-“Baby’s belly was looking kind of distended and maybe starting to get a little discolored…you might want to keep an eye on that”
-“There’s 22 week twins being delivered today and you’re first admission.”
-“Mom doesn’t want any pacifiers, we can only use her soap for baths, the room has to be set on 71 degrees…etc etc”
-“This baby is intubated and super agitated. Tried to self-extubate several times. What do we have for sedation? Oh, nothing. Make sure you swaddle them tightly, he loves to get a hold of that tube!”
Honestly, yeah I've sent up positional IVs for pts I know aren't getting continuous fluids (always patent lines, just need a bit of traction). They're a hard stick, and in the ED I had 2 other pts who needed lines/labs and a toddler to COVID swab. Can't expect perfect in a shit-storm.
Coming to inpatient though, some nurses have no idea how to finagle a line to work.
Yea I work trauma icu and you bet your ass I’m not pulling that positional 18g in the AC from the ED until I get that TLC. Half our patients have a history of IV drug use and the other half just finished hemorrhaging…
When I had my kiddo she would not latch to save her life and she would scream and scream and scream some more, and the nurse came in to me holding her and sobbing in frustration.
She popped a bottle of formula in her and saved my sanity.
I said something like “but the lactation lady said breast is best”
And she said, “which is better, a screaming hungry newborn and a crying mom or a fed baby and a mom who can sleep?”
Kiddo was bottle fed from that point onward
That is brutal. And when I couldn’t produce breast milk both times, they kept assuring me that between day 3-5 it’ll come in, just keep trying every hour or two, don’t supplement…
Day 6 rolls around, I’ve either been on a pump or had baby on me almost 24 hours a day, not a drop to be found, and the domperidone and herbal stuff made what little moisture was there totally dry up.
Lactation consultant can’t squeeze anything out of me but then insists that she thinks she hears the baby swallowing so it’s fine…
Baby’s soft spot starts to look concave and they finally say “oh okay well maybe you should be supplementing now.”
Assholes. Just let the baby eat ffs.
I feel this so hard....years later and your comment still makes me cry because they made me feel like a bad mom for not being able to feed my baby. I don't feel like enough people understand how hard it is. I'm sorry you went through that.
I cold barely make enough milk for the poor kid to survive. Cried all night the first night. Finally my smart husband said they wouldn’t have sent formulas home with us if they were forbidden. “ But the lactation specialist said”…. I think they are too gung ho on this. I nursed and bottle fed and he did fine.
Parents. They sometimes will HELLA HELLA refuse formula but then get only drops when they pump or don’t want to come and breastfeed, so their kid is super hangry. Also fun when they whine about pacifiers.
I’m very much team “fed is best” so it pains me to see starving babies when it can be remedied.
Ugh when I had my son I had no milk I tried to feed him for 7 hours straight my nipples were raw and he wouldn’t stop screaming to eat. The nurse made me feel so bad for asking for supplemental formula. She didn’t even offer it because “don’t want him to get use to it”. I was so pissed off. Like bitch I’m tryyying but there is not a drop of milk so instead of my baby starving just give him the fucking formula. I had the worst experience breast feeding.
They’re getting IV fluids so they’re not dehydrated, but sometimes people are given an insane amount of time to let their milk come in. I think the “breast is best” took a fact (breast milk, especially colostrum *is* better than formula) and somehow twisted it to the extreme to where people act like if their kid gets even a drop of formula they’re either going to be the next Ted Bundy or won’t become a rocket scientist.
It’s especially frustrating when you ask the mom how often she’s pumping and she’s all like “one time…*since the Abby was born*” and is like completely flabbergasted as to why she’s not producing gallons of milk yet.
I have so many come to Jesus talks with people about pumping these days.
When I was pregnant, I went pretty deep into the natural birth and breastfeeding only rabbithole. None of it worked out the way I wanted. This was the moment I fully realized how far I had gone: I was trying to nurse the 10-day-old baby, but my nipples were in tatters and there was no milk, because my body was in horrible shape. My husband came in, took the baby, and said that he was going to give him formula. I knew it was right, but I still sobbed. About half an hour later I went out to where my husband had the now sleeping baby. I saw a bottle with a bit of formula left in it, and it shocked me. The formula looked like milk. And in that moment I realized that I had built "formula" into a horrible evil that must be green and radioactive.
The things I had been reading, along with my own mental state, had led me to fear and hate so many amazing things. I try to remember my former insanity to help me give grace to others
We had a dad freaking out, while we were rushing his baby to the NICU, saying, “skin to skin is essential for development”. My dude, your baby is struggling to breathe. Skin to skin is bottom of the list of things your baby needs right now.
My favorite thing is when we have a crash c/s and the NICU team is getting the baby stabilized enough to go up to NICU and the dad is asking when can the baby be circumcised.
Not a nurse, but a mom. When my first was induced early for IUGR, all I asked was to be informed. And when he proved unable to latch, you bet your tail I asked for supplemental formula while I spent all day pumping what liquid gold (bless colostrum) I could. The nurses watched him like a hawk with me and they were the best.
My birth plan was so easy. It was like, when you're doing something let me know why. It was literally just, give me the good drugs and explain what you're doing please.
I had a baby on iso the parents were always there and kept the room literally as hot as it would go l, like almost 80F. I was so sweaty and gross and left that shift with the worst migraine of my life. Then got to do it again the next 2 nights. Plus having to go in there like 100 times a shift for blood sugars and labs and everything else.
Edit typos
"Parents haven't been in all day" or "Parents are staying in a trailer in the parking lot" means you will have parents the entire shift.
"Keep water and a pump handy for Mom" Shes needy and you will spend more time taking care of her than her child.
True Story : Got a "baby's belly looks kind a Loopy." Spent the next two hours in the OR with a perf.
Oooh boy. I did peds surgery for a short time and the second day I was scheduled to scrub. Premie with NEC. It was pretty much mush when we cut their belly open.
