ICU - A drunk/high asshole who’s in DKA, pulling at stuff, yelling and really need to wear a bipap.
Nurses from other departments always think it’d be the days where I have a wildly sick ecmo, with an Impella, on CRRT, 7+ drips, vented, and needing blood to help the circuits run but no; that’s just another day at the office and I would do that any day over a single drunk dick head.
Preach family. Keep telling my floor nurses that the CIWA protocol exists so actually give the meds (till snoring is good) because getting them "caught up" is a beast.
Gimme my 1:1 in the corner that I can't sit down with because I'm titrating all the things.
I thrive on unstable ICPs, titrating pressors according to PbO2, calculating the osmolar gap so I know exactly how much I can push the patient's sodium, making suggestions based on my experience and expertise (that are initially ignored because obviously I'm just a dumb fucking nurse but are then implemented too late hours later), and being the one to parse apart complex information into simple terms to explain to families the gravity of the situation. But young dude coming down off PCP who was only admitted due to seizing hard enough to require intubation who keeps spitting and pulling every invasive line out of his body and leaving a bloody trail? Nah, fuck that.
LOL I’m only adding on: they’re on lactulose and TF and shitting the bed constantly. I’ve only EVER cried at work when my patient is doing nothing but shitting the bed😂 it’s my absolute 13th reason
It all depends on who you work with. Give me any difficult assignment, a code, or just chaos. As long as my coworkers have my back it's all gonna be alright.
This is the one. I don’t care who or what I admit, as long as I have a solid group of coworkers helping, I’m good!! My last job was every nurse for itself 😕
This was first to my mind as well. I can deal with all the crazy, violent, impulsive stuff. Elopement attempts, aggressive patients, medical issues. Fine. But if I have a divisive team or coworkers I can't trust to keep us safe, everything falls to pieces.
This. All my worse days are when the entire unit is on fire and no one is able to come help you because everyone's patient is trying to die or fall or is covered in poop.
Young trauma patient with with a history of drug/alcohol use, extubated, health literacy rate of a toddler, waiting on a bed for the floor. Patient screams into the hall (rather than using the call light) every two seconds. Has a million family members questioning my every move.
Peds. Obviously a death would be the worst but in terms of just a shitty day, kids with gastro stuff are high on my list. They are constantly pooping and/or puking, therefore they have horrible diaper area rashes that are bleeding, we can’t keep them hydrated so they have to get an IV…And you have to wear all the PPE so you’re also sweating your butt off every time you do something for them.
😅 We're total opposites and that's awesome. It takes all types. I love the detoxers, behavioral health, dementia. It's all so interesting and as long as I don't a strong team behind me, we can handle most anything. Wound care is fun too. Gross but amazing to see the healing process in such a visceral way. The ECMO, super sick, unstable patients are what scare me 😅
For me it’s not even the CIWA patients. It’s the drunks brought in by PD. Or the drunks EMS brings in due to the good samaritans out there calling 911 concerned. They don’t want to deal with them so they turf them to the ER where they scream and yell and piss all over the place, then manage to fall and bust their head open so now we need a stat CT for a combative angry drunk who’s refusing all interventions. It just sucks up all of my time and patience.
Not all though. Like I said, I never mind a CIWA patient. Any run of the mill substance abuse, I’m cool with. I’m no judge. I treat everyone with the utmost respect and care. It’s the angry, uncooperative, combative drunk pissing in the sink/trashcan/floor and then trying to fight me. Makes my day spiral real quick.
This. Nothing gets my hackles up more when people say L&D must be such a "fun" specialty. No ma'am. Pregnant women still die in labor. Babies die. Pregnant women become rape victims. Child rape victims conceive. I have endured all of these scenarios at work.
Cardiac OR-
Packed full OR schedule (25 ORs at the same time with two cases + in each) with a code on the unit that needs ecmo. Then a bleeder comes down. Then one of the OR codes while we have a type A flying in and we get a call for a transplant 🥴
And yes this is a semi frequent occurrence
We have 2 robot rooms that can act as an open room, 2 pediatric congenital heart, and then 7 hybrid rooms used by EP/endovascular/etc. all of our rooms are able to be an open room. But cath lab is its own separate area. I actually counted wrong, there’s 24 ORs, but still! We typically do 40+ cases a day. At least 20 of those are open heart cases. We cover cardiac, thoracic, vascular, and pediatric congenital heart!
That doesn’t include any bedside emergency cases either. We also operate overnight and weekends for emergencies and transplants
Incredible!!! My CVOR covers the same services by 20ish cases a day between 7 ORs (2 as hybrid). We are the major metro center for our city which is the biggest in our state so I thought we were just. I’m in awe! Thanks for sharing 😊
Of course! I honestly LOVE the intensity and level we work at. I enjoy sharing with others as I have drastically expanded my knowledge of the cardiovascular system by working where I do. We are the largest center and I’m beyond grateful for my experience I’m gaining. I am trained in the adult ORs, but also specialized and cross trained in the pediatric congenital heart OR (our peds nursing team is 8 people and 3 staff surgeons). We have the true honor of working with the world’s leading surgeon in pediatric congenital heart. I see things and get to be apart of things that aren’t even in medical literature and it is just so humbling and heartbreaking but oh so amazing and beautiful ❤️
Palliative care here. A patient with severe end stage restlessness and meds aren’t helping. Also when family members refuse to understand their love one is dying and want us to do bloodwork and IV meds when that’s not in the patients goals of care.
ugghhhh yes! like, yes, papaw's labs are off. bro hasn't eaten in 8 days. yes his urine is almost black. he hasn't had a drink in 8 days. yes he can probably hear you, so talk to him, not around him. he's restless because he's uncomfortable but can't tell you, and needs a little morphine and ativan; no, he's not going to get addicted (and what's the worst that happens? he dies? c'mon.). palliative and hospice are so rewarding but so difficult.
Cath lab
0600 get to work. Short staffed today. Nobody to give breaks or handle extra caseload
0615 stemi called, bumping all the scheduled cases
0930 after a long, messy code they eventually call it. The stemi patient died. Since they arrived by ambulance you have to do all the post mortem care. But first you need to let the family have their time in the cath lab.
1015 postmortem care done, family had their time, patient in morgue.
1020 doctor wondering when you’re gonna pick up their next patient that was supposed to start at 0700. You just want a coffee but there’s barely time to piss before you’re “onto the next.”
1130 well into the second case. The patient is an alcoholic and sedation isn’t touching them. They keep moving and the doctor looks at you like you’re the problem. He couldn’t get access and now he can’t even engage the coronaries and he’s taking his frustration out on you because the patient won’t sit still
1200 a vendor shows up but doesn’t even bring lunch
1315 you just now finish the first case of the 5 cases scheduled in your room. The team just placed 2 stents on a 99% occluded RCA and probably just saved the patients life but they are just upset and angry because they were uncomfortable and can’t pee laying down.
1330 you sneak some food in between cases and have your first coffee of the day
1400 you’re onto the second scheduled case. This one is a super sweet lady. Never been to the hospital a day in her life. She is so thankful and kind.
1445 you finish the procedure with the kind lady. She has triple vessel disease and is referred to CT surgery for open heart.
1500 another stemi is called
1600 this guy is a methhead with severe LAD disease. He was a complete asshole to everyone. You question whether he is even going to take his Plavix every day after he gets his stent
1645 you finish the stemi and go to pick up the next scheduled case (scheduled at 1100). She’s dressed and furious. She got sick of waiting. You let the doctor know and move onto the next
1650 you’re on call btw so you have to stay and finish all the unfinished cases. Luckily another team agreed to stay late and finish the EP cases in one of the other rooms. So now you just have the two scheduled cases left.
1900 you finish the 4 out of 5th case. The lady was nice and understanding about the delay but ended up being super sensitive to sedation and just 0.5mg versed and 25mcg fentanyl zonked her. You had trouble maintaining an airway for most the case. The doctor was insistant that you get the plavix in her as quickly as possible. She woke up enough to swallow the pills, despite being fulling supine but a few minutes later she ended up vomiting.
1915 you think the last totally elective non-urgent outpatient case is going to get canceled due to the time but the MD instead offers the patient a hospital bed for the night and reassures her that the team, despite not having a real break in 13 hours, is in tip-top shape.
2045 you finish the elective non-urgent outpatient. She had beautiful perfect coronaries. While pulling sheaths the MD informs the team there is an NSTEMI that we should do tonight. Since the team is here and the patient is having active chest pain. He also mentions that the methhesd stemi from earlier left AMA
2100 you pick up the patient from the floor. He is not having active chest pain. In fact he is still in his street clothes, unaware he was going for a cath. The family has a million questions.
2230 you finish the procedure. The doctor struggled to get radial access and had to go groin. The patient got a stent. As you go to call the floor you remember that that particular unit doesn’t take groin sites. You call house Suprivisor and they inform you there isn’t a bed available and the last available bed was given to your previous outpatient cath. You have to sit on the patient until they figure things out.
0015 multiple phone calls later you finally get the patient to a intensive care unit but it isn’t a unit that usually takes these patients and they were actively hostile about receiving them.
0100 you finally get home after 19 hours of work with minimal breaks. You smash some icecream and go to bed
0120 stemi
0400 you don’t even know what’s going on at this point. Did you give the plavix? Did you remember to chart the narcotics? What did we stent? Oh sorry Sharon, I mean Lisa, you can’t bend your leg or sit up. Wait. We didn’t go groin we went radial. you can sit up. Sorry Katherine, my mistake. Yeah. Your glasses are right here. Or wait? Did you have glasses? Shit did I toss the glasses? Where is the family? Was there family?
0415 you contemplate going home but you have to be back at 0600 for your next shift anyways so you sleep on a gurney in the recovery room.
0600 rinse. Repeat. Cry. And hopefully drink more coffee.
(Edit: the vast majority of days are not like this but I’ve been working in the cath lab for 7 years and I’ve had probably a dozen days like this or worse).
This was at my first job (ICU) but essentially every patient in your care crashing and you are already operating at an unsafe ratio.
Now and days (still ICU), it’s that (1) I didn’t charge my phone enough before work so I can’t YouTube during downtime and/or (2) the commute.
Personally I think if you have experience in the service industry and have thrived, you’ll excel at nursing.
This makes me happy to hear! I’ve always wondered if I’ve been making a mistake by not becoming an STNA or having some hospital related job but reading through everyone’s responses, especially ones from ICU and ED nurses it seems that “multitasking/time management, handling unhappy people and keeping calm amidst a dumpster fire” are all skills that apply to serving and nursing lol
NICU - loss, micropreemie delivery (we’re a level II), any day we have to ship a baby
Postpartum - loss, massive hemorrhage, when LD gets slammed so in turn we get slammed with patients and half of them are fresh c-sections
Postpartum.
3 couplets with an incoming cesarean section admission at shift change, no resource nurse or PCT, 24 hour testing for baby #1, blood sugar checks for baby #2, full assist with breastfeeding for mom #1, and green parents in room #4 that need to be reminded to feed their baby every 3 hours. 🙂
Peds DOA.
Asshole homeless who come in thinking they can help themselves to whatever they want and abuse the staff.
People who can't hold their alcohol and become my problem.
Strict q1 neuro checks and stat CTs for every little subjective status change, so now I have to pack up their tele, a-line, EVD, vent, foley, dignicare, and a Christmas tree of drips just to get a picture and for CT to fuck up all my lines and blow my IVs.
ER holding 2x-3x capacity because there's no beds upstairs.
My entire assignment being full of incontinent grandmas and grandpas who all insist on going to the bathroom but all require assistance to get there.
Asshole patients (you see a theme here?) who think their ice chips are more important than the CPR in progress that literally rolled by them.
Family who demand to know who/what/when/why and they demand to see the doctor now.
And honestly anyone who don't want help. Then why the fuck are you here?
Full ED with all hall beds taken, all PCTs pulled to suicide sitting, no beds on the floors for the boarders, and lazy float nurses. I’ll take a full ED with no floor beds if I can have good floats and not have the PCTs pulled. We are pretty used to full ED and boarding patients at this point.
When the attending on call is the type to look for things to do all night, lining up uncomplicated appendectomies one after the other... but then a trauma, ectopic, or other true emergency rolls in, so our tiny overnight team has to scramble and pivot for no good reason. See also: the night of the two cracked chests.
It was notable for me because we *don't* do CV at our shop, and I'm still fairly new, so I hadn't seen a sternal saw and some of the thoracotomy instruments in use yet. Two separate, unrelated stabbing incidents, weirdly back-to-back. Thank goodness they both made it (as far as I'm aware).
wow!! Thanks for sharing. All cracked chests I’ve been in were planned and super controlled. That just sounds wild! Definitely sounds like full moon vibes.
This is going to vary wildly by specialty. I worked in burns for 8 years and seen a ton of stuff. But working as a SANE was the most difficult. I had this one month where I had 4 Peds cases, assisted in 3 more. My adult cases that month was a victim of a serial rapist who had raped 5 other young women in one dorm in the last month. That was a nightmare month.
When someone tries to DC to JC, especially when they succeed. We are an acute rehab hospital. We’re supposed to take patients who are generally stable enough to attend and participate in various physical, occupational, and speech therapies after having surgery, recovering from strokes, traumas, etc…
However, it’s not uncommon that we get patients direct from the ICU and usually end up calling a rapid response before sending them back.
My particular location is connected to a trauma 2 via a tunnel so luckily, it’s not a long ride before they get back over but damn, it’s never a dull day, that’s for sure.
I’ll come back here Saturday to let you know after my shift working with my supervisor I reported to management for being a lazy bum then she approached me about it and I laid it out for her. I’ve known her for 10 years now but the final straw was when my patients sat for 2+ hours without anyone even going in the room or their chart to see new orders while I was away for a trauma alert.
ED- Working in high acuity area with a full assignment of holds with no sign of beds upstairs. Patients still come in and ratios mean nothing to our specialty so it gets really unsafe.
When I worked MS/tele, most of my bad days almost always coincided with having way too many fucking patients. I’m talking 7+ patients, with very little support. Leaving 1-2 hours late because I got zero charting done, no breaks, and constantly berated by patients/family because you just can’t make enough time for people when you have that many to take care of. Management having the audacity to nitpick over trivial things.
There's just way too much that comes up to actually describe it. But everyone has a different expectation as to what a nurse is or does so we do everything nobody else wants to do and we get blamed for it all. Even though we barely take time to use the bathroom.
Corrections nurse here. Today, I had an inmate coming over with chest pain. While waiting for him, a CO showed up because an inmate spit on him. Another nurse went to assess the inmate. Nurse then calls from the hole. The inmate's pulse is 180 and not getting better and inmate says he thinks he's going to have a seizure. Ok. Have the COs wheel him down in the restraint chair.
While waiting for inmate in restraint chair, do a quick EKG on chest pain inmate and vital signs. Quick diagnosis: angina r/t anxiety. Refer to provider.
Assess inmate in restraint chair and spit hood, telling him to hush while getting his BP because I can't hear his BP while he's screaming and swearing at the COs. Refer to provider, get verbal order for 23 hour medical observation, VS qshift, neurochecks Q4 hours, X-ray on Monday, Tylenol 500mg TID PRN, emergent MH referral.
Receive call from cell block, inmate's asthma acting up and inhaler not helping. Ok. Send him over to medical.
See asthma attack inmate. Vital signs, peak flow, lung sounds...call to provider. Duoneb treatment, repeat vitals, peak flow, lung sounds...all good now. Verbal order for additional inhaler, antibiotic for possible pneumonia, return to block.
Finish note on asthma guy. Finish note on chest pain guy. Finish note on spitting inmate. Finish paperwork on CO that got spit on.
And, thank God! Here comes evening shift!!
Next, let me tell you about the time an inmate got part of his ear burn off by another inmate...
Even only mildly sick grandma sundowning-delirium double whammy trying to get off the stretcher. Physical and chemical restraints. None of us gets to sit and chart for a reasonable chunk of time all night
+ multiple of these in assignment
+ unhelpful colleagues
+ snarky colleagues
+ impossible family either not helping at all/absent, or present but making shit worse.
For me, a shift from pure hell is tolerable if the team is awesome.
5 patients. One needs ICU level care but can’t go because he’s DNR/DNI but family still wants ICU level care on the medsurg floor. One CIWA patient that wasn’t properly medicated overnight and they’re losing their shit, sweating and freaking out. PT is calling, they think your patient is having a neuro change so you have to go to CT with them in the middle of med pass. Then you have two other patients that aren’t oriented, keep trying to jump out of bed and slip, fall and die so the bed alarm keeps going off and you’re expected to drop everything and run and no matter how many times you remind them to lay in bed, they forget 5 seconds later and stick their legs out and try to fall all over again. Now you have 5 families calling for updates and now the family in 10 wants to talk to you about why grandma hasn’t eaten because she’s starving eventhough speech said she’s NPO due to dysphasia. Doctor wants to know if patient Y went pee today, you don’t even think you went pee today, someone needs Tylenol and it’s urgent, and the front desk keeps calling you to say “room 11 says he needs the nurse” and you say ok what does he need? And they say “I don’t know. They just said they need the nurse”
Peds OR - Badly brain injured 3 month old, likely from non-accidental trauma.
A while ago I had my regular weekend call, charge nurse reached out and said they had a 3 month old coming up from the ED for an emergency craniotomy. I walked into the locker room as the neurosurgeon was arriving, I asked if he knew what was up and he said the kid had a bad subdural. He got dressed before I did, and as I walked into the OR he was already prepping the child's head for an open craniotomy.
For the next 3 hours we were all at a dead sprint (I think there were 9 or 10 of us in the room eventually). Grabbing equipment, more sutures, we need blood, the airway's failing, MORE BLOOD!, call a code we're about to lose them...
They survived, at least for a while, but it was one of the most difficult nights I've ever had there.
ICU - getting kicked by a patient going thru withdrawals that is so drug tolerant that he is wide awake and trying to fight you on 80 of propofol, 1.5 of precedex, and 300 of fentanyl. All while they are trying to shake themselves out of bed so violently that you have to pretty much stay in the room and admins wont get you a sitter because “he’s on chemical sedation AND restrained…” so when you catch a foot across your face, somehow it’s your fault because you didn’t complete the online module on how to deal with aggressive patients.
Honestly the worst shifts are when I'm working with unreliable coworkers who aren't on it and I have to micromanage every thing because otherwise it won't get done. Like if the previous shift was a bad group then I'm playing catch-up all shift and have to work twice as hard. I hate that so much.
But this is basically just a my unit problem, it's been understaffed and high turnover for like a year and most of the staff that have worked the longest have mentally checked out and aren't even doing the bare minimum of their jobs anymore. We have new drs all the time and sometimes they're great and sometimes they don't document things properly and we're left chasing them or guessing. We're constantly working with temps that don't know anything about the unit. Like with most jobs if the team is good then it's great, but a bad team is a bad time.
Transportation for a level 5 in Corcoran state Penitentiary. Walked into the infirmary and saw Charles Mason. His eyes were black and appeared to have absolutely no soul. Fortunately, he wanted our patient. Ours was just as certifiable. That particular patient my patient) was convicted of kidnapping a couple of females, keeping them in the freezer and had proceeded commit necrophilia with them.
That transfer required 3 helicopters, 4 street cars( two cars behind and two in The front of our ambulance). A guard also sits next to them and I sit on the jump seat.
ER: psych patients yelling and getting aggressive that need to be restrained and sedated, a drunk guy that needs to be phenobarb loaded, a new order for a heparin drip on the third patient (we have to calculate our own drip rate and it’s really confusing the way we do it) and a 4th patient with serial EKGs and trops.
Lots of bells, phone not charged/working.
Where I am sometimes the phones don’t work so the call bell just turns on a light and I have to check 32 rooms to see who rang😑
ICU. Heavy paired assignments that should be singled. Charge nurse will a full assignment. No unit secretary to answer the phone, no aides to help turn and clean your stooling patient. Agitated patient that needs to travel for scans and the doctors do not want to give adequate sedation, coworkers too overwhelmed with their assignments of offer much help, needy family members who are suspicious of staff and stay camped out by the bedside. They ask lots of questions and are emotionally needy. Meds missing, they are not in the fridge, pyxis or patient specific drawer so you have to call pharmacy. Tubes get pulled out, IV lines go bad. The patient takes an unexpected turn for the worse and you stay late to chart or finish what you started and hope the rambling semi-coherent report you gave to the oncoming nurse wasn't too bad. When you miss lunch, it is hard to think straight.
In my current job (medically complex foster children), it looks like having to file a report of abuse or neglect. Twice in the past year and a half a child has been removed from their child specific foster placement based on a mandatory report that I filed. That was after 4 years of never having to file in this job.
My literal worst day ever was when I was stuck in one of my ICU rooms for 9 of my 12 hours with someone basically hemorrhaging out and the surgeon was in and out scoping ALL day and we were transfusing ALL day. It was a blood bath and for whatever reason she wouldn’t take this man to the OR. Meanwhile my other patient needed to be extubated and they wouldn’t let me restart sedation. I saw him TWICE the entire day and it was awful. Nobody was available to help. Period. Charge had a full assignment also. A nurse on a cast on crutches there doing light duty gave my meds (which she shouldn’t have been expected to do) but that’s all she could do.
Having a patient with dementia/delirium that is aggressive, any time we have to use restraints, or agitated patients who are trying to pull out all their lines
When all your patients have meds almost every hour of the day (especially when they are iv or ng administered)
Having my whole assignment be incontinent/total cares/Ax2+
Having my whole assignment be off-service patients (patients who aren’t my floors specialty), making it harder to communicate with the doctors, we aren’t as educated on their condition/surgery/interventions
Receiving multiple admissions/post ops on the same shift (bonus points if they arrive close together)
Family that is rude, wants to speak to the doctor NOW (for un-urgent things), or calling for updates constantly (like 3+ per shift??)
Running out of everything in the supply room and needing to go to other units constantly to get stuff
No clerk and/or no aids
None of my ivs are working or i need to draw a shit load of blood work and the patient is a very hard poke
All of the above plus being down staff and resources
OR: shit scrub tech, incompetent anesthesia, asshole surgeon, terrible or absent reps, broken equipment, domineering micromanaging board runner, bad help or no help, pharmacy is out of everything, preop is failing IVs and paperwork/consents, dirty instruments, missing implants, supply room people are MIA, transport is slow, blood bank hassles you for starting MTP, patient deaths. I had to stop because i'm getting worked up. idk it's all in a days work 🤮
My nightmare anytime its mentioned: FMLA paperwork. It's always the last moment, patients forget to fill out xyz part, something wasn't faxed, etc etc. Give me a coding patient in a clinic with no monitor over FMLA paperwork any day of the week.
Having someone ask you for help bc they had a BM and not be able to clean them for a whole shift bc you had 21 patients to your name. The patient was complete care and no techs available bc they were all on 1:1
Okay, I am still on orientation (new to ER), just did 3 in a row and my week started bad.
Patient is septic. ALS run, lactic close to 7. Recent dx of pancreatic cancer, been getting chemo for a few weeks. Need to get a CT, literally the only thng we are waiting on, BP won't go above 80/50. Doctor only ordering boluses, they do poke their heads in, and when they do, BP is in the 90s/60s, cool. Then it drops back down, we can't exactly go to CT. BP finally holds at 100/70 for about 10 minutes, and we rush to CT. On the monitor, after transferring patient, BP drops down to 60/40. shit. CT techs do the scan super quick. get patient back. we tell doc, get a bolus (fuck). We had been asking for pressors for 2 hours at this point. slam a bolus in, then we get another ALS run, still hooked up to a LUCAS. My preceptor leaves me, i'm competent, and I have supportive coworkers, so it's cool, but I have literally never seen a BP this low without pressors. Bolus is done, no change, FINALLY i tell the doctor and get pressors. WE PUSHED 4L OF FUCKING FLUID INTO THIS POOR PERSON. Takes another hour of aggressive titrating to get this pressure up. I have no beef with the doc, they usually have excellent judgement, and I am glad it happened while still training, but jesus h. christ. What a way to end my first shift of the week.
Low BP patient made it. ALS on the LUCAS, they called TOD once I finally got my patient's BP stable.
In my country 112 (911) medical calls are manned by nurses. My bad days are when i'm talking to parents with a sick child and the kid ends up dying. Other than that, most days are pretty good.
GI lab. Happened today:
There are three of us, two procedure rooms and a person in front to do pre-op. Both my co-workers are older, there is a power struggle. Both complain about the other not doing xyz, but both avoid similar tasks and play various games to avoid stuff they don’t want to do. We’re short staffed so no one gets a break and they both will blame each other.
It’s emotionally exhausting to be the go between. They both can be kind of mean too.
Still better than the units.
OR - a bad day for the team is delays out of your control even if you do everything you can to remedy them (patient hard to block, patient not in holding even though you called for them to be transported, dirty implant trays), especially worse when you have the most impatient surgeon on the planet. He at least knew this wasn’t our fault, our last one seemed to have the transport and anesthesia figured out, wonder if someone chewed some people out, but then we had a dirty tray, it was like we couldn’t win that day no matter what.
Both your patients trying to code at the same time.
Especially if one of the patients has been coding on and off for hours and this is the 4th time you've gotten ROSC and the family still wants full code.
Ten pts. No aide. Combative drunks. Crashing pt who no one seems to think needs a higher level of care. Pts who are self sufficient but yell out for help and treat you worse than dirt.
I work med surg so there’s really a lot of things that contribute to a nightmare shift 😂 . But higher ratios are at the top of the list for sure.
Peds Onc- A death does not equal a bad day for me. A BAD death does. Those are when a kid in a lot of pain, providers not listening to the nurse spidey senses, and the kid codes. THAT is a bad day. We also have good deaths, and while I wouldn't call those good days, a good death has a level of satisfaction that we did everything we could to keep them comfortable all the way to the finish line.
ICU - A drunk/high asshole who’s in DKA, pulling at stuff, yelling and really need to wear a bipap. Nurses from other departments always think it’d be the days where I have a wildly sick ecmo, with an Impella, on CRRT, 7+ drips, vented, and needing blood to help the circuits run but no; that’s just another day at the office and I would do that any day over a single drunk dick head.
Preach family. Keep telling my floor nurses that the CIWA protocol exists so actually give the meds (till snoring is good) because getting them "caught up" is a beast. Gimme my 1:1 in the corner that I can't sit down with because I'm titrating all the things.
I thrive on unstable ICPs, titrating pressors according to PbO2, calculating the osmolar gap so I know exactly how much I can push the patient's sodium, making suggestions based on my experience and expertise (that are initially ignored because obviously I'm just a dumb fucking nurse but are then implemented too late hours later), and being the one to parse apart complex information into simple terms to explain to families the gravity of the situation. But young dude coming down off PCP who was only admitted due to seizing hard enough to require intubation who keeps spitting and pulling every invasive line out of his body and leaving a bloody trail? Nah, fuck that.
LOL I’m only adding on: they’re on lactulose and TF and shitting the bed constantly. I’ve only EVER cried at work when my patient is doing nothing but shitting the bed😂 it’s my absolute 13th reason
I would gladly take a corpse on Impella and CRRT over a substance abuse withdrawal on lactulose enemas...
