I Just REALLY Need To Vent.... - page 2
OK... how to do this and maintain confidentiality?? screw it.... got a patient from ER... the report was pretty benign, post partum a couple weeks, c/o pain for a week, n/v past few days. No... Read More
Jul 11, '02(((((LORI))))),
You are a good nurse and your instincts were on the ball.
I too have wanted to pull my hair out when our ICU staff start acting like that girl on the excorcist movie (schizo like). Now, I am NOT bashing all ICU nurses, just the few I've come across freauently (I work recovery, so I deal w/them every day). I have had them question me like I am trying to sneak a war missile into their unit, IN THE HALL---pt in the bed---stating "Why are they here, they are too stable for us", then with the next, unstable patient "how could you bring this pt in such unstable condition? The B?P is 80/46!!!" OH MY GOSH. So, babe, I know where you are coming from.
p.s: Feel better after the vent? I know I do
Jul 11, '02originally posted by fgr8out
ok... how to do this and maintain confidentiality??
got a patient from er... the report was pretty benign, post partum a couple weeks, c/o pain for a week, n/v past few days. no mention of a temp. gets to our med-surg floor... within 10 minutes, my cna reports she's "blue...shaking." sure enough, she looks like hell... room air sat 82%, cyanotic, shaking uncontrollably, temp 103, bp 90's/50's and dropping and pulse 170 (yes).
call admitting doc immediately and get an order to send this gal to icu, now.
call icu... whereupon the charge proceeds to grill me..."what do you mean she's "blue"..."what do you mean you're running her fluids wide open, why are you doing that?"..."did you crank her o2 up?"... all of this after i've given a brief report and indicated why i've done the things i've done... "gee miss icu charge... i dunno, do you think maybe cuz her pulse is 170 she's not perfusing well and that could be why she's cyanotic??" "gee miss icu charge... her bp keeps dropping and her pulse is racing... do ya think bolusing her with fluids is a good idea?" you get the general idea.
about 15 minutes later... the icu charge come to look at this patient... nevermind i've already said the doctor ordered icu. for some reason, it seems that doctors orders no longer mean squat if icu doesn't think the patient meets criteria. i'm asked if telemetry would be ok to send her to... at that moment the doc arrives and i run it past him... he says fine.. but he wants her on a monitored floor now.
so i give report...20 minutes later... to tele... who decide this patient (the one who isnt unstable enough for icu)... is too unstable for telemetry....
something magical must have happened... because an icu bed mysteriously becomes available... and finally.... 2 hours after the original order... my patient is taken to icu. but even then, the nurses taking her looked and spoke to me as if i didn't know what the hell i was doing.
now i understand that occasionally a nurse might just be uncomfortable with a patient and feels they would be better off in icu or somewhere similar... but i'm an rn with over 7 years experience and besides that... this patients symptoms screamed for more intensive interventions. what if i had been some namby pamby nurse who lacked the self confidence to push for this patient to be moved? hell, a thousand what if's....
even if i had been told that, in all honesty, there just wasn't a bed available for this patient... but had been given support by my fellow nurses from icu... i could have dealt with that. but in all sincerity... i feel as if my own assessment was being questioned and this patient's needs were severely jeopardized by the lackadaisical way this entire event was handled.
there...all off my chest now.
Jul 11, '02I am a computer novice, please be tolerant with me.
Try not to be so upset, this nurse wasn't questioning your judgement, she was showing her insecurities!!and stupidity.
Jul 11, '02I can understand your anger, you had a difficult time trying to do the right thing for your patient's welfare.
Jul 11, '02now!!!!!!!!!!!!!
You may have an idea what a snf nurse feels like, when we send a pt to the emergency room per mds orders due to continued deteriorating symptoms, definitely in distress, and all has been done at the snf to diagnose this pt. labs, xrays, meds and she is still deteriorating, but because shes a DNR and coming from a snf we dont know what the hell we are doing!
And after giving a report to the ambulance people and then to the RN in the ER and then to call back 1hr later and be told , honey are you sure she's not just comstipated and whats your policy about use of laxatives!!!!!!!!
Oh I am so tired of being treated like an idiot, by other nurses who work in acute settings!!!!!
SORRY its 2:30 am and I cant sleep I am so angry!
Jul 11, '02Venting is good...