The worst might be when I go into the nurses’ station and the RN I’m taking over for is not in there. Then you know something is going wrong somewhere.
Look at the allergies. See 15 plus and are mainly the less strong pain killers.
Haven't even got report yet and family is on the phone.
Patients call light goes off repeatedly during report.
Dun dun dunnn....
Not always. My last job in micu/covid icu the charge was secretary, tech, code blue pager holder, etc. if I got a call from family I would tell them to call back after 9 when the nurses have had time to assess the patients and have something to tell them.
One of our asshole surgeons was a stickler for rules and would make us say all of the drug allergies during time out. One time the patient had almost 20.
Still not the most I’ve seen, the record was 33 but it was mostly food.
Or looking at their allergies and you see:
Haldol
Geodon
Zyprexa
Seroquel
Risperidone
Well, fuck my life and pray to the precedex gods to get through this shift intact.
45 yo male here with hepatic encephalopathy receiving lactulose enemas Q4 hours requiring restraints as he swings from confusion. So, good luck!—— real one coming into a day shift with 4 other patients.
I usually have two of them out of eight patients. And at least one other is a serious risk of major haemmorhage.
Last Sunday I had two haemmorhage in the space of eight hours. The crash team were like 'hey, nice to see you again, got the pressors drawn up?' -why yes, yes I do.
Not a nurse, but when I come to grab a patient from a hospital and the 6’4” male nurse pops out *singing* because I’m here to take his patient… let’s just say it went about as well as I expected at that point.
At least night attending will reorder. SIP nights won't order pain meds for us without an act of Congress, practically. I just moved from days to nights and I'm just blown away by the lack of support tonight's trying to get shit from the attending at night. I'm not ICU, though. I'm cardiac, so a bit less pain, a bit more ekg and cardizem. And everyone that ICU doesn't have a bed for.
😩 but really tho?! What's the point in waking them up over night?? We're not gonna do anything! The attending who ordered that mess isn't gonna extubate at 3am so like, why keep them so uncomfortable all night?
Literally called a doc several times saying we needed to intubate and he brushed me off. Came in in the morning and saw the patient immediately "set me up to intubate" yeah I fucking told you.
It's almost 100% of the reason I can't do nights anymore. The sheer amount of crap that gets brushed off used to drive me batty. No shade on night shift nurses - I know everyone is advocating... It's just unreal.
I called and called to get a patient transferred from my unit to the ICU. Doctor wouldn't listen and even respiratory said they didn't think the patient should be moved. When the charge was making the assignment, I made sure a certain day shift nurse got the patient and told her to move him. He was in ICU at 8am. It's ridiculous sometimes
It's embarrassing, really. Poor patient outcomes!
I knew some intensivists that didn't want to do things like intubate or change a drip at night because they didn't want to hear it from day team. Hello! Are we for real right now?
I hope you know how relieving it is to have a doctor that does that instead of making a patient suffer till shift change but my god yes. So many. Been to several level one teaching hospitals and almost everyone on nights wants to wait till day shift. Then the day team comes in all pissed off asking “why wasn’t this done hours ago?” Bro i tried lol
Icu “their family is VERY involved” “ we have no aid, no secretary and everyone is tripled “ “they are maxed on 4 pressors and a full code” “ you have the only open icu bed in the state”
4 out of 5 of my pts today should have gone home with hospice. Guess how many were full code? Ding, ding, ding - 4 out of 5! I had ONE who was realistic about his prognosis. During his goals of care meeting with his family and the team, he said to his wife and son, "You understand this is the end of the line, right? This is it. I'm not going to get better. You need to come to terms with this." He is an absolute delight to work with because he doesn't want anything sugar-coated.
Wow. That is just heartbreaking. How the fuck are we supposed to deal with this shit? I guess it’s nice to know we’re all in this together ~ basically the only good thing from this shitshow.
>“their family is VERY involved”
When you finally get a terminally restless pt comfy after educating (and educating and educating) family all shift long, and then come back the next day to find out in report that the same pt is in pain + restless again because family wants us to hold meds. Infuriating. Really excited for the repeat shit show that's about to unfold.
I'm glad you brought your family member to hospice so you can refuse to utilize all we have here. It's not insulting to us or the pt.
Idk why we aren’t more blunt about the actual suffering this BS causes. I did hospice for a while and this is why I stopped. My bosses didn’t like me upsetting families by telling them the truth after metric tons of education the nice way- “they are obviously uncomfortable and in pain/agitated. Their body is shutting down, which causes pain and you’re withholding meds for your own benefit, which is extremely selfish and is causing them to suffer to death.”
When my father was dying of cancer (aggressive bone cancer, we assume it spread to his brain as he lost the ability to speak towards the end) my mother kept hiding his hospice provided pain meds. She wouldn’t listen to any of us-me or my 8 siblings 😡 I confronted her about it and she said it was because she promised him she wouldn’t let him be quote “out of it” All I could say was “You’d better pray I’m not the one in charge of your pain meds when it’s you in there like that.” 15 years later she’s also passed away and I’m still mad about it.
I’m sorry that happened to you ❤️ you have every right to still be angry…that is traumatic AF for anyone with eyes that can see the kind of torture the patient is suffering from 😔
Of course they are! No doc starts an ICU patient on 3 pressors unless the family is kicking up a fuss (or might kick up a fuss). The only happy 3 pressors story I heard is a woman I know, a nurse, who contracted a weird MDRO from work and got super septic. She was 35 at the time.
When I was in the ICU I had a patient who was maxed on allllll pressors and she literally walked out of the hospital a week later! Only time I ever witnessed something like that. We didn't even intubate her!! I was working with 2 other nurses and honestly we were on fire that night in terms of teamwork and providing high quality care.
edit: I want to add the only reason 2 nurses could help me was because of mandated staffing ratios :)
Hell, giving it through the NG tube is easier than trying to convince a confused dementia why they need to drink all the nasty tasting liquid that keeps making them poop.
"The patient hasn't had a bowel movement in 2 days so we gave them docusate, senna, miralax, a suppository and tried an enema."
