Help me, I'm falling...

l.rae · Jan 19, 2003

ICU nurses have a lower nurse/pt ratio, are very methodical in assessments, everything your need for a critical pt must/should be at hand....it is really not surprising that it is more difficult to multi-task, delegate and prioritize so many pts. Not anyones fault, just a "side effect" of being in a different nursing environment.......then not to mention all the life changes and stress.....we all adapt to our different nursing enviornments and being thrown into an unfamiliar situation is difficult...doesn;t mean you are inadequate...not at all!........LR

LoriAnnRN · Jan 19, 2003

Yes, you are qualified for home care. You were pulled to a place you were not familiar with, that's all. Don't doubt yourself and don't give up; we've all had shifts like that. I personally think floor nursing is enough to try Florence herself! It's not you, it's the entire floor-nursing world (in my opinion anyway).

ruby360 · Jan 20, 2003

Wow, you've really been through a lot! I can't imagine how you must be feeling after having been through so much in a short period of time. Don't be too hard on yourself. I think the administration at your hospital made a mistake by floating you to a stepdown unit in the first place. Its unconscionable! It really should not be done routinely, if at all. ICU nursing is very different from work on a floor. I can see pulling a very experience ICU nurse to work the floor but, a fairly new nurse who went straight to an ICU orientation without first working on a floor, well that's just asking for trouble. :eek:

I had a preceptor during my maternity rotation in nursing school who told me a similar story. She went straight to work in labor and delivery after graduating. She been a nurse for about two years and one night, they pulled her to work on a med/surg floor! She said it was a disaster and something she never wanted to go through again. However, the hospital reviewed their floating policies and it never reoccurred. She stayed in L & D, loved it, and has now been a nurse for 15 years. In addition, she moved forward in her career and works (at the same hospital) as the RN coordinator for perinatal services, a nice 9-5 no weekend job! :)

In the past, the vast majority of new nurses had at least a couple of years of experience on a med/surg floor before moving into a specialty area. Now it is not uncommon for many new grads to start directly in a specialty (LD, ICU, ER, etc.). At any rate, it takes most nurses 2-3 years just to become competent in the particular area they practice in! You are probably a very capable nurse, who does a fine job in the ICU! Pulling you to work on a stepdown unit with 6 patients is like you starting as a new grad all over again without any orientation. Yes, you made a mistake by not asking for more help but, you can take from that experience and learn from it. Furthermore, I believe the hospital/nurse managers must take the blame for most of what occurred. It was bad decision making on their part!

As for what you should do now, you have several options. I think getting some help from employee assistance to help with the grief process is a good start. However, I don't think that your grieving had much to do with what happened that night. It could have happened to any nurse pulled to an area they are quite unfamiliar with. You can tough it out and stay at that hospital, making sure that they honor your request not to be floated to the floor without a lot more orientation or back up. You may feel uncomfortable there now but, as they say, "this to will pass". If the hospital is unreasonable, I would leave! Look for another institution that is more supportive of their nurses.

With the nursing shortage the ball is in our park, although hospitals may not want us to believe it. If we are not more assertive, many hospitals/administrators will continue to coerce us into situations which may be unsafe for us and patients, just to fit there own agendas. I'm sorry for what you are going through! Good luck, I'll be rooting for ya'!

sunnygirl272 · Jan 20, 2003

Originally posted by BadBird
Perhaps a transfer to med/surg floor will benefit you, it sounds like your nurse manager is offering you help so reach out and take whatever is offered. It takes a long time to master critical thinking skills and to deal with all sorts of stressful situations, this does not mean that you aren't a good nurse you just need time to learn to organize and prioritize. I know how frustrating it is to work with no supplies, no computer code, etc.. Please don't be afraid to ask for help, let the charge nurse get your supplies if you don't have a code, reach out and ask questions, ask for help, we must all learn to work together but no one can read a mind so speak up. Don't give up, even though you had a bad night you will also experience many great nights too.

i second this....

also advise seeking help fromeap which you said you are doing....regarding home care, most agencies i know of require a full yr of med-surg type experience (icu would qualify)....home care is a unique specialty (well, each specialty is unique in its own way..) as someone mentioned, thjey are in their own home, so they call the shots...their compliance issues are more obvious...and more troublesome to deal with, as they are on their turf...you are out on your own....have to learn to improvise,as you may not have on hand exactyl what you need....

PM me if i can be of help in with home care questions.

i am sorrry for you rloss, and i commend you for trying to stick with things.

whipping girl in 07, RN · Jan 20, 2003

I think you're being a little too hard on yourself. I graduated December 2001 and went straight into ICU. Until September of last year, I had to periodically float to different floors in the hospital. Now we are decentralized and can float if we choose to (instead of being cancelled for low census). I hated floating, and I think some of the nurses would deliberately be harder on me (give me the worst patients down 3 halls and then be too "busy" to help me). Most of the time, things went OK, but a few times I had the night from hell. I think your manager is also being too hard on you if you had a bad night floating with no orientation (they did the same thing to us).