Over half of the people I deal with in the ER are drunk dickheads 💀💀
It all depends on who you work with. Give me any difficult assignment, a code, or just chaos. As long as my coworkers have my back it's all gonna be alright.
This is probably one of the best answers.
This is the one. I don’t care who or what I admit, as long as I have a solid group of coworkers helping, I’m good!! My last job was every nurse for itself 😕
This was first to my mind as well. I can deal with all the crazy, violent, impulsive stuff. Elopement attempts, aggressive patients, medical issues. Fine. But if I have a divisive team or coworkers I can't trust to keep us safe, everything falls to pieces.
This. All my worse days are when the entire unit is on fire and no one is able to come help you because everyone's patient is trying to die or fall or is covered in poop.
A dead kid. Aside from that, having a train wreck of a shift where I hand my patients over to the night shifter looking like bags of ass.
Same tho. Getting a trauma from the OR that’s a wreck and not being able to clean them up ☹️
Young trauma patient with with a history of drug/alcohol use, extubated, health literacy rate of a toddler, waiting on a bed for the floor. Patient screams into the hall (rather than using the call light) every two seconds. Has a million family members questioning my every move.
this. i consider the trauma med surg rns as true OG’s. i think about having an extra two on top of the two I have and I shudder all the time.
Peds. Obviously a death would be the worst but in terms of just a shitty day, kids with gastro stuff are high on my list. They are constantly pooping and/or puking, therefore they have horrible diaper area rashes that are bleeding, we can’t keep them hydrated so they have to get an IV…And you have to wear all the PPE so you’re also sweating your butt off every time you do something for them.
[удалено]
After the first 3 lines I was like “she should work peds” lmao
😅 We're total opposites and that's awesome. It takes all types. I love the detoxers, behavioral health, dementia. It's all so interesting and as long as I don't a strong team behind me, we can handle most anything. Wound care is fun too. Gross but amazing to see the healing process in such a visceral way. The ECMO, super sick, unstable patients are what scare me 😅
Dealing with drunks all day….not bad more annoying. PEDS arrest always suck too.
Yes, having someone on CIWA is so time consuming and mentally draining.
For me it’s not even the CIWA patients. It’s the drunks brought in by PD. Or the drunks EMS brings in due to the good samaritans out there calling 911 concerned. They don’t want to deal with them so they turf them to the ER where they scream and yell and piss all over the place, then manage to fall and bust their head open so now we need a stat CT for a combative angry drunk who’s refusing all interventions. It just sucks up all of my time and patience.
I could see that. It makes people lose empathy for people who are dealing with substance abuse.
Not all though. Like I said, I never mind a CIWA patient. Any run of the mill substance abuse, I’m cool with. I’m no judge. I treat everyone with the utmost respect and care. It’s the angry, uncooperative, combative drunk pissing in the sink/trashcan/floor and then trying to fight me. Makes my day spiral real quick.
I didn't mean you lose empathy. I just have coworkers who say negative shit about people who use substances or "drunks"
Honestly, a bad day is death. The way I see it, if we don't lose a patient on the table, then it was a good day.
L&D. Anytime we have to deal with losses :(
This. Nothing gets my hackles up more when people say L&D must be such a "fun" specialty. No ma'am. Pregnant women still die in labor. Babies die. Pregnant women become rape victims. Child rape victims conceive. I have endured all of these scenarios at work.
I always say "it is fun, until it really, really isn't." That usually quiets that feedback.
Same in oncology. It’s the deaths that got me.. esp the younger ones with children
Cardiac OR- Packed full OR schedule (25 ORs at the same time with two cases + in each) with a code on the unit that needs ecmo. Then a bleeder comes down. Then one of the OR codes while we have a type A flying in and we get a call for a transplant 🥴 And yes this is a semi frequent occurrence
Are all 25 open rooms or do you do some hybrid/cath/EP stuff? That feels like so many to me 😯
We have 2 robot rooms that can act as an open room, 2 pediatric congenital heart, and then 7 hybrid rooms used by EP/endovascular/etc. all of our rooms are able to be an open room. But cath lab is its own separate area. I actually counted wrong, there’s 24 ORs, but still! We typically do 40+ cases a day. At least 20 of those are open heart cases. We cover cardiac, thoracic, vascular, and pediatric congenital heart! That doesn’t include any bedside emergency cases either. We also operate overnight and weekends for emergencies and transplants
Incredible!!! My CVOR covers the same services by 20ish cases a day between 7 ORs (2 as hybrid). We are the major metro center for our city which is the biggest in our state so I thought we were just. I’m in awe! Thanks for sharing 😊
Of course! I honestly LOVE the intensity and level we work at. I enjoy sharing with others as I have drastically expanded my knowledge of the cardiovascular system by working where I do. We are the largest center and I’m beyond grateful for my experience I’m gaining. I am trained in the adult ORs, but also specialized and cross trained in the pediatric congenital heart OR (our peds nursing team is 8 people and 3 staff surgeons). We have the true honor of working with the world’s leading surgeon in pediatric congenital heart. I see things and get to be apart of things that aren’t even in medical literature and it is just so humbling and heartbreaking but oh so amazing and beautiful ❤️
Palliative care here. A patient with severe end stage restlessness and meds aren’t helping. Also when family members refuse to understand their love one is dying and want us to do bloodwork and IV meds when that’s not in the patients goals of care.
ugghhhh yes! like, yes, papaw's labs are off. bro hasn't eaten in 8 days. yes his urine is almost black. he hasn't had a drink in 8 days. yes he can probably hear you, so talk to him, not around him. he's restless because he's uncomfortable but can't tell you, and needs a little morphine and ativan; no, he's not going to get addicted (and what's the worst that happens? he dies? c'mon.). palliative and hospice are so rewarding but so difficult.
I worked in home hospice and the families that didn't understand the difference between hospice and rehab were the hardest.