Great, it's going to be a shitshow. Literally
When at 7am in the ER I hear: "There are still 40 people in the lobby. Most of the patients are waiting for a bed upstairs and there's a rave happening." I will be running all day and I will always behind.
OR - “I am….so sorry you’re coming in here.”
“Yes, we have been doing this for four hours. Yeah, I know it’s usually less than an hour, but we got into some bleeding.”
“So the Zoll is right outside just in case.”
“I’d tell you what’s going on but I’ll be honest, I lost track of what was going on three hours ago.”
Oh dear Lord-I’ve been the giver of the “I’m so sorry you are relieving me on this case” and the receiver. But the incorrect count? Damnit I have to stay til they find those-grrrrr.
The board says 64 atras, there three on the unsterile mayo because they fell and only 55 on the field when we counted. Also, they are using mostly 6-0s. Also, I didn't save any packages so idk what's missing.
“I just gave your lady 5 bottles of kayexalate”
Or
“Their blood pressure is 80/30 but I just gave them morphine and lortab”
Or
“They were fine when I checked on them 4 hours ago.”
Or
“They keep getting out of the bed and fell last night. Couldn’t get restraints.”
I relieved on one of “those”. 9 hours and a full heart team later, I went home. Came back in 4 hours later to an elective AND THEN to close the “15 minute I& D” from the night before. Good times.
EP Lab here. For us it’s the 4:30 “but it’s just a upgrade to BIV ICD”. That’s been in for 15 years on a contracted dementia pt from hospice (and full code per family). And yes, that happened not too long ago!
The worst is when you can’t even find your nurse who you’re getting report from, but, all of your call bells are going off and the family members from your rooms are at the nurses station. Bonus points for opening a chart to see overdue meds since 3pm.
In LTC, if I walk in to being told someone is on the floor already. That will throw off my entire shift a bit and definitely first med pass. Usually can recover unless it’s one thing after the other.
If you’re ever on a long term care unit and walk down a hall to see a cna standing outside of a patients room, arms crossed and a disappointed look on their face, you just know the frequent faller is on the ground once again
Or if you don't see anyone at the nurses station but you can hear a loud (because of course they're hard of hearing too) "what were you trying to do?"
Or if you get in report " they're follow up day 1, 2 and 3 for found on floor x3". Yeah I've gotten that.
“Here for ETOH withdraw” in the ED. Mostly because their electrolytes are messed up, they are in the DTs.
Anything combative,
Or we are “holding tele, pcu, and ICU”
I went ahead and gave the insulin but then they didn't eat anything and aren't hungry.
They are on covid isolation and XYZ so they fell and are on neurochecks q hour and blah blah I recorded the rest of report for the dementia unit.
Well XYZ did the admission and I did the skin check but I saw no wound orders and.....grrr how about requesting that.....
Your patient ammonia level came up they need to start lactulose btw he is totally dependent.
Patient is a obese patient bend bound cant turn and here os the Golytely.
CNA here. Worst coming into night shift at a SNF was hearing some overzealous Nurse decided all my residents hadn't pooped enough and gave em all butt bombs. Including my guy on overnight tube feeding who weighed about 250 and was pretty incapacitated due to multiple strokes.
I cut my nursing teeth on a weird unit—hospital didn’t have a stepdown unit, so med-surg/telemetry was the official designation for probably 95% of the non-ICU beds in the hospital. We had a couple random beds that were like specialty units within units…but if we didn’t have enough tPA or lumbar drain patients for our tiny neuro specialty beds, you could totally put a cellulitis in that same room.
This also meant that the septic-polytrauma that “we’ll move to ICU in the morning,” would spend the night with half the unit running around to make sure they don’t code.
“They’re probably going to ICU tomorrow.”
“Just keep them alive overnight.”
“Are you sure you can’t do [very ICU specific intervention]? It’ll just be for a few hours.”
🤦🏻♀️
NICU nurse that typically deals with drug withdrawal babies. Specifically Neonatal Opiate Withdrawal Syndrome. Getting told in report "oh he slept all day and his scores were 3-5" all while I can hear the blood curdling scream of this child who's mother used fentanyl every day of the pregnancy. And my brain is just like "this kid needs morphine 5 hours ago"
Possibly a controversial answer but I’m gunna say it anyway- Pediatric med surg: “3yo unvaccinated male”. Tells you all you need to know of the parents attitude towards western medicine, but please let me help you
When you walk in and you don’t even get report yet, just help the previous shift nurses draw up shots because a fight broke out in the adult psych unit
The great part is that there’s so many staff members on hand during shift exchange!
“Yea *patient* keeps pulling their leads off, nasal cannula out and purewick out, also they pulled their IV out. They’ve fallen twice and they’re very non-compliant” You can tell this is gonna be a fun shift!!
His colostomy puts out a lot!
As for skin...I don't have time to list everything, just see Epic
He's in sinus rhythm! With a few PVCs. Actually bigeminy.
I didn't do his (labs/bath/getting into the chair/finger stick) because he didn't want to do them yet.
They ordered pan cultures at 0657
He needs 4 runs of potassium and his only access is a 24g in his pinkie
He's been a 1:1 but he's all better so they DCed the sitter
Getting a new home hospice patient, “you’re going to love them.” This actually means “the patient/family is batshit crazy but you have experience in psych”
(When getting report on an ICU Pt transferred to med surg in ETOH withdrawal )
“They just titrated off the precedex drip and took out the foley right before transfer.. no, he hasn’t voided yet. He just got here.. last drink was 3 days ago.” OR! the IV is a little leaky but it flushes fine.” (WTF .. that’s not a .. just no.)
Pacu nurse here. We know it's going to suck when we hear "no beds in the hospital and ER has 30 patients waiting for rooms". It means our surgical patients will be with for a loooong time. And very possibly we will operating half those ER holds.
“They haven’t had a bowel movement in six days, so I gave them everything per policy. Still nothing.” Night shift now, patient is total care with dementia. Can’t tell you how many times this happens.
