Nurse's Guilt

So last night I had a patient that was originally admitted with diabetic ketoacidosis amongst other things (like for instance a pus filled toe that she had previously stubbed). Last night she was having some major breakthrough pain in her foot that was causing her to also have some referred chest tightness. I paged the hospitalist who corrected some of the major errors that the previous hospitalist had made (like for instance, the fact this woman had not been put on an insulin protocol for her insulin drip and that she hadn't been ordered any pain medicine for the pain to her foot and the fact she needed an MRI to that affected toe).

An emergency MRI and an orthopaedic consult later, she was fine -- except for her hourly blood sugar checks, but that was to be expected. I drew labs this morning, and didn't get the results until pretty late (our unit didn't send off labs until about 4:30am). By the time my results had gotten back to me it was past 6am, and I was told that the hospitalist was changing shift. I figured it would be ok to let it slide until the hospitalist came to see the patient this morning because the labs I was calling about were a really low calcium (0.4) and a potassium of 2.5. I made my effort and paged once (which I'd forgotten about) and another nurse had also paged in regards to her patient. It was change of shift and not a word back from the hospitalist -- it was almost expected since they themselves were changing shift around that time as well.

Here I was giving report to poor Erin who had admitted my patient the afternoon before and she was already bombarded with this problem. I felt guilty because the lab values were critically low and she wasn't able to get a hold of the hospitalist even after I had re-paged him during report. To top it all off, she'd be traveling down to x-ray with that patient later in the day -- and this after an orthopaedic surgery consult and a vascular surgery consult. And ps: don't forget the hourly blood sugar checks.

It's always a nurses guilt to leave work hanging for the next person, and this morning I feel guiltier than most because it was leaving work for a friend of mine versus just being another co-worker. I hate the feeling that I didn't finish everything I needed to -- and most of all for leaving her hanging with critical values. The only consolation was that the patient was otherwise feeling fine and had no ectopy. Hopefully the hospitalist will get back to her within the day. I'll have my patient later again tonight (at least this is what I'm assuming), so hopefully it'll at least be easier for her to pass her back to me.

Lesson learned: who cares if the hospitalist gets pissed off -- page however many times you need to. And if they bitch at you -- write them up.