I have had my head in some books researching some blog topics. I don’t know about you but I am constantly brainstorming and when I come to a conclusion about something I want to talk about, I like to do research behind the topic to ensure I’m on the right track with my thought process and information. Then, I hit the rabbit trail of going off on to other topics. Are all nurses like this? And by like this I mean, so neurodivergent. HA! While I was doing research, I thought of this story, and I’d like to share it with you!
When I started doing agency nursing, I went in with some research, but not the best execution. I’ll admit, I ran into quite a few awkward situations and feeling a quite defeated. During my first few assignments, I did mostly night shifts (which I thought night shift would be easiest, but you really have to know what you’re doing to cover nights, there aren’t many resources for help troubleshooting at those hours). One facility in particular was a complete horror show of a night. What ended up being a horrible night, turned into quite ironic if you ask me.
It all started at beginning of shift at a facility I had never been. I was assigned to 40+ patients at a skilled rehab and the nurse giving me report was not super informative. I was doing a 10-6 and rounding – I went into a room and specifically checked on my patients G-TUBE formula who was on a continuous feed. Upon observation (what are we charting here? HA!) the patient appeared diaphoretic and I didn’t have a baseline, she was non-verbal, limited ROM but had no apnea and her pulse was WNL. So I immediately grab some vitals. I had not yet thoroughly reviewed any patient charts. I just received report and started rounds to ensure everyone was safe and accounted for.
Vital signs were normal, BP elevated just a tad. However, her blood glucose was less than 40, so I rush to get glucagon from the med cart or med room. NONE. No glucagon. What in the actual heck is going on around this place?!
I run to the other nurse (only one other nurse in the facility!) and she’s like “I’m agency too. IDK!” She needed glucagon as well (you can’t make this stuff up, are you SERIOUS?) we ended up finding 2 doses and let’s just say it was someones personal supply, we found the doses while I was calling EMS because there was no way I was letting this get out of hand.
We’re nurses, if we need something, I can promise you, we’re going to make it happen. If we had not had quickly found the last bit of glucagon, we would have used our critical thinking skills for this patient and had some make shift remedy.
So, I’ve administered the glucagon injection; and EMS arrives takes her BG, gets report and has to put her on an IV drip as her BG was not moving.
I called to inform the Director of nurses for this facility of the patient being sent out as the protocol for the facility indicated, and she replies “Thanks for letting me know” and I said “Also, you have zero glucagon in the building, at least a dozen of my patients are diabetic with orders for glucagon. It’s dangerous, I called to inform pharmacy and they’re sending refills on the fly.”
When the AM nurse comes to relieve me, it was a facility nurse (thank GOD) and by then I had received the glucagon I called into the pharmacy. As I’m giving her report and letting her know about the patient I sent out, she says “oh yeah, that patient has been having issues with her gtube feeding rate and blood glucose. I told the DON I don’t think she needs the insulin at this point. Just her metformin.” I told the oncoming AM nurse. “Seriously? I was not given any info during report, no info on 24 hour reports, and no documentation in the patients chart on this. How dangerous.” The AM nurse proceeds to tell me “The patient has been low on glucagon, it’s been administered recently, several times!” And there was also no documentation of the med being given. Absurd!
Did I mention, I had a new admission? The CNAs for the facility, were staff and when I asked them to check on the new admission (who was a full code, a&ox4 and ambulatory with family at bedside and had no big needs) so they would feel tended to as I had only been there a couple of times, and the patient family communicated I’m the only person who has been there. I wanted the new admit to just feel welcomed, not to force people to do any hard labor. The CNAs scoffed at me and continued to chill at a table at the front of the building away from the halls.
So that’s it, I thought to myself, I’m NEVER doing agency again. Mind you, my previous job was Director of Nurses for a memory care. I was accustomed to being the BOSS, running my own department, working hard, and having things in check for my patients AND staff. It was hard to feel so helpless at a facility and not know all the information. When I was a DON, when I had agency in the building, I left them an up to date “Cheat Sheet” with a small bit of 411 on their patients, where to find stuff, the chain of command, communication list with phone numbers, codes to the doors, their PCC access and my contact info. Sometimes I would even meet and greet them at the facility as I lived nearby. I was so taken back by the operation of agency staffing and I feel very passionately about the education and pursuit of it, because of my experiences.
I left that facility with a bad taste in my mouth. When departing the facility I decided to note to self in my iPhone notes, under the facility name – before I even left the parking lot I left myself a note “DO NOT RETURN TO THIS FACILITY, BLOOD GLUCOSE” as a reminder. (I keep my login info in my phone notepad) Would you believe, they put me on the DNR (do not return list) because of the education I provided the DON and their staff? I thought, well the trash took itself out today.
My story isn’t to scare you, but to let you know, whether you’re planning to travel, do agency work or any nursing endeavor you should apply yourself to – EDUCATE yourself and prepare yourself prior to the shift. My dilemma with the glucagon could have easily been remedied with the questions I now use during shift report when I pick up with agency staffing. And the routine I follow at the beginning of each shift. It may sound daunting because it looks and sounds like extra work, but ultimately, the little bit of extra work initially causes you to avoid many issues during the flow of your shift.
We often feel anxiety about the unknown, but it only takes a little research and a little wisdom from someone who’s been there, done that – to give you the knowledge you need to feel confident.
I hope you keep following for more info, stories and tid bits! Keep your nursing spark alive, but not just that, your life spark alive! Don’t get broken down by being overworked, underpaid and no time off.
I haven’t been posting much, but I have been doing a lot of research about what I would love to share with you. You have to cross your t’s and dot your i’s when you’re sharing information with others.
Stay tuned for the next blog/article at NurseNanook! Please leave your stories, tips and tricks, and questions in the comment section. I would LOVE to hear from you! All healthcare peers welcomed, and even non-health care because WORK is WORK and we all have good information.
Because we’re nurses, of course we don’t gate keep good info! Be safe Nurses & friends.