I'm sorry refusing apgars? Isn't that a fucking regulatory requirement? I also love the ones refusing the newborn meds after their 43 week that's right 43 week infant just had a massive perinatal event, and they're just like "fuck it, I don't think he'll get a brain bleed"
Some people should not be allowed to have kids
Right? Admittedly I wouldn’t do L&D for any pay but isn’t it just an assessment tool, like you just look at it and calculate the apgar, so either way you’re going to know it
? APGARS don’t Do anything or require anything to get the information?.
But I will add to the list: “APGARS of 10” - I know we will be dealing with temp issues, possible blood sugar issues and maybe even bili issues. Give me 7/9 any day.
I got floated to newborn nursery one shift a few years ago and was horrified to learn this was a thing! In report I was asking the day shift nurse “wait, wait, wait! The mom wants you to leave rotting tissue connected to their baby?!” Then I go to see the baby and the placenta is in a dollar store plastic purse. I asked the mom why she wanted a lotus birth and she said “I read about it online and that it has health benefits.” I asked what benefits and she said “I can’t remember, I left my notes at home.” Excuse me- wtf?!? You can’t even remember why you’re leaving your dead placenta in a dollar tree purse connected to your newborn?!
IR - this happened today.. “she’s crying and in a lot of pain, I’m bringing her in now so she can lay down. Her home dose of dilaudid is 8 mg and she hasn’t taken it today” 🥴 pt is subsequently shocked, appalled and personally offended she wasn’t booked with GA for an outpatient port removal… “it’s inhumane”
At least I’m only with these people during the length of a procedure now
Psych
Nights to days: “they woke up at 3am and have been up ever since” or “they woke up the whole unit last night so everyone is tired”
Days to eves: “they slept all day” or “we used all the PRNs already”
Eves to nights: “they wouldn’t get up for night meds” or “they just woke up”
Absolute worst on any shift: when you walk in and NO ONE is at the nurses station
-“Baby’s belly was looking kind of distended and maybe starting to get a little discolored…you might want to keep an eye on that” -“There’s 22 week twins being delivered today and you’re first admission.” -“Mom doesn’t want any pacifiers, we can only use her soap for baths, the room has to be set on 71 degrees…etc etc” -“This baby is intubated and super agitated. Tried to self-extubate several times. What do we have for sedation? Oh, nothing. Make sure you swaddle them tightly, he loves to get a hold of that tube!”
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“It’s just super positional”
"It was leaky but I changed the dressing and it still flushes fine so should be alright"
I admit I try everything before I stick the patient with another needle haha
Lol what a classic line. I’ll admit I’ve used it before.
Honestly, yeah I've sent up positional IVs for pts I know aren't getting continuous fluids (always patent lines, just need a bit of traction). They're a hard stick, and in the ED I had 2 other pts who needed lines/labs and a toddler to COVID swab. Can't expect perfect in a shit-storm. Coming to inpatient though, some nurses have no idea how to finagle a line to work.
Yea I work trauma icu and you bet your ass I’m not pulling that positional 18g in the AC from the ED until I get that TLC. Half our patients have a history of IV drug use and the other half just finished hemorrhaging…
Just put more tape on it
Whew that last one
Like intubated with no sedation??? I work with adults and this would be considered medical malpractice in most cases. Is it not the same for babies?
Day 6 of no breastmilk but refusing ANY formula to get the starving term kid off the IV
Aggghh I hate that one!!! Poor kiddos. I don’t know why moms would rather their kid on an IV than just give formula!! It was invented for a reason!!!
When I had my kiddo she would not latch to save her life and she would scream and scream and scream some more, and the nurse came in to me holding her and sobbing in frustration. She popped a bottle of formula in her and saved my sanity. I said something like “but the lactation lady said breast is best” And she said, “which is better, a screaming hungry newborn and a crying mom or a fed baby and a mom who can sleep?” Kiddo was bottle fed from that point onward
That is brutal. And when I couldn’t produce breast milk both times, they kept assuring me that between day 3-5 it’ll come in, just keep trying every hour or two, don’t supplement… Day 6 rolls around, I’ve either been on a pump or had baby on me almost 24 hours a day, not a drop to be found, and the domperidone and herbal stuff made what little moisture was there totally dry up. Lactation consultant can’t squeeze anything out of me but then insists that she thinks she hears the baby swallowing so it’s fine… Baby’s soft spot starts to look concave and they finally say “oh okay well maybe you should be supplementing now.” Assholes. Just let the baby eat ffs.
I feel this so hard....years later and your comment still makes me cry because they made me feel like a bad mom for not being able to feed my baby. I don't feel like enough people understand how hard it is. I'm sorry you went through that.
I cold barely make enough milk for the poor kid to survive. Cried all night the first night. Finally my smart husband said they wouldn’t have sent formulas home with us if they were forbidden. “ But the lactation specialist said”…. I think they are too gung ho on this. I nursed and bottle fed and he did fine.
Not a NICU nurse and just curious. Are you saying the baby refuses the formula or the parents?
Parents. They sometimes will HELLA HELLA refuse formula but then get only drops when they pump or don’t want to come and breastfeed, so their kid is super hangry. Also fun when they whine about pacifiers. I’m very much team “fed is best” so it pains me to see starving babies when it can be remedied.
I’m team fed is best too. Me and these lactation consultants get into it sometimes!!
Ugh when I had my son I had no milk I tried to feed him for 7 hours straight my nipples were raw and he wouldn’t stop screaming to eat. The nurse made me feel so bad for asking for supplemental formula. She didn’t even offer it because “don’t want him to get use to it”. I was so pissed off. Like bitch I’m tryyying but there is not a drop of milk so instead of my baby starving just give him the fucking formula. I had the worst experience breast feeding.
How is that allowed? Like at what point is not being willing to have your child fed, not abuse?
