Sunday, April 12, 2009

Murphy's Law Morning

The night started out as any other normal nightshift. My night was very uneventful! I had time to do the little extras, to "fluff and puff" as I call it. So when 3:00am came around, I thought I would put off some of my normal duties to allow my patients a little time to sleep in.

At 4am one of the patients put on his call light. I went into his room only to find out his speech was a little slurred and the right side of his mouth was slightly doopy. After completing a full assessment I called the on call number for his doctor and got a returned call from the nurse. We sent him for a STAT CT Scan. Within 15 minutes he was whisked off the floor to the CT. "Whew. . .", I thought, "Now I guess I should quit waisting time and get busy!"

Another patient, was going into what is called Diabetes Insipidus (DI). He was putting out way too much urine. So again, I had to call the same nurse to report this output and see if we were going to start giving him DDAVP. We decided to just keep measuring and monitoring. He needed to be watched closely.

I quickly began to go room to room doing assessments, taking vitals, drawing blood, and meeting the needs of my other patients. I had made it through most of my rooms and sent all the blood drawn down to the lab, when another call light went off. Upon entering this particular room, I found the patient in the bathroom with BM all the way from the bed to the bathroom. I felt so bad for him. He just kept saying he was sorry. I told him to stay in the bathroom and I would go get clean linen for his bed, a clean gown, wash clothes and towels as well as something to clean up the floor. While I was in the linen room gathering my supplies, my phone rang. Another one of my patients had a critically low potassium. I had arms full of linen and the phone between my ear and shoulder. I quickly went to the desk, set down the linen, wrote the information down and repeated it back to the lab tech. I paged the doctor, grabbed the linen and was finally on my way to help this poor man get cleaned up.

With a fresh clean bed and clean gown, and freshly mopped floor, the nice older man was ready to get back to bed. My phone rang, I told the doctor about the critical potassium and got new orders to give that patient a potassium replacement via IV. I took a deep breath and reminded this doctor that the patient that needed the potassium had 4 different IV antibiotics going, and only one line. The potassium would take four hours and we didn't have that kind of time due to the timing of the antibiotics. So, I asked if there was a reason she couldn't take it PO (by mouth). He ok'd the order for the PO potassium, so I wrote that order and sent it to pharmacy.

As I was heading back to her room with the potassium effervescent tablets, my patient that had the CT Scan is coming down the hall. The transporter needed help getting him back to his bed. So I have to stop to get him situated and comfy again. He is doing good, no change from before, thank God. So off I went with the potassium. The patient took it and I was on my way to my next patient. Just in time for another phone call from lab.

My gentleman who had the BM mishap, had a critically low Magnesium. So I called the doctor. As I was on the phone with the doctor another call light was going off. It was the patient with the low potassium. I was on the phone with the doctor as I walk into her room. She had vomitted! "Ok", I am thinking to myself, "deep breath". Anyone that knows me, knows I don't do vomit well. I handed her a washcloth, while I was listening to the verbal orders coming from the doctor talking to me on the phone. Then I noticed that the patient only vomitted the liquid potassium I had just given her. So, I needed to find another route to give this. I decided I would just use her tube, since she has one. She asked that I wait about 30 minutes to give her stomach a break. Now I was feeling time is getting away from.

I took the order for the magnesium replacement and send it to pharmacy. I had to wait for them to get it to me so I took a minute to try to chart. HOLY COW! Is that dayshift people I see? It was now 6:30am, day shift is coming in!!! I had not charted anything since 4:00am, I still had magnesium to give, potassium to give, and try to watch for the results of the CT Scan so I could call that nurse back. WAIT! What about the guy who was urinating every hour. . . .?

Yep sure enough there goes his call light, another 400mls of urine that require urine being sent to lab, as well as another call to the nurse. Now I was feeling a little overwhelmed.

I got the urine taken care of, and checked for the CT results. Oh great. . . the CT showed nothing new, but it did show an old stroke. Nowhere did his chart say ANYTHING about an old stroke!!! Later the patient told me he had a stroke about four years ago. Boy, I wish I had known that earlier!

Now day shift to be ready for report. Still the potassium had not been given, the magnesium was not up from pharmacy yet, and I had still not charted. I went ahead and gave them report, and the potassium and magnesium had to be done by day shift. I sat down to chart my morning, trying to concentrate on deep breaths, so I could stop feeling overwhelmed.

I left that morning feeling like a horrible nurse. I put things off for an hour thinking I was doing a good thing by letting my patients have one extra hour of sleep, and it threw my whole morning off. I hate leaving things for the next shift and now they had to give meds that I should have given. Was there something I missed, the morning went so quickly it all seemed like a blur.

That is when I remembered that nursing is a 24 hour operation. We all do our best to not leave things for the next shift. Sometimes that is out of our control. We just work for it to not be a habit. I did what was needed to be done. I made the calls. I tended to the needs, and prioritized as best I could. I was so thankful it was my last day of the week because at that point I was exhausted!

I prayed on the way home that all my patients for that night would ok during day shift and that they knew I did my best. Then I resolved that this particular morning was nothing more than a "Murphy's Law Morning".

Moral of the story? Don't put off for an hour, what can be done now, to save your behind later! And, if you decide to put it off anyway, make sure you have a pair of rollerskate to get keep up the pace.



  1. Found you on McMamma's blog. I am a nurse in an ICU and totally know exactly what kind of nights you're talking about. My mom always tells me that I should write a book about what all I've seen in my 5 year career, but I always tell her that nobody would believe it but other nurses and they could write their own book! Happy Easter!

  2. This was pretty overwhelming and I found myself starting to try and "bargain" with God and myself about becoming a R.N. Then, the way you concluded totally brought me back to knowing that, not only am I on the right track, but I Can- do this, too. (I just need to invest in Rollerblades and a hefty backpack. lol Thank you so much for sharing your experiences. Keep on keeping on.:)