i need a new job

how much is too much? when i started on the floor over 2 years ago, i swore i wasn't going to be one of those people who used our floor as a stepping stone to get experience. i DEFINITELY wasn't going to be one of those superior ICU nurses who tossed around words like 'rapid sequence intubation' and 'dopamine drip'. but now, i admit, i've been wavering lately. the main problem is this: too many patients, too sick, not enough me to make sure that they're all breathing, not to mention actually doing any "extras".

like last night: i'll say it, I'M SUCH A SUCKER. so when the floor called to ask me to pick up a half shift PM, i agreed. i felt bad, because our floor is hard enough when we're staffed, and when we're not it turns into a nightmare. so here we are: 31 patients, 8 nurses. appropriate according to our grid. except that my assignment is horrible. not on purpose, not that anyone else had a cake walk, but still horrible. the rundown:

1. a trached, confused man with NJ tube feeds, on flat bedrest, just came back from dialysis
2. a small bowel obstruction woman with a ton of mental health issues, psych meds, and a leaky NG
3. a trauma patient who just also happens to have cancer with mets to the brain. foley, rectal tube, C diff positive, a strange accordian drain i have never seen before, both legs in immobilizers and CRABBY
4. an ortho patient who can't pee, so i bolus her, all the sudden she can pee and she's calling for the bedpan every 5 minutes, taking herself on and off of it, then spilling urine all over requiring THREE complete bed changes in 6 hours

i started to think about where i would rather work right about the time that my trach guy started vomiting green mucousy grossness from both his trach and his mouth. because the night's not truly bad until somebody gets aspiration pneumonia. i'm way behind, i've now got a patient with a compromised airway, and still no one will leave me alone. i fielded three phone calls from family members in about an hour. every ten minutes i'm in with miss no bladder control trying to pry the bedpan out of her hands and convince her to call for help. my tech seems to have disappeared, and i find myself emptying all the drains and clearing all my iv pumps alone. as i strip the tubing on my patient's leg drain, she begins to swing at me because it hurts, finally grabbing my hand and DIGGING HER DAGGER NAILS into my flesh. the guy across the hall is irate because no one has repositioned him 'all day' and why did i forget to bring him that menu? and i haven't been in to check on the lady with the leaky NG in at least a few hours because she is the only one that i feel can handle being left alone for more that five minutes.

the conclusion: i need less patients. or ones that can do things by themselves. such as get up out of bed. or eat. or go to the bathroom IN THE BATHROOM.

this is not going to happen. thus: i need a new job.