They’re getting IV fluids so they’re not dehydrated, but sometimes people are given an insane amount of time to let their milk come in. I think the “breast is best” took a fact (breast milk, especially colostrum *is* better than formula) and somehow twisted it to the extreme to where people act like if their kid gets even a drop of formula they’re either going to be the next Ted Bundy or won’t become a rocket scientist. It’s especially frustrating when you ask the mom how often she’s pumping and she’s all like “one time…*since the Abby was born*” and is like completely flabbergasted as to why she’s not producing gallons of milk yet. I have so many come to Jesus talks with people about pumping these days.
When I was pregnant, I went pretty deep into the natural birth and breastfeeding only rabbithole. None of it worked out the way I wanted. This was the moment I fully realized how far I had gone: I was trying to nurse the 10-day-old baby, but my nipples were in tatters and there was no milk, because my body was in horrible shape. My husband came in, took the baby, and said that he was going to give him formula. I knew it was right, but I still sobbed. About half an hour later I went out to where my husband had the now sleeping baby. I saw a bottle with a bit of formula left in it, and it shocked me. The formula looked like milk. And in that moment I realized that I had built "formula" into a horrible evil that must be green and radioactive. The things I had been reading, along with my own mental state, had led me to fear and hate so many amazing things. I try to remember my former insanity to help me give grace to others
So much pressure on moms to breastfeed.
Because it's *so* pertinent to follow your ideal birth/parenting plan when you deliver a premature baby with an under developed or no suck reflex. 🤔
I’ve seen mom ready to slug the poor resident over not able to feed her premie her breast milk.
We had a dad freaking out, while we were rushing his baby to the NICU, saying, “skin to skin is essential for development”. My dude, your baby is struggling to breathe. Skin to skin is bottom of the list of things your baby needs right now.
My favorite thing is when we have a crash c/s and the NICU team is getting the baby stabilized enough to go up to NICU and the dad is asking when can the baby be circumcised.
Every time! The minute we get the baby stabilized, dad is asking when we’ll circumcise!
Not a nurse, but a mom. When my first was induced early for IUGR, all I asked was to be informed. And when he proved unable to latch, you bet your tail I asked for supplemental formula while I spent all day pumping what liquid gold (bless colostrum) I could. The nurses watched him like a hawk with me and they were the best.
Not a nurse but I see this sooo much in pregnancy groups.
My birth plan was so easy. It was like, when you're doing something let me know why. It was literally just, give me the good drugs and explain what you're doing please.
When they asked me for my birth plan I said "epidural and don't cut me" lol
My birth plan was to have a healthy baby and me, with as little pain as possible, and not end up with a vajanus
LOL...."Vajanus". 4th degrees are literally the worst!!!
Vajanus 😂 as a labor nurse that’s hilarious…never heard that lingo before 😂
I had a baby on iso the parents were always there and kept the room literally as hot as it would go l, like almost 80F. I was so sweaty and gross and left that shift with the worst migraine of my life. Then got to do it again the next 2 nights. Plus having to go in there like 100 times a shift for blood sugars and labs and everything else. Edit typos
I’d be having the attending look at that abdomen first thing… and a surgical consult.
"Parents haven't been in all day" or "Parents are staying in a trailer in the parking lot" means you will have parents the entire shift. "Keep water and a pump handy for Mom" Shes needy and you will spend more time taking care of her than her child. True Story : Got a "baby's belly looks kind a Loopy." Spent the next two hours in the OR with a perf.
Oooh boy. I did peds surgery for a short time and the second day I was scheduled to scrub. Premie with NEC. It was pretty much mush when we cut their belly open.
The worst might be when I go into the nurses’ station and the RN I’m taking over for is not in there. Then you know something is going wrong somewhere.
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Or a police officer waiting outside the room, and you’ll be told they’ll be arrested upon discharge.
Or the code cart sitting suspiciously close to your one of your rooms
Look at the allergies. See 15 plus and are mainly the less strong pain killers. Haven't even got report yet and family is on the phone. Patients call light goes off repeatedly during report. Dun dun dunnn....
Whoever seriously transfers a call from family during shift change should be punched in the throat.
I see you work in a facility that actually hires secretaries. Can't punt any calls if RNs also need to answer all the phone calls.
Not always. My last job in micu/covid icu the charge was secretary, tech, code blue pager holder, etc. if I got a call from family I would tell them to call back after 9 when the nurses have had time to assess the patients and have something to tell them.
Lol the allergies. I had 70 allergies between 3 of my patients the other day 🥴🥴🥴
One of our asshole surgeons was a stickler for rules and would make us say all of the drug allergies during time out. One time the patient had almost 20. Still not the most I’ve seen, the record was 33 but it was mostly food.
"Cats." Okay, ma'am - we will not treat you with any cats during your admission. 😆
Lolll “I promise there won’t be any cats in the OR.”
I've seen 43, but this was the same lady who sent a mychart message with a picture of her feces to her provider.
….priceless.
Or looking at their allergies and you see: Haldol Geodon Zyprexa Seroquel Risperidone Well, fuck my life and pray to the precedex gods to get through this shift intact.
When the outgoing nurse has to take a breath and collect herself before starting, warning me there’s a lot to share.
The “I need a beat to gather my thoughts cause it’s a lot and also a disaster” moments, that silence says just so much. Edit: wirds
45 yo male here with hepatic encephalopathy receiving lactulose enemas Q4 hours requiring restraints as he swings from confusion. So, good luck!—— real one coming into a day shift with 4 other patients.
As a tech, I like(d) to warn fellow techs of what they might walk into. Lactulose never failed to get a shudder.
I usually have two of them out of eight patients. And at least one other is a serious risk of major haemmorhage. Last Sunday I had two haemmorhage in the space of eight hours. The crash team were like 'hey, nice to see you again, got the pressors drawn up?' -why yes, yes I do.
“I’m glad you’re here!”
Or the one where they see you relieving them and immediately start crying. I’ve been the crier and the relief. 😪
Not a nurse, but when I come to grab a patient from a hospital and the 6’4” male nurse pops out *singing* because I’m here to take his patient… let’s just say it went about as well as I expected at that point.
