarnurse]

Yeah, 24 hours *is* a bit on the dicey side. But to hear my former DON talk, she's done it and 'sees no problem'.....but I won't go into that particular story.

[RNsRock]

Hi Sunnijudi,
I think it's illegal to be SCHEDULED to work that long (I'm not sure what the cut off is) but under extenuating circumstances it is allowed and not illegal.

[normalil]

Dixiedi, Redrosegal and all others. Thanks for sharing your horror stories, I'm sure we all have many. They make chilling reading indeed.
My career is over now, I work part time in a dementia asses. unit. Nights are more convenient for me, as I am full time carer for my mother too. Night duty is a nighmare! I am the only trained on duty, should have 3 support workers with me, but often only two, sometimes one. Some of the support workers are older than the patients. Some of our patients can be very physically aggressive. This is not too great a problem is the patient is physiacally frail, but often their physical health is perfect. To obtain a doctor, we have to phone up the main hospital, half an hours drive away. Intra-muscular prn meds are never written up as routine. They are never written up until there has been an incident!
Yes I know, prn is and should be, the last resort. I do not give it willy-nilly.
Also, our ward, (22patients,) is mixed sex. It is a stuggle to meet the combined needs of frail, demented little ladies, with the needs of the relatively young men...the whole set up is a nightmare.
As an aside, I must say that basic hygiene is totally ignored. It's only when I am on duty that toilet seats etc are cleaned. Patients are never helped to wash their hands after using the toilet...( I have complained to my boss on days on several occasions about cleanliness and hygiene. He tells me that no-body ever died of dirt!) I assure you that is true. Comments please! :cry_smile::cry_smile: