Rough but educational night shift

Tait, MSN, RN · Dec 18, 2007

It's funny you mention "flaming" here. I have been posting on a board for a game I play for years, it is littered with 12-40 year old males who think "ur mom is a hooker" is a good reply to a thread. :rolleyes:

Anyway, I think you did your part of your job last night. You checked in on your patients, did your assessment and made sure they would be ok. I guess I don't quite understand the "nurse assigned with me" part. I assume they were playing the role of your tech. If they were truely another RN I am extremely surprised they didn't alert you to the low sats, HOWEVER being said that it was another RN they may have just decided that they had the title of RN as well and could take care of the pt while you were doing your admit.

Either way it seems there is a lack of clear definition as to who is primarily responsible for the pt. There should be no "we both are" here, it should fall on one person's shoulders. That way there is no question as to who needs to know what information.

But as far as I can tell you did what I know I would have done. I would have walked in, gotten a feel for each pt, assessed, checked for any meds I needed ASAP (pain, n/v etc) and then done my admit while letting people know where I was if they needed me!

Taitter :)

suanna · Dec 18, 2007

Sound like you have a handle on the general flow on the floor. My only question was if your patient was going down the tubes for an hour how is it possible you didn't notice something was "amiss" on the floor. With a patient introuble there is usualy a lot of commotion: x-ray, alarms, people running to an fro with labs, orders, and the like. Could the problem be you suffer from a bit of tunnel vision. If I am the RN responsible for a patient under the care of an orientee and that patient gets in trouble, I'm am usualy going to take over the care unless the orientee is about ready to come off. Even if they are ready, if I'm first there I'm in charge of the nursing care until they arrive and take over. I don't know if finding you to alert you to the patients status was the most pressing need at the time- caring for the patient was. It's hard when in an unfamiliar enviornment not to focus on one thing at a time even for seasoned staff but part of the learning process is gaining an awareness of the unit as a whole and adjusting your priorities as patient status changes. If it hadn't been your patient but someone elses you should have been aware enough to pitch in until the crisis is resolved. I could be off base with this- maybe your floor isn't set up to facillitate this kind of awareness but one of the hardest thing I have to teach orientees is not to get isolated doing one task at the expense of everything else on the floor. I've seen new hires completely ignore V. tach, or other high alert alarms so they could get thier baths done, check thier MARs, hang thier meds...

AprilRNhere · Dec 18, 2007

Anyway, I think you did your part of your job last night. You checked in on your patients, did your assessment and made sure they would be ok. I guess I don't quite understand the "nurse assigned with me" part. I assume they were playing the role of your tech. If they were truely another RN I am extremely surprised they didn't alert you to the low sats, HOWEVER being said that it was another RN they may have just decided that they had the title of RN as well and could take care of the pt while you were doing your admit.
Either way it seems there is a lack of clear definition as to who is primarily responsible for the pt. There should be no "we both are" here, it should fall on one person's shoulders. That way there is no question as to who needs to know what information.
Taitter :)

We are often assigned in RN/LPN teams. The last time I said LPN though...it ended up in a debate about THAT. I didn't want this thread to sound like I was against my LPN. Just that I was frustrated that I was responsible for the pt..and they didn't let me know.

AprilRNhere · Dec 18, 2007

My only question was if your patient was going down the tubes for an hour how is it possible you didn't notice something was "amiss" on the floor.

I knew something was amiss. But...on our floor we have it set up so that one person is assigned as the relief to help in CCU if that nurse is called away. I was at the desk checking orders when the relief was told she was needed in the unit. The charge nurse was obviously busy...and since I was right there and not spoken to....I assumed it was not my pt (I know..don't assume...but I figured in this case I SHOULD be able to)....anyway...I thought as a new grad....if they already had the situation covered I'd be of more use covering the other lights/pts on the floor.

Tait, MSN, RN · Dec 19, 2007

We are often assigned in RN/LPN teams. The last time I said LPN though...it ended up in a debate about THAT. I didn't want this thread to sound like I was against my LPN. Just that I was frustrated that I was responsible for the pt..and they didn't let me know.

I am curious about this "LPN debate". If you feel so inclined please drop me a PM and tell me more about it.

Oh and as far as anyone on these boards telling you that you missed this or missed that, no one can say that because we are just getting a snapshot of the situation. You are the only one who knows if you missed anything.