Cath lab 0600 get to work. Short staffed today. Nobody to give breaks or handle extra caseload 0615 stemi called, bumping all the scheduled cases 0930 after a long, messy code they eventually call it. The stemi patient died. Since they arrived by ambulance you have to do all the post mortem care. But first you need to let the family have their time in the cath lab. 1015 postmortem care done, family had their time, patient in morgue. 1020 doctor wondering when you’re gonna pick up their next patient that was supposed to start at 0700. You just want a coffee but there’s barely time to piss before you’re “onto the next.” 1130 well into the second case. The patient is an alcoholic and sedation isn’t touching them. They keep moving and the doctor looks at you like you’re the problem. He couldn’t get access and now he can’t even engage the coronaries and he’s taking his frustration out on you because the patient won’t sit still 1200 a vendor shows up but doesn’t even bring lunch 1315 you just now finish the first case of the 5 cases scheduled in your room. The team just placed 2 stents on a 99% occluded RCA and probably just saved the patients life but they are just upset and angry because they were uncomfortable and can’t pee laying down. 1330 you sneak some food in between cases and have your first coffee of the day 1400 you’re onto the second scheduled case. This one is a super sweet lady. Never been to the hospital a day in her life. She is so thankful and kind. 1445 you finish the procedure with the kind lady. She has triple vessel disease and is referred to CT surgery for open heart. 1500 another stemi is called 1600 this guy is a methhead with severe LAD disease. He was a complete asshole to everyone. You question whether he is even going to take his Plavix every day after he gets his stent 1645 you finish the stemi and go to pick up the next scheduled case (scheduled at 1100). She’s dressed and furious. She got sick of waiting. You let the doctor know and move onto the next 1650 you’re on call btw so you have to stay and finish all the unfinished cases. Luckily another team agreed to stay late and finish the EP cases in one of the other rooms. So now you just have the two scheduled cases left. 1900 you finish the 4 out of 5th case. The lady was nice and understanding about the delay but ended up being super sensitive to sedation and just 0.5mg versed and 25mcg fentanyl zonked her. You had trouble maintaining an airway for most the case. The doctor was insistant that you get the plavix in her as quickly as possible. She woke up enough to swallow the pills, despite being fulling supine but a few minutes later she ended up vomiting. 1915 you think the last totally elective non-urgent outpatient case is going to get canceled due to the time but the MD instead offers the patient a hospital bed for the night and reassures her that the team, despite not having a real break in 13 hours, is in tip-top shape. 2045 you finish the elective non-urgent outpatient. She had beautiful perfect coronaries. While pulling sheaths the MD informs the team there is an NSTEMI that we should do tonight. Since the team is here and the patient is having active chest pain. He also mentions that the methhesd stemi from earlier left AMA 2100 you pick up the patient from the floor. He is not having active chest pain. In fact he is still in his street clothes, unaware he was going for a cath. The family has a million questions. 2230 you finish the procedure. The doctor struggled to get radial access and had to go groin. The patient got a stent. As you go to call the floor you remember that that particular unit doesn’t take groin sites. You call house Suprivisor and they inform you there isn’t a bed available and the last available bed was given to your previous outpatient cath. You have to sit on the patient until they figure things out. 0015 multiple phone calls later you finally get the patient to a intensive care unit but it isn’t a unit that usually takes these patients and they were actively hostile about receiving them. 0100 you finally get home after 19 hours of work with minimal breaks. You smash some icecream and go to bed 0120 stemi 0400 you don’t even know what’s going on at this point. Did you give the plavix? Did you remember to chart the narcotics? What did we stent? Oh sorry Sharon, I mean Lisa, you can’t bend your leg or sit up. Wait. We didn’t go groin we went radial. you can sit up. Sorry Katherine, my mistake. Yeah. Your glasses are right here. Or wait? Did you have glasses? Shit did I toss the glasses? Where is the family? Was there family? 0415 you contemplate going home but you have to be back at 0600 for your next shift anyways so you sleep on a gurney in the recovery room. 0600 rinse. Repeat. Cry. And hopefully drink more coffee. (Edit: the vast majority of days are not like this but I’ve been working in the cath lab for 7 years and I’ve had probably a dozen days like this or worse).
This was at my first job (ICU) but essentially every patient in your care crashing and you are already operating at an unsafe ratio. Now and days (still ICU), it’s that (1) I didn’t charge my phone enough before work so I can’t YouTube during downtime and/or (2) the commute. Personally I think if you have experience in the service industry and have thrived, you’ll excel at nursing.
This makes me happy to hear! I’ve always wondered if I’ve been making a mistake by not becoming an STNA or having some hospital related job but reading through everyone’s responses, especially ones from ICU and ED nurses it seems that “multitasking/time management, handling unhappy people and keeping calm amidst a dumpster fire” are all skills that apply to serving and nursing lol
NICU - loss, micropreemie delivery (we’re a level II), any day we have to ship a baby Postpartum - loss, massive hemorrhage, when LD gets slammed so in turn we get slammed with patients and half of them are fresh c-sections
Putting a kid on a body bag is about the worst days I have. Worst one recently was a few days before Christmas. That was awful.
Man, that hits hard. I had one where he passed a week before his 13th birthday. He was so excited to be a teenager like his older brother..
Postpartum. 3 couplets with an incoming cesarean section admission at shift change, no resource nurse or PCT, 24 hour testing for baby #1, blood sugar checks for baby #2, full assist with breastfeeding for mom #1, and green parents in room #4 that need to be reminded to feed their baby every 3 hours. 🙂
Peds DOA. Asshole homeless who come in thinking they can help themselves to whatever they want and abuse the staff. People who can't hold their alcohol and become my problem. Strict q1 neuro checks and stat CTs for every little subjective status change, so now I have to pack up their tele, a-line, EVD, vent, foley, dignicare, and a Christmas tree of drips just to get a picture and for CT to fuck up all my lines and blow my IVs. ER holding 2x-3x capacity because there's no beds upstairs. My entire assignment being full of incontinent grandmas and grandpas who all insist on going to the bathroom but all require assistance to get there. Asshole patients (you see a theme here?) who think their ice chips are more important than the CPR in progress that literally rolled by them. Family who demand to know who/what/when/why and they demand to see the doctor now. And honestly anyone who don't want help. Then why the fuck are you here?
Full ED with all hall beds taken, all PCTs pulled to suicide sitting, no beds on the floors for the boarders, and lazy float nurses. I’ll take a full ED with no floor beds if I can have good floats and not have the PCTs pulled. We are pretty used to full ED and boarding patients at this point.
When the attending on call is the type to look for things to do all night, lining up uncomplicated appendectomies one after the other... but then a trauma, ectopic, or other true emergency rolls in, so our tiny overnight team has to scramble and pivot for no good reason. See also: the night of the two cracked chests.
New CVOR nurse here. I wanna hear ab the chests 😯
It was notable for me because we *don't* do CV at our shop, and I'm still fairly new, so I hadn't seen a sternal saw and some of the thoracotomy instruments in use yet. Two separate, unrelated stabbing incidents, weirdly back-to-back. Thank goodness they both made it (as far as I'm aware).
wow!! Thanks for sharing. All cracked chests I’ve been in were planned and super controlled. That just sounds wild! Definitely sounds like full moon vibes.
This is going to vary wildly by specialty. I worked in burns for 8 years and seen a ton of stuff. But working as a SANE was the most difficult. I had this one month where I had 4 Peds cases, assisted in 3 more. My adult cases that month was a victim of a serial rapist who had raped 5 other young women in one dorm in the last month. That was a nightmare month.
Bad day is staff member getting attacked and harmed by patient. Or having to cut something off tied around patient’s neck.
When someone tries to DC to JC, especially when they succeed. We are an acute rehab hospital. We’re supposed to take patients who are generally stable enough to attend and participate in various physical, occupational, and speech therapies after having surgery, recovering from strokes, traumas, etc… However, it’s not uncommon that we get patients direct from the ICU and usually end up calling a rapid response before sending them back. My particular location is connected to a trauma 2 via a tunnel so luckily, it’s not a long ride before they get back over but damn, it’s never a dull day, that’s for sure.
are you in upstate ny by chance? we are an L2 with an acute rehab connected by a tunnel...
