My unit Christmas party is tonight. We always have great Christmas parties. Everybody, including the boss, gets a little tipsy. I don't drink, but it sure will be fun watching the others get that way.
Frankly, After the week we had...we all deserve to do a few shots. Yesterday I had gotten to work to find that 3 out of my 5 patients were total care. When I whined about it, I found out the whole floor was practically total care.
How can that happen? What are the odds? What happened to all our ambulatory homeless guys coming in from the cold?
You'd think they would increase the staffing with accuities being so high. It just makes sense. I was running around without lunch breaks or potty breaks all week.
It really bothers me when I simply don't have time to give the best care to all of my patients. If it's just one patient taking up my time, I can usually manage to break away to get to my other patients. But when I'm in 3 rooms all day, changing briefs, giving bed baths, removing or starting Foleys.....I have no time for the not-so-heavy patients who still need my care.
Not even the best Delegation and Prioritization skills in the world will help if there is simply no one to help.
One patient looked pretty bad, admitted with pneumonia and UTI from a certain government run mental facility. Their temp was elevated, BP started crashing, HR increasing (Yeah...you know what this sounds like) going from unresponsive to screaming incoherently (I was told that was their baseline). I asked the Resident to consider moving the patient to a critical care floor. She said they'd discuss it in rounds. It didn't happen.
So with my heavy load, I did frequent assessments, charted everything in detail (Including the "Dr X notified of this, no orders received")
That patient had no business being on my unit.
Another patient with whom I had developed a rapport called me a "Dirty Rat". He had Necrotizing Fascitis in his arm muscles, a result of several failed attempts to shoot up some sort of illegal drug. (He didn't elaborate)
He was upset with me because the wound care nurse had taken off his bandages from a Post-op incision and drainage and I hadn't warned him about what his arm looked like. It was a big filet. Sliced open from wrist to underarm in several places.
You could get a pretty good anatomy lesson by checking out his ligaments, muscles and bone. I told him I had no idea his arm looked like that...the MD had ordered the bandages to stay on for 24 hours. He forgave me.
He'll probably lose that arm though.
I still love my job, but days like that make it very hard to continue loving my job.