Am I supernurse or superdud? Or somewhere in between?

[Suninmyheart]

I had 5 patients last night though not all at the same time. We have a limited ratio in California of 1:4.

So here's my night. I was floated to another cardiac PCU. It was my very first time floating but I have been around for a year and a half and I certainly was up for the challenge.

I start out with 3 patients.

1930 Pt#1 Goes into afib RVR sustaining in the 130's. day nurse is otta there.

So between 2000 and 0000 I get her under control then assess, medicate, do dressing changes, check RBS and treat my other pt's. So far the night is going ok. Slightly rough start for not knowing my way around here but not bad. Now I have time for all my charting, give scheduled meds and keep a close eye on my peeps.

0000 Admit Pt #4. No problem he's stable. I take a lunch break. Pt #1 is still in afib but marginally controlled in the high 90's low 100's.

0230 Pt #1 Goes into acute respiratory distress. Desats to 60. RT is hemming and hawing (different story). While I've got doc on phone she desats to 40 and doc tells me to call a code. Of course that stirs up the wrath of the ICU nurses but I don't care I have a patient who is quite literally dying.

0500 Pt#5 I admit new patient from med-surg. She is non-response with hepatic encephalopathy. Only upon assessment I note her non-reactive pupils are roving back and forth in a slow motion. Then within an hour she starts a sustained heart rate in the 130's

0600 Stat CT for Pt#5 with several more calls to get an order for sedation and clarify wrong dosage given to me for Indural. Then Pt#2 goes into afib RVR requiring cardizem gtt set-up and more phone calls etc.

To sum it up I had a total of 5 patients, 3 of them unstable causing 4 different episodes requiring emergent attention, one of them being a transfer to ICU.

Please note, on top of all this, I had numerous family calls to make and one family member shows up in person crying and needing attention. And at one time I actually had a chart in each hand, my shoulder holding a phone to my ear and another phone on hold talking to 2 MD's with a 3rd MD call coming in on another line.

Of course people offered to help. One nurse did all my a.m. blood sugars. Another nurse entered some vitals for me and hung a vanco. My coworkers all came up to me at one time or another telling me I was doing a great job and they were amazed at how well I was handling myself and even smiling and being very courteous and calm while dealing with it all.

I am on their unit until 1000 charting. The day charge actually has the gall to say to me "it wasn't that bad, you only had 2 unstable patients". That was the last thing I heard when I walked out the door. Of course I suppose the manager will hear all about me, the nurse who couldn't handle 2 unstable patients and called a code when it should have been a rapid response. It IS all about time management isn't it?

And I am sure you would love to hear about what happened in the room when both the RR AND the code team show up. But I really can't go into that here cuz...well...

I am sitting here feeling like a bad nurse. Another part of me feels like I am a great nurse because I did handle myself so well and did everything I should have.

Thanks for listening. I still feel new at this.

[SoundofMusic]

I vote for supernurse! I am not sure I could have handled such a night myself. Thank God at least some of your co-workers were helping.

And it makes my blood boil to hear such a comment coming from your charge nurse. You "only" handled 2 unstable patients? Is she perhaps unstable herself?

I swear, these management types and the charges who are always charge and never seem to take patients I think forget what it's like to multi-task for 12 hours straight. I think they see us doing it sometimes and perhaps actually get threatened by us and wonder silently if they themselves could handle it. Then they get goofy and say stupid things -- I just have to wonder, honestly.

And I have no idea why you would have been told not to call RR or codes when they were necessary? That makes zero sense.

[sicushells, RN]

If the patient's sat dropped to 40% and stayed there for longer than... like 5 seconds, I think calling a code was the way to go to. If you can't oxygenate, your heart's not going to be pumping for very long.

I think if you had called RR, by the time they got there, you would have been calling a code anyway. And what does that mean, "It doesn't look good for the unit if we call a code". It's not about looking good it's about patient care! (am I right or am I right) jeez!

Good job, don't stress. Could be the nurse that said something rude was just miffed that you held yourself together even though you're a float.

[RNperdiem, RN]

I don't think you are a bad nurse. I think you had a bad night.

I'm suprized that the charge nurse gave an assignment like that to a float nurse.

Hopefully your charge nurse didn'nt have an assignment and was able to give you enough help.

[leslie :-D]

i think you sounded totally on the ball.

tell the cn to bite you...

and keep that head up.

leslie

[cloister]

Sats in the 40s? Hell, I'd be calling a code too, and I'm an ICU nurse. You don't screw around with that, and the misinformed folks who told you that it "looks bad for the floor" might want to consider that it looks much worse when no help is called and folks subsequently get hauled to the morgue. I've never berated a floor nurse for calling a code in the middle of the night, and I've reeducated a few of my super nurse colleagues who had the temerity to sneer over what they considered "inappropriate codes". It's never inappropriate to call for help, and frankly, the rapid response guys would have done the same thing. Been there, done that.

The day charge needs a reality check. Hell, at least you stayed over to do the charting. Did the night charge take some of the load off you? Does your floor have a resource nurse? No? Well, then, short of cloning yourself or ignoring your other patients, sounds like you did all that was humanly possible. Two unstable patients? Some nights, I'm overwhelmed with ONE unstable patient. All of your patients still had pulses at the end of your shift, and baby, some nights, that's the only goal in mind.

Quit flogging yourself. Sounds like you did a great job!

[Thankful RN,BSN]

why did the doctor have to tell you to call a code for your pt with the super low sats? why didn't you call rapid response or the code on your own?

[cursedandblessed]

sounds like super nurse (but hey i'm just a lowly student-you all look like supernurses)

[Suninmyheart]

why did the doctor have to tell you to call a code for your pt with the super low sats? why didn't you call rapid response or the code on your own?

I had the doc on the phone while she went down to 40. It all happened within several minutes.

[Suninmyheart]

Sats in the 40s? Hell, I'd be calling a code too, and I'm an ICU nurse. You don't screw around with that, and the misinformed folks who told you that it "looks bad for the floor" might want to consider that it looks much worse when no help is called and folks subsequently get hauled to the morgue. I've never berated a floor nurse for calling a code in the middle of the night, and I've reeducated a few of my super nurse colleagues who had the temerity to sneer over what they considered "inappropriate codes". It's never inappropriate to call for help, and frankly, the rapid response guys would have done the same thing. Been there, done that.

The day charge needs a reality check. Hell, at least you stayed over to do the charting. Did the night charge take some of the load off you? Does your floor have a resource nurse? No? Well, then, short of cloning yourself or ignoring your other patients, sounds like you did all that was humanly possible. Two unstable patients? Some nights, I'm overwhelmed with ONE unstable patient. All of your patients still had pulses at the end of your shift, and baby, some nights, that's the only goal in mind.

Quit flogging yourself. Sounds like you did a great job!

Actually it was 3 unstable patients. 2 were RVR afib with one acute resp distr and the other was neuro with unstable sinus tach>150. Thank you so much for your support. I really don't get all the confusion about codes vs RR. In an ideal world can you tell me what should have happened? I would have liked a full code to play out with a doc there stat. But my charge downgraded it to RR and caused all this confusion. Plus an ICU nurse asked in the room "why did a code get called for this?" ??? Pt at 41%??? I don't get it.

Again thank you. And thanks eveyone for such support. I am really not flogging myself. I am ok with my behavior and choices and judgements that night. I just sometimes take it personal when a more experienced nurse gets so critical. I want to be able to look up to them and really find some mentors.

Sun