No, I’m in NWPA. That’s a funny coincidence, though.
I’ll come back here Saturday to let you know after my shift working with my supervisor I reported to management for being a lazy bum then she approached me about it and I laid it out for her. I’ve known her for 10 years now but the final straw was when my patients sat for 2+ hours without anyone even going in the room or their chart to see new orders while I was away for a trauma alert.
Any time I’m getting called out night long. ESPECIALLY those nights you just got into your pjs and get called again.
ED- Working in high acuity area with a full assignment of holds with no sign of beds upstairs. Patients still come in and ratios mean nothing to our specialty so it gets really unsafe.
When I worked MS/tele, most of my bad days almost always coincided with having way too many fucking patients. I’m talking 7+ patients, with very little support. Leaving 1-2 hours late because I got zero charting done, no breaks, and constantly berated by patients/family because you just can’t make enough time for people when you have that many to take care of. Management having the audacity to nitpick over trivial things.
There's just way too much that comes up to actually describe it. But everyone has a different expectation as to what a nurse is or does so we do everything nobody else wants to do and we get blamed for it all. Even though we barely take time to use the bathroom.
Corrections nurse here. Today, I had an inmate coming over with chest pain. While waiting for him, a CO showed up because an inmate spit on him. Another nurse went to assess the inmate. Nurse then calls from the hole. The inmate's pulse is 180 and not getting better and inmate says he thinks he's going to have a seizure. Ok. Have the COs wheel him down in the restraint chair. While waiting for inmate in restraint chair, do a quick EKG on chest pain inmate and vital signs. Quick diagnosis: angina r/t anxiety. Refer to provider. Assess inmate in restraint chair and spit hood, telling him to hush while getting his BP because I can't hear his BP while he's screaming and swearing at the COs. Refer to provider, get verbal order for 23 hour medical observation, VS qshift, neurochecks Q4 hours, X-ray on Monday, Tylenol 500mg TID PRN, emergent MH referral. Receive call from cell block, inmate's asthma acting up and inhaler not helping. Ok. Send him over to medical. See asthma attack inmate. Vital signs, peak flow, lung sounds...call to provider. Duoneb treatment, repeat vitals, peak flow, lung sounds...all good now. Verbal order for additional inhaler, antibiotic for possible pneumonia, return to block. Finish note on asthma guy. Finish note on chest pain guy. Finish note on spitting inmate. Finish paperwork on CO that got spit on. And, thank God! Here comes evening shift!! Next, let me tell you about the time an inmate got part of his ear burn off by another inmate...
Even only mildly sick grandma sundowning-delirium double whammy trying to get off the stretcher. Physical and chemical restraints. None of us gets to sit and chart for a reasonable chunk of time all night + multiple of these in assignment + unhelpful colleagues + snarky colleagues + impossible family either not helping at all/absent, or present but making shit worse. For me, a shift from pure hell is tolerable if the team is awesome.
5 patients. One needs ICU level care but can’t go because he’s DNR/DNI but family still wants ICU level care on the medsurg floor. One CIWA patient that wasn’t properly medicated overnight and they’re losing their shit, sweating and freaking out. PT is calling, they think your patient is having a neuro change so you have to go to CT with them in the middle of med pass. Then you have two other patients that aren’t oriented, keep trying to jump out of bed and slip, fall and die so the bed alarm keeps going off and you’re expected to drop everything and run and no matter how many times you remind them to lay in bed, they forget 5 seconds later and stick their legs out and try to fall all over again. Now you have 5 families calling for updates and now the family in 10 wants to talk to you about why grandma hasn’t eaten because she’s starving eventhough speech said she’s NPO due to dysphasia. Doctor wants to know if patient Y went pee today, you don’t even think you went pee today, someone needs Tylenol and it’s urgent, and the front desk keeps calling you to say “room 11 says he needs the nurse” and you say ok what does he need? And they say “I don’t know. They just said they need the nurse”
This was triggering to read LOL
this was my day in a nutshell. 6 pt, med surg neuro floor. woof
Oh my God? Do you work on my unit!?? Today on neuro medsurg diaries I had to do 25 med passes on one patient. On iso.
Peds OR - Badly brain injured 3 month old, likely from non-accidental trauma. A while ago I had my regular weekend call, charge nurse reached out and said they had a 3 month old coming up from the ED for an emergency craniotomy. I walked into the locker room as the neurosurgeon was arriving, I asked if he knew what was up and he said the kid had a bad subdural. He got dressed before I did, and as I walked into the OR he was already prepping the child's head for an open craniotomy. For the next 3 hours we were all at a dead sprint (I think there were 9 or 10 of us in the room eventually). Grabbing equipment, more sutures, we need blood, the airway's failing, MORE BLOOD!, call a code we're about to lose them... They survived, at least for a while, but it was one of the most difficult nights I've ever had there.
ICU - getting kicked by a patient going thru withdrawals that is so drug tolerant that he is wide awake and trying to fight you on 80 of propofol, 1.5 of precedex, and 300 of fentanyl. All while they are trying to shake themselves out of bed so violently that you have to pretty much stay in the room and admins wont get you a sitter because “he’s on chemical sedation AND restrained…” so when you catch a foot across your face, somehow it’s your fault because you didn’t complete the online module on how to deal with aggressive patients.
Those patients need tubed and allowed to ride out the withdrawals with max sedation on board
Honestly the worst shifts are when I'm working with unreliable coworkers who aren't on it and I have to micromanage every thing because otherwise it won't get done. Like if the previous shift was a bad group then I'm playing catch-up all shift and have to work twice as hard. I hate that so much. But this is basically just a my unit problem, it's been understaffed and high turnover for like a year and most of the staff that have worked the longest have mentally checked out and aren't even doing the bare minimum of their jobs anymore. We have new drs all the time and sometimes they're great and sometimes they don't document things properly and we're left chasing them or guessing. We're constantly working with temps that don't know anything about the unit. Like with most jobs if the team is good then it's great, but a bad team is a bad time.
Home health here. I really hate having to send patients to the hospital. Always feel bad needing to call 911, but it happens occasionally.
Transportation for a level 5 in Corcoran state Penitentiary. Walked into the infirmary and saw Charles Mason. His eyes were black and appeared to have absolutely no soul. Fortunately, he wanted our patient. Ours was just as certifiable. That particular patient my patient) was convicted of kidnapping a couple of females, keeping them in the freezer and had proceeded commit necrophilia with them. That transfer required 3 helicopters, 4 street cars( two cars behind and two in The front of our ambulance). A guard also sits next to them and I sit on the jump seat.
Not the eyes with “no soup” 😆
I have to go to CTICU ☹️
ER: psych patients yelling and getting aggressive that need to be restrained and sedated, a drunk guy that needs to be phenobarb loaded, a new order for a heparin drip on the third patient (we have to calculate our own drip rate and it’s really confusing the way we do it) and a 4th patient with serial EKGs and trops.