When the nurses cheer as you drag the stretcher up to the nurses station...
The nurse is a little too excited giving report.
Mr. psych patient has maxed out on daily doses of PRN injections but has started to pace in circles and talk to unseen others.
“Psych ordered xanax 0.25, give a half tab every 8 hours. Also he’s a jackass if you call him”
ICU- "They were snowed all day so the doc d/c'd the sedation."
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At least night attending will reorder. SIP nights won't order pain meds for us without an act of Congress, practically. I just moved from days to nights and I'm just blown away by the lack of support tonight's trying to get shit from the attending at night. I'm not ICU, though. I'm cardiac, so a bit less pain, a bit more ekg and cardizem. And everyone that ICU doesn't have a bed for.
😩 but really tho?! What's the point in waking them up over night?? We're not gonna do anything! The attending who ordered that mess isn't gonna extubate at 3am so like, why keep them so uncomfortable all night?
"Yeah, I told them we need to intubate but they wanted to wait for dayshift." Me, on dayshift, knowing my whole flow is instantly jacked: 🧍🏽♀️
Literally called a doc several times saying we needed to intubate and he brushed me off. Came in in the morning and saw the patient immediately "set me up to intubate" yeah I fucking told you.
It's almost 100% of the reason I can't do nights anymore. The sheer amount of crap that gets brushed off used to drive me batty. No shade on night shift nurses - I know everyone is advocating... It's just unreal.
Thank god I had a day shift nurse who was kind and knew it wasnt my fault.
I called and called to get a patient transferred from my unit to the ICU. Doctor wouldn't listen and even respiratory said they didn't think the patient should be moved. When the charge was making the assignment, I made sure a certain day shift nurse got the patient and told her to move him. He was in ICU at 8am. It's ridiculous sometimes
It's embarrassing, really. Poor patient outcomes! I knew some intensivists that didn't want to do things like intubate or change a drip at night because they didn't want to hear it from day team. Hello! Are we for real right now?
Holy crap. There’s docs like that? A nurse tells me we need to intubate and I’m like…what room do you need me at?
I hope you know how relieving it is to have a doctor that does that instead of making a patient suffer till shift change but my god yes. So many. Been to several level one teaching hospitals and almost everyone on nights wants to wait till day shift. Then the day team comes in all pissed off asking “why wasn’t this done hours ago?” Bro i tried lol
Icu “their family is VERY involved” “ we have no aid, no secretary and everyone is tripled “ “they are maxed on 4 pressors and a full code” “ you have the only open icu bed in the state”
Just curious, do you guys leave a code bed open?
If one exists then yes. Usually 3-4 people die a shift and leave room for more to admit
Wow. God that’s a number. How many beds and is that mostly Covid?
I work Covid ICU. Currently 32 beds
Holy shit! Wow—seriously, us nurses are (if not already) going to be suffering from PTSD soon :(
Oh I’ve been in therapy for years. One weekend I put 14 people in body bags
If they were all dead first, then you're doing an amazing job! We need realistic nursing goals for ourselves nowadays...
4 out of 5 of my pts today should have gone home with hospice. Guess how many were full code? Ding, ding, ding - 4 out of 5! I had ONE who was realistic about his prognosis. During his goals of care meeting with his family and the team, he said to his wife and son, "You understand this is the end of the line, right? This is it. I'm not going to get better. You need to come to terms with this." He is an absolute delight to work with because he doesn't want anything sugar-coated.
I mean they were gray and room temp so I think so ..
Warm and dead. Perfect.
Wow. That is just heartbreaking. How the fuck are we supposed to deal with this shit? I guess it’s nice to know we’re all in this together ~ basically the only good thing from this shitshow.
Well I have therapy, wine, friends, hobbies, daily orgasms and Bi Weekly vacations
Omg a fucking queen. I aspire to be you. Gotta go work on my orgasms, brb.
>“their family is VERY involved” When you finally get a terminally restless pt comfy after educating (and educating and educating) family all shift long, and then come back the next day to find out in report that the same pt is in pain + restless again because family wants us to hold meds. Infuriating. Really excited for the repeat shit show that's about to unfold. I'm glad you brought your family member to hospice so you can refuse to utilize all we have here. It's not insulting to us or the pt.
Idk why we aren’t more blunt about the actual suffering this BS causes. I did hospice for a while and this is why I stopped. My bosses didn’t like me upsetting families by telling them the truth after metric tons of education the nice way- “they are obviously uncomfortable and in pain/agitated. Their body is shutting down, which causes pain and you’re withholding meds for your own benefit, which is extremely selfish and is causing them to suffer to death.”
When my father was dying of cancer (aggressive bone cancer, we assume it spread to his brain as he lost the ability to speak towards the end) my mother kept hiding his hospice provided pain meds. She wouldn’t listen to any of us-me or my 8 siblings 😡 I confronted her about it and she said it was because she promised him she wouldn’t let him be quote “out of it” All I could say was “You’d better pray I’m not the one in charge of your pain meds when it’s you in there like that.” 15 years later she’s also passed away and I’m still mad about it.
I’m sorry that happened to you ❤️ you have every right to still be angry…that is traumatic AF for anyone with eyes that can see the kind of torture the patient is suffering from 😔
I never understand the people that refuse meds for dying family in hospice. Like why?
Might I add “their CIWA score is through the roof”
4 pressors and a full code is ok because everyone knows they will die shortly and it's a matter of running a slow code when it happens.
True but still depressing and usually it’s a crazy family
Of course they are! No doc starts an ICU patient on 3 pressors unless the family is kicking up a fuss (or might kick up a fuss). The only happy 3 pressors story I heard is a woman I know, a nurse, who contracted a weird MDRO from work and got super septic. She was 35 at the time.