Floor nursing has a totally different focus than critical care. If you are used to spending 15-20 minutes assessing each patient and another 15-20 minutes charting the initial assessment and you approach your floor assignment the same way, then you'll start out way behind and have a hard time catching up. So you'll have to focus on the reason why the patient is in the hospital and do a quick head-to-toe.

Another trick I learned is to pass your meds when you're making your assessments. For instance, if you are working 7p-7a, pass your 2100 meds as you do your assessment. Also, in report, if the nurse tells you about a wound, ask what supplies are needed to change the dressing and if they are already in the room. You may want to save that patient to assess last and do the dressing change (if it's BID or q shift) right then.

Finally, if a patient is saline locked, flush it to make sure it works when you do your assessment (even if it's on the MAR to be done at a certain time, it won't hurt to do it early). I can't tell you how many codes I've been to where the patient is saline locked and it doesn't work; then you're trying to start an IV while someone's doing chest compressions!

Don't be afraid to ask for help, even if you're working with a bunch of jerks who act like they're too busy to help you. If you don't ask, they can always say, "I assumed she was doing OK, she didn't ask for any help." And of course, you have to be willing to help as well.

If you like ICU, there's no reason why you shouldn't stay in ICU! You might consider another facility (ideally one that is decentralized or at least floats to only one or two similar areas) but you should not run to home health just because you had a bad night on stepdown.

Tweety, BSN, RN · Jan 20, 2003

Asking an ICU nurse to take care of six patients and have it go smoothly is crazy. I'm sure you did the best you could, if they don't appreciate your efforts it's their loss.

Do whatever you need to do for yourself, including employee assistance. I hope you're feeling better soon.

-jt · Jan 20, 2003

Come a little closer so I can slap that right out you. You think YOU did this? YOU did not "fail". The system in that hospital failed & the "leadership" that put you into that situation set you up & failed you. Got it? This happens constantly & its why we have our contracts ban floating out of clinical divisions, limit floating completely, & have formal orientations to "sister" units within the same clinical division. Its a safety thing cause what you just described is happening over & over again. Its also why we have new Rns first work in med-surg areas for at least one year before going into a specialty. They gain organizational skills & learn better how to manage pts there. Ive been in ICU for 20 years & still feel discombobulated when I float to step down & have to keep track of 5 pts. Its not just you, so stop doubting yourself. Its no reason to jump ship.

Did you get any formal orientation to that unit? Did you ever get any formal orientation & practice in caring for its pts before they threw you in there & let you fly by the seat of your pants? If not, just put it right back on them, hold your head up, & demand that they take some responsibility for this too. Technically, you should have protested the assignment in writing - that gives them the liability for anything that hits the fan & protects you some from what they are charging you with now. You should have notified the charge nurse and/or the supervisor that things were getting out of hand, especially when you got backed up on the pt care & meds cause "we couldnt help if we didnt know you needed it" - & med errors are a big thing. But you were put into this situation & they did it to you. Dont accept the blame for all of it yourself.

If floating to this unit is an acceptable thing & you can expect to float there again, demand a real orientation there. If you dont get one, file a formal protest in writing next time you float. You shouldnt be agreeing to work anywhere that you havent been oriented & educated to work in. If you dont protest it, its assumed that you "agreed" & they use the "you failed to tell us it was a problem so its all your fault alone" thing. And then you could get reported to the state for med errors when you shouldnt have even been there in the first place. Why do you want to work in home care? If its because you think you are a failure & are running to hide - dont. You will always doubt yourself then. Just live & learn & grow. And speak up more. Theres no reason to allow yourself to be put into unsafe situations again.

P_RN, ADN, RN · Jan 20, 2003

Big old hug....... I worked 22 years in a 700 bed hospital...on one floor.... knew it like the back of my hand......low census and we'd get pulled.....even 4o feet across the lobby I'd feel pretty much like you did. Condolences on the loss of your Father.

You have had a lot to deal with....my dad's been gone 21 years come this month and I can remember how it affected me.

Take the Emplolee Assistance.....you're NOT totally at fault and don't let them tell you that you are. Write an anecdotal record of what you have told us here.......And there is no shame in realizing you got over your head........take it easy on yourself.

Coco48170 · Jan 20, 2003

Oh my Gawd, I feel like I just got a group hug from everybody! When I look back on that nite, I think part of the problem was I wanted to really assess my patients and I couldn't!!! I have got to learn to ask for help when things start to get out of control. Period. There is a nursing job fair coming to this area this week, I think I am going to go just to see what else is out there, too:)

Thank you everybody for your thoughts and support, they helped more than you'll ever know. :kiss