Just a few things that I had to help deal with or deal with directly last night:

• Bed 4’s heart rate was >130, blood pressure about 70, and feet were ice cold and pulseless.
• I ran to the lab to deliver some blood draws for another nurse and proceeded to have to deal with those lab draws for 3 hours after dropping them off. Specifically, they weren’t logged in correctly, and every time I tried to set it straight, I had to deal with a different person, had to recount the entire tale all over again, and ended up with the same result: confusion and passing off of the situation to someone else.
• Beds 3 and 4 did not receive their TPN (Total Parenteral Nutrition – basically, dinner in an IV bag) until 6pm (it needed to have been hung at 5pm) and one patient ran out (not a good thing). This actually almost never happens, and I did not appreciate having to deal with it.
• Bed 7 was okay until they started having respiratory distress and a blood pressure of 59.
• Beds 8 and 9 were new admits of the day. Unfortunately, the part of the computer software that sends registration information to the part of the computer system that we use to enter orders, obtain lab results, chart meds, enter admission information, and pretty much just do everything, wasn’t working. So for those patients, we had to resort to paper. Lab slips for ordering labs, paper for receiving results, central supply slips for ordering supplies, Medication Administration Records for charting meds, IV records for charting IV’s hung, and last but certainly not least, physician order sheets. It was a mixture between amusement and horror that we had to tell every single doctor consulting on those two beds (and there were plenty) that they would have to write out all of their orders on paper. The fun part will be when the system is working again – every single order, lab test, result, equipment/supply charge, med and IV given will have to be retroactively charted. Dear God, please don’t let me have to be there when that happens.
• Bed 12 was a transfer from another floor and had emergent major surgery, having to come back intubated on a ventilator and needing vasopressors. She has had a long standing history of everything, and even anesthesia had trouble getting a stupid IV line in her. That apparently didn’t prevent them from sending her back to us (intubated and on pressors, I remind you) without a central line. That left us with 2 lines with which to infuse Dopamine, a mainline, a PCA line, antibiotics, and sedation, none of which can go together except the mainline and one other of the above, not including sedation, and requiring the PCA and the mainline to infuse together. Add in that she had typical post-op hypotension exacerbated by the morphine we tried to give her for extreme pain, and it was all that much worse. Also add in that because of her low BP, we were unable to provide enough sedation to knock her out sufficiently so that she wasn’t so freakin’ awake, and you have a patient who is miserable. Oh, you can also add in that her nurse had been gone for about a month and is sorta inexperienced. Oh yeah, and she was in contact isolation. (That would be the cherry on the sundae, for those of you who don’t work on hospital floors.)
• We were short staffed on night shift. This actually somewhat resolved itself (well, someone else resolved it) but I had to worry about it until then. And even then, it didn’t resolve itself all the way, but we had to do the best we could.
• Sometimes they test the power. The back-up generators come on, there’s a small flickering of lights, no big deal. Last night, they were doing something different, and 2 times the power went off. But it was different – the monitor screens went blank and the vents, although capable of battery backup, would stay on but alarm a zillion different alarms to tell you that they were on battery now, and the unit’s emergency lights went on, and yes the whole thing only lasted about 4 seconds, but those were the longest 8 total seconds of my life, quite possibly.

Fun, fun, fun all around.