(Vent) Busy night...unsafe?

Specialties CCU

Published

Specializes in CVICU, CCU, MICU, SICU, Transplant.

So the other night in CVICU, I got a really awful assignment. Kinda think it was unsafe, however I got through it somehow.

Pt #1: s/p bilat lung transplant, fresh out of the OR 3 hours ago; still intubated/sedated - staying that way till at least in the AM when they do the bronch. Swan reads still Q1 for a few more hrs; on Epi, propofol, Nitro, insulin gtt, Dopamine. Vitals essentially stable + hemodynamics (were kinda dry but thats how they want the lung transplants). SVO2 60's to 70's. Chest tubes x 4 + mediastinal tube - ok output. BG's q 1 hr bc of the insulin and epi. H/H stable so far. Low K (2.5) - gotta replete it. Low urine output x 2 hours ( 20 cc's & 15 cc's respectively). Surgeon wants some 5% for this, just not too much. Labs Q 6. Gotta start several of the immunosuppression meds/IV antibiotics. Temp spike from 99 to 101.5. Surgeon says just monitor for now. Negative airflow isolation per transplant protocol.

Pt #2: s/p heart transplant 2 days ago. Still intubated, sedated, but responds appropriately when awakened. Still Swan'd and line'd. VSS, but BP a kinda low (90's, high 80's). Hemodynamics stable, except high PA sys (50's). Prev shift started Nitric oxide @ 6ppm thru the vent. On Epi, Nitro, just a touch of Levophed, Milrinone, insulin, propofol. Pacer wires capped, NSR 80-90's. Incision stable. Chest tube output ok, but Hemoglobin down from 9 to 7.9 - surgeon wants 1 units RBC's - thinks some of it might be dilutional bc the pt hasnt been peeing much until recently. Q 2 hr blood sugars - has been stable on the insulin. Q 6 ABG's d/t the nitric oxide. Boat-load of transplant meds/antibiotics. And of course transplant neg airflow isolation, too. Few hrs later - up the Nitric to 8 ppm, PA sys now 40's and surgeon is happy with that for now. Pt now waking up too much, tapping on the siderails, being needy - up'd the propofol, gave pain meds. No time to sit and hold his hand for 30 minutes ;)

Told the charge nurse that I thought this was an unfair assignment, even though everyone was relatively stable but still super busy in their own way. Asked her why I couldnt have had my 2nd pt be the stable pt with no drips who was sitting up in the chair all day - didn't get a clear explaination, just an "oh well, do your best. We will help you." Later she said something to the effect of "gosh this is busy, i'd be mad if I were you" LOL

Was still expected to bathe both patients too, otherwise I would have gotten frowns from the day shift ;) Don't know how I did it all but it sure wasn't pretty. No one was primped and the rooms/counters weren't clean, couldn't read up details in the charts. Manager better not bust me for staying late to chart or I will scream.

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Specializes in ER.

That sounds physically impossible, let alone baths or if anyone dared get sicker. Crazy.

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I've had days like that in my CVICU. We are superhuman... .apparently....as nurses. I never had a lung transplant, but I pulled an extra at night once (I'm on days) and had a type I aortic dissection w/IABP AND CVVH. We were 1:1. God love those shifts. I think I've had 3 in all the years I've worked...

Anyway, stupid me takes a "lunch". I come back to discover I am picking up a fresh heart w/an open chest (luv them bugs). I would NOT be giving up my first pt. However, the charge nurse was kind enough to point out that she thought of me and moved our pod neighbor to a room so I could have my kiddos right next to each other. *sigh* It's always about me, I know.

Best part is my RN "pod mate" was a newbie and fresh off orientation. So I was constantly fielding questions on her patients, explaining things about my patients, and keeping my eyes/ears out for the standard new nurse "uh-oh's". At 0530, as any good pt should, her near-perfect CABG/MVR/AVR recovery pt CODES, but not before we both work our tails off to get his pressures up and him responsive. It was one of those situations where there was so much going on, you literally couldn't walk the 15 feet to the phone. It's yell and hope someone hears. Obviously, that didn't matter once we hit the button, but still!