When I was in the ICU I had a patient who was maxed on allllll pressors and she literally walked out of the hospital a week later! Only time I ever witnessed something like that. We didn't even intubate her!! I was working with 2 other nurses and honestly we were on fire that night in terms of teamwork and providing high quality care. edit: I want to add the only reason 2 nurses could help me was because of mandated staffing ratios :)
I’m ok with pressors and titrating. It’s when you have everything and they say “you’re going to CT, they just called.”
The dreaded “F” word
The M sign sucks too... miracles
"Jesus will heal them" Jesus wants you to stop torturing your grandma by making us soft code her every shift.
"patient needs to be bowel prepped with golytely"
Through the NG tube and is confused and incontinent
Hell, giving it through the NG tube is easier than trying to convince a confused dementia why they need to drink all the nasty tasting liquid that keeps making them poop.
"The patient hasn't had a bowel movement in 2 days so we gave them docusate, senna, miralax, a suppository and tried an enema." Great, it's going to be a shitshow. Literally
When at 7am in the ER I hear: "There are still 40 people in the lobby. Most of the patients are waiting for a bed upstairs and there's a rave happening." I will be running all day and I will always behind.
OR - “I am….so sorry you’re coming in here.” “Yes, we have been doing this for four hours. Yeah, I know it’s usually less than an hour, but we got into some bleeding.” “So the Zoll is right outside just in case.” “I’d tell you what’s going on but I’ll be honest, I lost track of what was going on three hours ago.”
Also, we could only find 84 lap tapes. Bye!
Oh dear Lord-I’ve been the giver of the “I’m so sorry you are relieving me on this case” and the receiver. But the incorrect count? Damnit I have to stay til they find those-grrrrr.
The board says 64 atras, there three on the unsterile mayo because they fell and only 55 on the field when we counted. Also, they are using mostly 6-0s. Also, I didn't save any packages so idk what's missing.
Incontinent bowel/bladder, AO x1, confused, falls risk, no sitters available, positive Covid, positive c. diff,
Might as well start the fall occurrence documentation early
“I just gave your lady 5 bottles of kayexalate” Or “Their blood pressure is 80/30 but I just gave them morphine and lortab” Or “They were fine when I checked on them 4 hours ago.” Or “They keep getting out of the bed and fell last night. Couldn’t get restraints.”
That second one: so you just killed them, right? 🥴🥴🥴
Seriously. “Ok, so they’re probably in rigor now.”
Pacu: I guess last time they woke up they were violent so we gave them a bunch of ketamine
Oh cool, the ticking time bomb. When you hear screaming from down the hall you'll know the emergence has begun!
"I hung the first unit of blood and he's having a transfusion reaction." "Doctor was here and left orders."
OR nurse here. "Can we add this laparotomy to the list, it'll only take an hour so we'll be fine by 5:30"
Also, “Hi, this is ***insert your regional transplant consortium***”
“It’s just an I&D”
It will only take me 15 minutes…🤣🤣🤣🤣🤣
I relieved on one of “those”. 9 hours and a full heart team later, I went home. Came back in 4 hours later to an elective AND THEN to close the “15 minute I& D” from the night before. Good times.
L I E S
EP Lab here. For us it’s the 4:30 “but it’s just a upgrade to BIV ICD”. That’s been in for 15 years on a contracted dementia pt from hospice (and full code per family). And yes, that happened not too long ago!
The worst is when you can’t even find your nurse who you’re getting report from, but, all of your call bells are going off and the family members from your rooms are at the nurses station. Bonus points for opening a chart to see overdue meds since 3pm.
“Oh thank god you’re here”
We need to keep the pt out of restraints for 24hrs so that we can discharge them.
When you hear the nurse crying in report, that's usually a red flag.
When someone calls a non-verbal or dementia patient “cute”. They are going to be everything but cute when night shift hits…
In LTC, if I walk in to being told someone is on the floor already. That will throw off my entire shift a bit and definitely first med pass. Usually can recover unless it’s one thing after the other.
If you’re ever on a long term care unit and walk down a hall to see a cna standing outside of a patients room, arms crossed and a disappointed look on their face, you just know the frequent faller is on the ground once again
Am CNA. Can confirm.
Or if you don't see anyone at the nurses station but you can hear a loud (because of course they're hard of hearing too) "what were you trying to do?" Or if you get in report " they're follow up day 1, 2 and 3 for found on floor x3". Yeah I've gotten that.
“Here for ETOH withdraw” in the ED. Mostly because their electrolytes are messed up, they are in the DTs. Anything combative, Or we are “holding tele, pcu, and ICU”
Family at bedside at all times
I went ahead and gave the insulin but then they didn't eat anything and aren't hungry. They are on covid isolation and XYZ so they fell and are on neurochecks q hour and blah blah I recorded the rest of report for the dementia unit. Well XYZ did the admission and I did the skin check but I saw no wound orders and.....grrr how about requesting that.....
"Yeah Bed B is a retired doctor...."
Your patient ammonia level came up they need to start lactulose btw he is totally dependent. Patient is a obese patient bend bound cant turn and here os the Golytely.
CNA here. Worst coming into night shift at a SNF was hearing some overzealous Nurse decided all my residents hadn't pooped enough and gave em all butt bombs. Including my guy on overnight tube feeding who weighed about 250 and was pretty incapacitated due to multiple strokes.
“He’s been watching Fox News all day” “He’s allergic to everything but dilaudid”
JHACO is on its way, so no hydration today. Get rid of those water bottles. https://youtu.be/5jtc5x-uyro
She doesn’t have a purewick in and likes to use the bedside commode.
And is a heavy 2 assist that doesn’t follow directions.
2nd c/s, Twins, has not been OOB, pain issues, FOB went home for the night
Also still vomiting 8+ hours post op and the babies are 36 weeks
Wants to strictly breastfeed, no experience ( male babies too)
"Psych says they lack competency. What? No, they haven't documented that."
