I agreed to work ICU at a local rural facility. When I arrived for the first time, as usual 'nobody had time' to orient me properly (the norm) so I poked around and got my bearings.
It was a 5 bed ICU, 2 vents, 2 unstable DKA's and a screaming old lady in CHF. They don't say a word to me til shift change then they announce proudly (like I should thank them) 'Well you were going to be alone but we found another nurse to work with you." I was amazed and my jaw hit the floor I'm sure.
The 2nd nurse arrives and airily announces "I want Bed 5...I had her last night"...I thought, OK fine...she is on her way to CT and the nurse needs to go with.... and I wanted to stay in the unit and get organized anyway.
Well, day shift leaves (they had 3 nurses all ICU qualified) THEN this 2nd nurse starts whining. "Never had a vent before" (so why is she in ICU and why did she ask for bed 5, I ask?)" This is just too hard for her and she is a NEW GRAD and I need to help her." She can only handle the 1 vent patient... so I need to take the other 4 patients and 'help' her with her one.
At this point steam is coming from my ears and I am truly feeling dumped on. I call the supervisor who says "I'm no ICU nurse...this is your problem". I say, nobody told me I would be in charge and be given a new grad to precept as my coworker in ICU...my first time out here. She shrugs. The DON doesn't care, isn't ICU qualified either, the unit director is out of pocket.
I figure...XX#OO%....just get through it...and don't look back. Well this new grad drives me nuts all night...basically I should have taken all 5 patients myself and delegated tech stuff to her because she had no clue, was a total drain on me, majoring in minors, has to walk out of the unit numerous times to 'get some air' while I never even got a sitdown break (didn't DARE leave her alone with the patients) Calls her floor friends to tell her how 'hard she is working' (with her one vent patient...whom I am supervising closely so she won't hurt her)
Shift end: the new crew comes in and tries to RECRUIT me...please come back, etc. I have to stifle guffaws and various other expletives...LOL! Trying to think exactly what I will tell my agency....but calming down first...!
Anywho, thanks for letting me vent ya'll...I LOVE the freedom and flexibility of agency work but I'm learning to stay clear of these small rural hospitals...I seem to get the same kinda crazy trip every time...guess I'll learn someday, eh? :roll
Feb 11, '03
Ever get the feeling some of the less experienced country docs just kinda 'experiment' with patients? They were anxious for my input...but I also am aware I REALLY shouldn't practice medicine without a license...LOL!
Had a 19 yr old with acute abd pain and WBC of 30K...the docs paniced, rushed her to surgery...found nada...then left her paralyzed on a vent for a day trying to figure what to do next...I do my asessment...it's like...guys...she has acute abd signs...foul vag discharge...sexually active...abd explore was negative...why have we not done a colp and cultured her up for PID?? And please let's extubate her b4 she has complications of mechanical ventilation!! The doc says uhhh...I can't extubate her...her CO2 is 4...I reply "Yah but it's respiratory not metabolic...did you know you have her on a rate of 36? ( altho I don't know WHY)
I suggest she is BLOWING OFF the CO2...and ask permission to wake her up, begin a wean schedule,observe, and extubate her if/when ready....He says "Do you know how to do that?"...I say sure I do.
The docs were like...uhhh...OK...good idea...thanks for your help...nice to have a 'real ICU nurse' here....hmm.
While it feels good to be appreciated.... Yup it's a little scarey at these country hospitals.
Makes me appreciate even the jerkiest of docs at my big facilities who DO know what they are doing and why despite their arrogance. (Can't believe I'm saying THAT) LOL!!
Maybe I'm being a little hard on them...they are young docs...probably trained in a big teaching hospital with lots of experienced docs and nurses around to help them...then relocated to the boonies (maybe on a rural med school scholarship program) and got a culture shock. Can't help but feel bad for patients way out there though...
Thanks for this forum...nice to be able to vent to other agency/travelers. We really have to hone our CYA skills don't we?! LOL! :roll
Gotta kid in college in this part of the county and know where I'll be if he ever ends up in THIS place...Mama won't leave his side til he's transfered OUT. :stone
Last edit by mattsmom81 on Feb 11, '03