By the time I got home, I thought I was going to DIE! I'm not sure if I'm exaggerating there. lol. I, like everyone else, feel my pts were 2 1:1 pts. Well...not if there aren't enough nurses to go around. Thankfully, those of us in these situations know what we're doing! So, you must know what you're doing...or at least the powers-that-be think so. OR you REALLY made someone mad. ;) Ha ha. Anyway, if there was an option to put you w/1 high and 1 low acuity pt, I think you should have gotten it. While unit nurses like us (that would be most) rock at what we do, it is because we put everything into it. That puts us at burnout risk. I don't think it's worth that in the long run. Your charge nurse should see that, too.

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Specializes in CVICU, CCU, MICU, SICU, Transplant.

Thanks for your story, SuperSleeper. Sounds like you were in a crazy situation also. At least this isn't a daily thing that happens for us. And I'm thankful that while the charge nurse didn't change my assignment, that I had other nurses with me that night to help me pass meds and do vitals.

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Specializes in CCU/CVU/ICU.
I've had days like that in my CVICU. We are superhuman... .apparently....as nurses. I never had a lung transplant, but I pulled an extra at night once (I'm on days) and had a type I aortic dissection w/IABP AND CVVH. We were 1:1. God love those shifts. I think I've had 3 in all the years I've worked...

Anyway, stupid me takes a "lunch". I come back to discover I am picking up a fresh heart w/an open chest (luv them bugs). I would NOT be giving up my first pt. However, the charge nurse was kind enough to point out that she thought of me and moved our pod neighbor to a room so I could have my kiddos right next to each other. *sigh* It's always about me, I know.

Best part is my RN "pod mate" was a newbie and fresh off orientation. So I was constantly fielding questions on her patients, explaining things about my patients, and keeping my eyes/ears out for the standard new nurse "uh-oh's". At 0530, as any good pt should, her near-perfect CABG/MVR/AVR recovery pt CODES, but not before we both work our tails off to get his pressures up and him responsive. It was one of those situations where there was so much going on, you literally couldn't walk the 15 feet to the phone. It's yell and hope someone hears. Obviously, that didn't matter once we hit the button, but still!

By the time I got home, I thought I was going to DIE! I'm not sure if I'm exaggerating there. lol. I, like everyone else, feel my pts were 2 1:1 pts. Well...not if there aren't enough nurses to go around. Thankfully, those of us in these situations know what we're doing! So, you must know what you're doing...or at least the powers-that-be think so. OR you REALLY made someone mad. ;) Ha ha. Anyway, if there was an option to put you w/1 high and 1 low acuity pt, I think you should have gotten it. While unit nurses like us (that would be most) rock at what we do, it is because we put everything into it. That puts us at burnout risk. I don't think it's worth that in the long run. Your charge nurse should see that, too.

Thats ridiculous and unsafe. Is your unit understaffed and/or is this a common scenario? I dont know if i'd stick around if this happened more than once. This is a recipe for disaster (luckily you handled things well)...but a patient sooner or later (if hasnt happened already) is going to die because of this unsafe practice/staffing.

If the public only knew...

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Sounds like some days/nights on our unit. Did they think it would be a reasonable assignment since both patients had propofol running? I know that often plays a role where I work.

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Specializes in CVICU/Trauma ICU ...moving on to SRNA!.

I think I worked at your hospital...lol. SuperSleeper has some good points though chances are you are a strong nurse that they trust in these situations to make the right decisions. I have had many of nights like those above and they can be hectic. And I am not sure if my manager was just feeding me some bs to get me through the night or what, but when I get these assignments they usually come with a side of "I'm sorry" and/or "I trust your abilities the most and I want to give this patient a fighting chance". That being said after the night is through you have to admit you feel like an awesome nurse.

Seriously, in these situations if you are prioritizing no one can complain about your baths not getting done (well they can, but that's just because there will always be that one petty, grumpy nurse on every unit). I learned very soon after starting on the ICU that if I had a cake assignment to go help the nurse about to drown, and for that matter if I had easy patients and was caught up with stuff then I would go find someone to help, even with easy stuff. We all need an extra hand at times like this, and if you offer to help others first, they are more willing to lend you a hand. You have to build a team to run a good ICU. Go Team!!!:w00t:

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