place: cardiac icu
bob is working an 8 hr shift and has two patients. one pt is expected to transfer to stepdown unit. the charge nurse tameka
just learned that an patient must be placed in their unit from the or. a bed is needed. there are 2 other nurses in the unit, sherry and sandy that have one patient. sherry has had one patient all morning and she is working a 12hr shift.
sherry and sandra both have an open bedspaces that are clean and ready to receive a pt from the or.
two hours before bob's end of shift:
the charge nurse tameka asks bob how soon can he get his patients up. the nurse informs tameka that he has to give iv meds, recheck labs, awaiting floor orders, pull lines, etc so no, not ready. tameka sighs under her breath and walks away.
1 1/2 hours before end of shift:
charge nurse tameka asks bob if he can get his patient out. bob stated that he called report and is in the process of preparing his patient for transport. he states that his patient will be ready to leave in about 10-15 minutes. tameka says, "good" you have a case called from the or. you have 30 minutes.
60 minutes before end of shift:
15 minutes has past and bob's patient is discharged from the unit, leaving 15 minutes for bob to set up the bedspace (getting supplies, setting kvo pump) all the while while briefly tending to the needs of his other patient. the cleaning crew also spend those same 15 minute disinfecting the bedspace (bed, pillows, pumps, taking out trash, mop floor etc).
45 minutes before end of shift:
the floor has just dried and the case is on its way from the or. bob receives the case. three nurses including tameka and sherry assists bob with getting report and getting patient settled into the bedspace. bob tends to patient needs, getting pt hemodynamically stable and addressing pain issues, retrieving meds, reviewing new icu orders, sending labs, and talking to family members.
bob notices that as he is doing his work, the charge rn tameka, sherry and sandy are all gossiping and laughing at the nursing station.
5 minutes before end of shift:
bob is unprepared but gives report to the oncoming nurse. the oncoming nurse is rushed to complete a lot of task for the new patient in addition to tending to the 2nd patient. bob spends and extra 20 minutes past his shift (10 minutes till next hour) finishing up his work (signing off meds, charting, shift i&o's).
what are your thoughts and opinions on this scenario?
Bob has the right to inquire as to why he is getting this new pt. when it seems clear that there are other nurses who are available/underassigned and more capable of being able to accept this pt. My question is what are the accuities of the other two nurses pts. Are they one on one pts? Are the other two nurses trained to take this level of OR pt.? Did Bob state any objection, now or previously, or is Bob such a nice guy he doesn't stand up for himself? I would have delegated a few things such as: asked for someone else to transfer my pt. ( pack him up, take him out, get meds ready...whatever) and ask someone else to get my meds or do accucheks for my remaining pt or whatever else i could have delegated to ensure that i stood up for myself and let Tameka know that she can't bowl me over. In the future, Bob should professionally state his opinion and delegate his needs thru his charge nurse.
Last edit by nrsgnerd on Dec 21, '09
: Reason: Forgot a key thought