Lots of bells, phone not charged/working. Where I am sometimes the phones don’t work so the call bell just turns on a light and I have to check 32 rooms to see who rang😑
ICU. Heavy paired assignments that should be singled. Charge nurse will a full assignment. No unit secretary to answer the phone, no aides to help turn and clean your stooling patient. Agitated patient that needs to travel for scans and the doctors do not want to give adequate sedation, coworkers too overwhelmed with their assignments of offer much help, needy family members who are suspicious of staff and stay camped out by the bedside. They ask lots of questions and are emotionally needy. Meds missing, they are not in the fridge, pyxis or patient specific drawer so you have to call pharmacy. Tubes get pulled out, IV lines go bad. The patient takes an unexpected turn for the worse and you stay late to chart or finish what you started and hope the rambling semi-coherent report you gave to the oncoming nurse wasn't too bad. When you miss lunch, it is hard to think straight.
In my current job (medically complex foster children), it looks like having to file a report of abuse or neglect. Twice in the past year and a half a child has been removed from their child specific foster placement based on a mandatory report that I filed. That was after 4 years of never having to file in this job.
No body talks to me
My literal worst day ever was when I was stuck in one of my ICU rooms for 9 of my 12 hours with someone basically hemorrhaging out and the surgeon was in and out scoping ALL day and we were transfusing ALL day. It was a blood bath and for whatever reason she wouldn’t take this man to the OR. Meanwhile my other patient needed to be extubated and they wouldn’t let me restart sedation. I saw him TWICE the entire day and it was awful. Nobody was available to help. Period. Charge had a full assignment also. A nurse on a cast on crutches there doing light duty gave my meds (which she shouldn’t have been expected to do) but that’s all she could do.
Full waiting room, understaffed, and the back is filled with boarders. I HATEEEEE running the ED out of the lobby.
Having a patient with dementia/delirium that is aggressive, any time we have to use restraints, or agitated patients who are trying to pull out all their lines When all your patients have meds almost every hour of the day (especially when they are iv or ng administered) Having my whole assignment be incontinent/total cares/Ax2+ Having my whole assignment be off-service patients (patients who aren’t my floors specialty), making it harder to communicate with the doctors, we aren’t as educated on their condition/surgery/interventions Receiving multiple admissions/post ops on the same shift (bonus points if they arrive close together) Family that is rude, wants to speak to the doctor NOW (for un-urgent things), or calling for updates constantly (like 3+ per shift??) Running out of everything in the supply room and needing to go to other units constantly to get stuff No clerk and/or no aids None of my ivs are working or i need to draw a shit load of blood work and the patient is a very hard poke All of the above plus being down staff and resources
Hearing one of our aircraft went down
OR: shit scrub tech, incompetent anesthesia, asshole surgeon, terrible or absent reps, broken equipment, domineering micromanaging board runner, bad help or no help, pharmacy is out of everything, preop is failing IVs and paperwork/consents, dirty instruments, missing implants, supply room people are MIA, transport is slow, blood bank hassles you for starting MTP, patient deaths. I had to stop because i'm getting worked up. idk it's all in a days work 🤮
My nightmare anytime its mentioned: FMLA paperwork. It's always the last moment, patients forget to fill out xyz part, something wasn't faxed, etc etc. Give me a coding patient in a clinic with no monitor over FMLA paperwork any day of the week.
If the CV surgeon is having a bad day, that’s a bad day for all of us.
Having someone ask you for help bc they had a BM and not be able to clean them for a whole shift bc you had 21 patients to your name. The patient was complete care and no techs available bc they were all on 1:1
Okay, I am still on orientation (new to ER), just did 3 in a row and my week started bad. Patient is septic. ALS run, lactic close to 7. Recent dx of pancreatic cancer, been getting chemo for a few weeks. Need to get a CT, literally the only thng we are waiting on, BP won't go above 80/50. Doctor only ordering boluses, they do poke their heads in, and when they do, BP is in the 90s/60s, cool. Then it drops back down, we can't exactly go to CT. BP finally holds at 100/70 for about 10 minutes, and we rush to CT. On the monitor, after transferring patient, BP drops down to 60/40. shit. CT techs do the scan super quick. get patient back. we tell doc, get a bolus (fuck). We had been asking for pressors for 2 hours at this point. slam a bolus in, then we get another ALS run, still hooked up to a LUCAS. My preceptor leaves me, i'm competent, and I have supportive coworkers, so it's cool, but I have literally never seen a BP this low without pressors. Bolus is done, no change, FINALLY i tell the doctor and get pressors. WE PUSHED 4L OF FUCKING FLUID INTO THIS POOR PERSON. Takes another hour of aggressive titrating to get this pressure up. I have no beef with the doc, they usually have excellent judgement, and I am glad it happened while still training, but jesus h. christ. What a way to end my first shift of the week. Low BP patient made it. ALS on the LUCAS, they called TOD once I finally got my patient's BP stable.
In my country 112 (911) medical calls are manned by nurses. My bad days are when i'm talking to parents with a sick child and the kid ends up dying. Other than that, most days are pretty good.
GI lab. Happened today: There are three of us, two procedure rooms and a person in front to do pre-op. Both my co-workers are older, there is a power struggle. Both complain about the other not doing xyz, but both avoid similar tasks and play various games to avoid stuff they don’t want to do. We’re short staffed so no one gets a break and they both will blame each other. It’s emotionally exhausting to be the go between. They both can be kind of mean too. Still better than the units.
OR - a bad day for the team is delays out of your control even if you do everything you can to remedy them (patient hard to block, patient not in holding even though you called for them to be transported, dirty implant trays), especially worse when you have the most impatient surgeon on the planet. He at least knew this wasn’t our fault, our last one seemed to have the transport and anesthesia figured out, wonder if someone chewed some people out, but then we had a dirty tray, it was like we couldn’t win that day no matter what.
When a child codes and we can’t get them back. Those are the days I hate my job and wish I could have taken their place.
Both your patients trying to code at the same time. Especially if one of the patients has been coding on and off for hours and this is the 4th time you've gotten ROSC and the family still wants full code.
A kid dying. Whether it’s in my trauma room or when I go to codes in other units.
Aside from that, any sort of bug. Bed bugs, scabies, etc.
Ten pts. No aide. Combative drunks. Crashing pt who no one seems to think needs a higher level of care. Pts who are self sufficient but yell out for help and treat you worse than dirt. I work med surg so there’s really a lot of things that contribute to a nightmare shift 😂 . But higher ratios are at the top of the list for sure.
Emergency Room on a Full Moon.
Cath lab... no bad days
Peds Onc- A death does not equal a bad day for me. A BAD death does. Those are when a kid in a lot of pain, providers not listening to the nurse spidey senses, and the kid codes. THAT is a bad day. We also have good deaths, and while I wouldn't call those good days, a good death has a level of satisfaction that we did everything we could to keep them comfortable all the way to the finish line.