I had every hope of getting called out of work on Saturday. I really wish I got the call saying that they didn’t need me to come in… But that isn’t how it’s been working at my hospital lately. Census has been through the roof. When I got into work, things were okay. I had four patients, one of which would be discharged. The discharge was simple, here’s your paper work, there’s the door. And my other three patients I had cared for the night before, and they were pleasant. I had time to provide some solid nursing care.
And then, I got a post-op admission.
This patient was young, and admitted for compartment syndrome. I was intrigued. As unfortunate as it was for the patient, I thought that it’d be so interesting. Needless to say, my interest faded fast.
A little background about our post-op routine. The PACU (post-anesthesia care unit) nurse brings the patient to the floor, together, we assess the patients vitals, any surgical dressings and drains, the patient’s level of consciousness, and any other pertinent information. If the patient is stable enough, a signature here, and a signature there, and the PACU nurse scurries off the floor and the patient becomes my responsibility. For the first hour, vitals are taken every fifteen minutes, then every half hour x4, and hourly x4, and then every four hours. Generally speaking, patients come to the floor very somnolent from their cocktails of fentanyl, hydromorphone, versed, and whatever else. This makes for a very cooperative patient.
Well this patient, came out of anesthesia rather quickly. I couldn’t get the first two sets of vital signs done before the patient was ripping off his gown, jumping up out of bed, and trying to run outside. Hospital policy doesn’t go for that so well. We like to keep our patients on the floors so the can be monitored, which is why they’re in the hospital in the first place. Anyways, there’s a little catch for the patient who just wants fresh air (or a cigarette), they can sign a form saying they’re going out against advice, have their IV taken out, and be on their way. This patient agreed to this.
No sooner do I return with appropriate documentation and supplies, is my patient down the hall, then down the elevator and gone. Perfect.
Security was called, as is protocol for when a patient leaves with an IV. Before the patient was brought back upstairs, he had ripped out his IV and got himself covered in blood (good thing he had decided to wear a white t shirt. Then again, somebody should have told him Halloween had passed). For the rest of the night, the patient was less than agreeable.
Writing it all out now, it seems like no big deal. But the amount of stress these events added to my day, and to my body, is unreal. At more than one point, I was seriously wondering if this patient was going to fly off the handle, I questioned my safety, I questioned the safety of this patient’s roommate (who was moved ASAP), the safety of my coworkers and the other residents. It’s hard to not be in control, and to not know what to do.
At the very least, I can say that I learned something from that day: the number for security.
Amanda, RN 