My employer plans on cross training me to be in ER, ICU, and Telemetry Units. My first stop is the ER. I finished 2 months of RN orientation and am currently on my own in the ER. This one particular busy day in the ER--we were short in resources. our Charge Nurse functioned both as a Charge Nurse AND Triage Nurse. Our only ED tech was unable to help any nurse because they had to watch 51/50s the whole shift. WE had no ICU nurses or beds available and so if we had an ICU pt- we would have to hold them in ER--amongst other things. (We do not have Unit Secretaries in my facility)
So I basically received an ICU patient who we ended up diagnosing and admitting the pt for- renal failure, pneumonia, dehydration, abd pain --and of course when labs came back - septic protocol was initiated- and so came a whole stream of antibiotics, blood work, exams, etc, etc. (Pt was relatively stable).
In addition, The Admitting physician had written orders for this patient and had ordered to get consults from 3 different specialties (Cardiology, Nephrology, and Pulmonology). So, I
had to call and get a hold of all these 3 different MDs and Look (and decipher) through all four MD's orders and try to carry out ALL their orders! A few of these orders included - Antibiotics, fluids, regular meds, labs (which the MD states to CALL THEM for the result), v/q scans, doppler studies, CT w/ contrast, and the list goes on and on. Sometimes you get orders that cancel each other out. One MD states they want NS while another MD states they want D5W as maintenance fluid. So the rule of thumb is to take the orders from the most recent MD who wrote the orders most recently...
I had all these orders from different doctors and so I tell my Clinical Director (who was nice enough to come down and help us out) " I need help, i got all these antibiotics ordered from 3 different Physicians..and shes in renal failure already!..and i have all these other orders..can you help me determine what I need to do and how I should go about doing this?" She tells me to basically do not worry about any other orders except the "STAT orders"..She reviewed the MD notes very briefly and saw that I did quite a few of these orders (even the non stat orders- i wanted to be nice to the ICU nurses!) and emphasized again to just do the STAT orders and ICU will have other orders dealt with. I also keep in my mind that this pt is ICU-which means as much as possible --be treated as an ICU pt--v/s and check up on them every hour- ekg strips every hour--thorough charting---pressure ulcer checks--i tried my hardest -- i didn't take a lunch break AND i stayed 2Hours OT! [Pt eventually got transferred to a proper ICU holding place]
Keep in mind that I am constantly getting patients in my other rooms--SOB, lethargic, weakness, helping with intubations, Chest pains, overdoses...who are also getting discharged or admitted or transferred out - so that means a whole new set of calling MDs for consults, calling ambulances, dealing with insurance people, case managers, and talking to accepting hospitals etc. etc.
@ the same time --the ERmd is throwing order after order..and sometimes they verbalize orders to nurses who are NOT the primary RN for a certain pt and sometimes the memo doesnt get passed to the proper RN.
Anyway, I went home 2H after I was supposed to actually go home--then I get a phone call from the night shift nurse who i gave report to for that ICU pt...she tells me that the Admitting MD for the ICU pt got super mad at me for not putting in certain labs in the system and not getting a hold of the cardiology MD, and told the night shift nurse to specifically tell me "an ICU hold in the ER means that they be treated as an ICU patient.......just think about how your loved one would want to be treated..don't let this happen again or else I am going to have a fit"..
Then the night shift nurses tells me that they will have to file a incident report and that my charge nurse and the clinical director is informed of this incident.
OMG,after i hung up..i couldn't help but cry
mainly because Im a New Grad and I know I am on probation just because i am new to this company!...I didnt know what to think and I do not know what is going to happen to me! Will i get fired? My boyfriend (who also works in ER) tells me he gets to be 1:1 when he gets a critical pt. I almost never see that happen in my ER...How are things supposed to be run when someone gets this kind of patient load?
IF the Admitting MD really wants me to treat this pt as an ICU pt ..doesn't that mean I should be 1:1 or even 1:2?
Can any shed some insight? Any advice would be greatly appreciated!