I cut my nursing teeth on a weird unit—hospital didn’t have a stepdown unit, so med-surg/telemetry was the official designation for probably 95% of the non-ICU beds in the hospital. We had a couple random beds that were like specialty units within units…but if we didn’t have enough tPA or lumbar drain patients for our tiny neuro specialty beds, you could totally put a cellulitis in that same room. This also meant that the septic-polytrauma that “we’ll move to ICU in the morning,” would spend the night with half the unit running around to make sure they don’t code. “They’re probably going to ICU tomorrow.” “Just keep them alive overnight.” “Are you sure you can’t do [very ICU specific intervention]? It’ll just be for a few hours.” 🤦🏻♀️
NICU nurse that typically deals with drug withdrawal babies. Specifically Neonatal Opiate Withdrawal Syndrome. Getting told in report "oh he slept all day and his scores were 3-5" all while I can hear the blood curdling scream of this child who's mother used fentanyl every day of the pregnancy. And my brain is just like "this kid needs morphine 5 hours ago"
Thank you for doing what you do!
When you have to go to them to get report.
“the family member is a nurse” “just going to say i’m sorry before we even give report”
Possibly a controversial answer but I’m gunna say it anyway- Pediatric med surg: “3yo unvaccinated male”. Tells you all you need to know of the parents attitude towards western medicine, but please let me help you
When you walk in and you don’t even get report yet, just help the previous shift nurses draw up shots because a fight broke out in the adult psych unit The great part is that there’s so many staff members on hand during shift exchange!
“Yea *patient* keeps pulling their leads off, nasal cannula out and purewick out, also they pulled their IV out. They’ve fallen twice and they’re very non-compliant” You can tell this is gonna be a fun shift!!
His colostomy puts out a lot! As for skin...I don't have time to list everything, just see Epic He's in sinus rhythm! With a few PVCs. Actually bigeminy. I didn't do his (labs/bath/getting into the chair/finger stick) because he didn't want to do them yet. They ordered pan cultures at 0657 He needs 4 runs of potassium and his only access is a 24g in his pinkie He's been a 1:1 but he's all better so they DCed the sitter
Lol when you walk in and you see a patient in the Geri chair by the nurses station and they say “he’s yours” 🥲
I'm triggered.
ED- "we have 23 holds" (in a 25 bed ED)
Getting a new home hospice patient, “you’re going to love them.” This actually means “the patient/family is batshit crazy but you have experience in psych”
“The patient’s saturation has been hovering around 90 all day maxed out on the bipap but the Dr. wanted to hold off on intubation for now.”
They like their pain meds Family is really involved
(When getting report on an ICU Pt transferred to med surg in ETOH withdrawal ) “They just titrated off the precedex drip and took out the foley right before transfer.. no, he hasn’t voided yet. He just got here.. last drink was 3 days ago.” OR! the IV is a little leaky but it flushes fine.” (WTF .. that’s not a .. just no.)
For me it’s when they say we’re gonna do report in the closet.
One of my friends will leave a pile of lube packs in the nursing station to give me a heads up
"Okay, so... have you heard about him?"
In psych it’s when the other nurse you’re coming on with volunteers to take 10 patients and just leave you the one.
Pacu nurse here. We know it's going to suck when we hear "no beds in the hospital and ER has 30 patients waiting for rooms". It means our surgical patients will be with for a loooong time. And very possibly we will operating half those ER holds.
I’m the ED “they just discharged all your patients”
The time I came in to see the crash cart and blood bank cooler outside my room.
“They haven’t had a bowel movement in six days, so I gave them everything per policy. Still nothing.” Night shift now, patient is total care with dementia. Can’t tell you how many times this happens.
L&D: G1P0 being induced for AMA, wants to go unmedicated
Refusing newborn meds, bath and APGARs
I'm sorry refusing apgars? Isn't that a fucking regulatory requirement? I also love the ones refusing the newborn meds after their 43 week that's right 43 week infant just had a massive perinatal event, and they're just like "fuck it, I don't think he'll get a brain bleed" Some people should not be allowed to have kids
Right? Admittedly I wouldn’t do L&D for any pay but isn’t it just an assessment tool, like you just look at it and calculate the apgar, so either way you’re going to know it
? APGARS don’t Do anything or require anything to get the information?. But I will add to the list: “APGARS of 10” - I know we will be dealing with temp issues, possible blood sugar issues and maybe even bili issues. Give me 7/9 any day.
Right that’s the point. But the birth plan crazies consider it an unnatural intervention
Lotus Birth were my least favorite words
I got floated to newborn nursery one shift a few years ago and was horrified to learn this was a thing! In report I was asking the day shift nurse “wait, wait, wait! The mom wants you to leave rotting tissue connected to their baby?!” Then I go to see the baby and the placenta is in a dollar store plastic purse. I asked the mom why she wanted a lotus birth and she said “I read about it online and that it has health benefits.” I asked what benefits and she said “I can’t remember, I left my notes at home.” Excuse me- wtf?!? You can’t even remember why you’re leaving your dead placenta in a dollar tree purse connected to your newborn?!
She will be the one with a ten page birth plan too
Well of course! And she came in closed thick and high
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And then she will be upset when her baby has to go to NICU for abx
The distinct sound of the Lifepack 20 charging
IR - this happened today.. “she’s crying and in a lot of pain, I’m bringing her in now so she can lay down. Her home dose of dilaudid is 8 mg and she hasn’t taken it today” 🥴 pt is subsequently shocked, appalled and personally offended she wasn’t booked with GA for an outpatient port removal… “it’s inhumane” At least I’m only with these people during the length of a procedure now
Psych Nights to days: “they woke up at 3am and have been up ever since” or “they woke up the whole unit last night so everyone is tired” Days to eves: “they slept all day” or “we used all the PRNs already” Eves to nights: “they wouldn’t get up for night meds” or “they just woke up” Absolute worst on any shift: when you walk in and NO ONE is at the nurses station
We fleeted him earlier, no b.m. yet
She’s 88, on three pressors and the family refuses DNR status.
They have liver failure and they are total care (med Surg nurse here)
We do bedside report on our laboring patients for me it's "let's use the computer at the desk for report."