no funny quotes for a title from my nonverbal patient

I got to work last night and I've been assigned 4 patients. Which is a HUGE red flag. That means I normally have the potential to admit 1 or 2. But now they have decided we can go up to 7 patients, even 8, because we no longer let them linger in the ED. Which is both fantastic and safe. I'm lying.

Three of mine last night were ok (two of mine and one I took from Kara), and didn't really need anything. Which was good because I pretty much completely ignored them after about... 11pm. I had one complicated patient who we got from ICU a day or two ago... and I wouldn't have minded if they'd kept him. He went down for an angiogram and came up at maybe 10:30. He needed vitals every 15min-1 hour for like 6 hours. His site started bleeding and we had to hold pressure on it for like 10 minutes, he had a IJ triple lumen that had antibiotics going in one port, TPN in a second, and after we gave the bleeding time to really stop, heparin in the third. He had a AV fistula that looked like it was going bad, and like it was going to pop out of his arm. He also had a heating blanket... thing he had to have wrapped around one of his legs. or draped over. or something, because it essentially doesn't get circulation anymore. He also had an NG tube that was clamped. He was confused, nonverbal for the most part, required pain meds 3 times, insulin checks twice, and he was in 3-point restraints. Now, the heparin, pain meds, and restraints add SO much charting by themselves. Plus those extra vital signs. All of that, and he's not one of the hospitalist patients, meaning I have to really weigh if I need the doctor because I'm going to wake him up if I have to call him. Anyway. My patient lived through the night (I was a little worried... his breathing seemed off and he just made me nervous). OH right the real kicker, he is a DNR, so if he starts going bad, you better act fast because you can't actually do CPR or intubate him. Also he was at the VERY end of the hall, so I spent my night walking walking walking back and forth between there and the nurses station.

Around maybe 5am? I don't even remember. I got an admission of someone who I couldn't tell if they were sleepy, confused, dumb, or hard of hearing. Either way he didn't want to answer questions, and then they put a bipap mask on him, so I procrastinated on his admission stuff and ended up having to pass it on to dayshift because they took him to CT (without prior warning to me, but whatever) before I gave report. Luckily I gave report to a really nice nurse who isn't usually on our floor, who was like, don't worry about it, I'll do it, go home and sleep. Anyway, that patient? His urine looked like beige paint. It was the most vile urine I've ever seen.

Another drama of the morning, that I'm really concerned about is that one of our nurses didn't show up, so we called her, and it turns out her husband found her on the floor unconscious and bleeding, and now she is in the ICU of another hospital :( She has two young kids, and is supposed to go to India this month for her sisters wedding I think, and she hasn't been back since she left. And we don't know what's wrong with her, so it's scary and sad.

One positive of the staffing issues, I have never seen night and day shift so bonded. Because everyone knows that this is NOT right. Someone made a good point this morning, I can find a new job, getting a new nursing license isn't so easy. But seriously, everyone from night and day shift this morning was talking about getting a different job, a second job, going part time. Who is ready for mother/baby nursing? um me.