UM Review RN, ASN, RN · Dec 19, 2007

first...i want to say i'm slightly hesitant to post here....as it seems many get flamed...but here goes.

i'm terribly sorry that you feel you might get flamed for posting. please know that we have moderators so that flaming can be nipped in the bud. if you feel you have been flamed, please feel free to report the post and i assure you, something will be done about it.

now on to the problem:

i had a very fast paced but frustrating night last night. i was supposed to finish up orienting to the ccu...but it was closed. (no pts) instead of putting me on call...they gave me pts on the floor as they were short staffed. i had an admit waiting for me when i got out of report.

first, it is my opinion that to float you to the floor from ccu is a very questionable practice. they are not the same. in my facility, no new orientee is allowed to float for the first 3 months. what happened to you that night is one reason why.

i was assigned on a team with another nurse.

i assume that you were assigned as a team with an rn. where i work, there are levels of lpn status and a new lpn grad cannot push iv meds or hang blood, so an rn always "covers" the lpn i.

first...knowing i had to do an admission....i went and eyeballed my patients. i checked to see if they were stable... checked pulses, rr, lung sounds and orientation. we have to do a head to toe at some point in the shift...and most of the med/surg nurses wait until the patients wake up...but i always check them at the beginning. the nurse assigned with me was going to do vitals...so i listened to them...and she was going to follow.
i went in to do my admission....was around..in and out checking orders etc...
anyway...long story short...one of my patients aspirated bile and went into respiratory distress. the nurse assigned with me notified the charge nurse...who called rapid response and the ccu charge nurse took over from there. neither of the med/surg nurses thought to tell me the pt assigned to me was crashing! i found out an hour after vitals were taken (o2 sats low 70's) when the ccu charge nurse said that since i was supposed to be orienting i should come learn. (she didn't know it was my pt)..then the med/surg charge nurse came to get me.
anyway...sorry so long...and overall a good night...i learned alot. but i was frustrated. i'm taking full loads on med/surg...i wasn't on orientation out there...and it was my assigned pt. i'm not saying they should have stopped a code to find me...but once things started to settle a little...they could/should have called me.

my assessment from reading what you wrote is that they were so short that they pulled you (no offense, but basically no floor experience) to a unit that is not your specialty, where one of your patients crashed. the rn either was too busy to find you or, knowing how long these things take, figured it would be faster for you to continue with the other patients while she handled this emergency.

i would not take offense at this because you were not orienting on this unit and because imo, you never should've been there to begin with and they knew it. it's quite possible also that because you were pulled to this unit, the rn already knew and had worked with this patient and knew the patient better than you did. therefore, she would be the obvious choice to take care of the crash.

why didn't they call you? probably because you were new and they were busy, and they just didn't think. i've actually done this quite innocently to nurses who've floated to our unit, because i knew the patient and i was aware that the float nurse didn't know that patient. also, that patient might've been trying to crump before you got there and everyone on that unit already had a heads-up that you didn't get somehow.

i usually apologise when i realize that i neglected to get the float nurse, but usually the float nurse is relieved that someone was able to take over and that the patient got the fastest response possible.

it happens. what's important is that the patient got appropriate, timely care.

AprilRNhere · Dec 19, 2007

i'm terribly sorry that you feel you might get flamed for posting. please know that we have moderators so that flaming can be nipped in the bud. if you feel you have been flamed, please feel free to report the post and i assure you, something will be done about it.

overall it's great here....i just don't like conflict...and worried people would pick apart my wording etc. thanks

AprilRNhere · Dec 19, 2007

first, it is my opinion that to float you to the floor from ccu is a very questionable practice. they are not the same. in my facility, no new orientee is allowed to float for the first 3 months. what happened to you that night is one reason why.

sorry...it's a little confusing. i have worked at this facility for 5 months. i was hired to be the unit relief. it's a small facility...and they train 1 person each shift to take a load on med/surg..but be able to report off and go to ccu if needed. i took this position with the agreement that as a new grad...i would orient to med/surg first...work a few months..then orient to ccu. i'm done orienting to med/surg and was scheduled for an orientation shift in ccu this night. however..the unit was closed...and the floor was short. instead of not having me come in...they gave me a pt assignement on the floor.

AprilRNhere · Dec 19, 2007

i assume that you were assigned as a team with an rn. where i work, there are levels of lpn status and a new lpn grad cannot push iv meds or hang blood, so an rn always "covers" the lpn i.

no- i was on an rn/lpn team. the lpn's at our facilities can't hang any iv meds. they do vitals, oral meds, and we split the load for adl's. we take a pt load together.

AprilRNhere · Dec 19, 2007

i would not take offense at this because you were not orienting on this unit and because imo, you never should've been there to begin with and they knew it. it's quite possible also that because you were pulled to this unit, the rn already knew and had worked with this patient and knew the patient better than you did. therefore, she would be the obvious choice to take care of the crash.
why didn't they call you? probably because you were new and they were busy, and they just didn't think. i've actually done this quite innocently to nurses who've floated to our unit, because i knew the patient and i was aware that the float nurse didn't know that patient. also, that patient might've been trying to crump before you got there and everyone on that unit already had a heads-up that you didn't get somehow.
i usually apologise when i realize that i neglected to get the float nurse, but usually the float nurse is relieved that someone was able to take over and that the patient got the fastest response possible.
it happens. what's important is that the patient got appropriate, timely care.

i was fully oriented to the med/surg floor. i have taken full pt assignments for almost 3 months now. the rest makes sense though. i'm sure she was just busy and didn't think about it. while i don't agree it's the way it should have gone...after your post i see noone meant any offense. she was assisting with the situation...and caring for her own pts as well.