Agree with the fact that the ICU nurse was a BULLY... ....
had a similar circumstance years ago...pt on tele going down the tubes...I talking seriously circling the drain... her rhythm was sinus tachycardia with increasing frequency of polymorphic pvc's,respirations were 36 bpm,shallow....first bully was a resp therapist....stated disbelief that the pt's SaO2 was 78% and I was told "give her a treatment"...did not come to see the pt until I " finally" (a whole diferent story) got a call back from the MD who ordered an ABG...ewww...the RT was "so suddenly" interested in my pt once she saw her...the MD comes in orders transfer to ICU,I called them and was told "we only have one bed left and we have to save it for "in house codes" "...welllllll....the perfect rabble rouser that I am said " Looky here...the doc is trying to prevent the trauma of a code from happening to the pt,he wants her there,NOW"...the nurse continued her ranting about the "in house code bed"...I just handed the phone to the doc and he told her " I suggest you pull back the covers,we are on the way with her and after she is there and stablized,you,me and administration are going to have a little talk"
Always seemed "strange" to me that an ICU could keep a bed "open"...anyway...once we got there,the BULLY was still all fired up about the "open bed "being taken for a tele pt who could have been stablized on the floor...etc,etc...after the pt was put on the ventilator and she was oxygenated and the pvc's had gone away following a hefty dose of Lasix, the MD turned on her like a rabid junk yard dog...phew....I was glad to get outta there,ya know...
I wish I had a book of wisdom that handled situations like your and mine and all the others...
Having worked tele for a number of years, I see this scenario more and more frequently...pts that "do" meet ICU criteria are place on our unit and we are extremely limited as to what we can do, due to policy...we could start drips but we cannot titrate them...oh well...that was where I used to work..now I work a "high level" tele unit where we do the drip/titration procedures but are not considered an ICU...so,we are not staffed as an ICU...we have no MD's who can handle a-lines or swanz ganz caths (nor are our monitors equipped for the modules necessary for hemodynamic monitoring), thus we are betwixt and between a very hard place...staffing does not change due to pt acuity and when there are nights when we have multiple pts on multiple drips, a whole lot of praying goes on... having also worked several ICU's...I know how quickly things can change no matter how many drips you have connected...if you cannot monitor a person's hemodynamic status during all of the meds and determine the response, we should just hire an on site psychic to determine the response...
ooopppps...I rambled...but I am also very frustrated with the bullying and down and out meaness AND STUPIDITY I see/hear every day...
I WOULD LET YOU BE MY NURSE ANYDAY!!!!! Thank you being an advocate for your patient!!!! You done GOOD!!!!
Jul 11, '02i hate when we have to fight with other staff to get our patients the care they need. its just stupidity when we dont have time for stupidity.
i had a pt going into arrest. told the supervisor that i needed an ICU bed NOW. she told me she only had one bed and didnt know if my pt qualified for it. "just put the crash cart outside his door"
his doc picked up the phone, called ICU..i have a pt that is going to arrest. im bringing him down NOW. a bed magically appeared. he coded 5 mns after he got there.
just put the cart outside his door...im not an ICU nurse..hes not going to get the care he needs. i couldnt believe her attitude.
Jul 11, '02My Oh My....these postings bring back vivid memories......
My thinking remains: burn out happens faster when it's your own kind setting the fires.
Here's to all nurses who won't step in the crap.
Jul 11, '02You go Lori! Your the one that makes us all look good!
I do agree with a few others and believe it should have started with E.R. No doubt they dropped the ball! And thanks to you for having the guts to pick it back up again and get it rolling in the right direction!
Its that drive you have that makes you so upset. Thank God for your drive and your knowledge.Last edit by andrewsgranny on Jul 11, '02
Jul 12, '02Telemetry units can be a scary place to work these days.
I'm an old ICU nurse who did a lot of telemetry /stepdown charge the last 2 years.....and I always told my ICU coworkers I worked harder and had more stress on tele than in the unit......those brave enough to float from ICU to stepdown/tele secretly agreed with me!! LOL!
Tele gets the half stable patients who are borderline critical and can turn on a dime....also gets overflows that SHOULD be in ICU but there is no bed OR no ICU nurse to assume care.
Since I was an ICU nurse doing stepdown charge, I was capable of intervening on the floor and keeping an intubated patient when we had to do so.....but nurses such as Lori that are not trained for this must get their supervisor involved for the patient's (and the nurses') safety. You did good Lori....too often these days ER patients are given limited attention...due to backup and pressure for short turn around time in the ER. Patients too often come to the floors with critical labs and dangerous symptoms undone or ignored.
Nurses today are so exhausted and overworked...and they are setting limits....which I understand too. If my hospital had it's way my ICU staff would have 4 patients each. Tele nurses would have 10. That is unsafe and I cannot accept that...see what I mean? I support nurses setting safety boundaries as we have professional liability.
There was no excuse for the ICU nurse's behavior towards you Lori...that was rude and uncalled for and you were right to call her on it. Good job!!
Bottom line...IMHO hospitals shirk their responsibilities by not ANTICIPATING and STAFFING appropriately for emergencies....and their solution is to browbeat and bully the staff into taking ownership of a situation that is NOT staff responsibility.
This issue is at the core of the nursing shortage, IMHO.
(sorry so long...this is one of my pet topics...hehehe)
Jul 12, '02Lori, I am so sorry this happened to you, and I can certainly understand how hopeless and frustrated you must have felt. Speaking from both sides, I just finished intervening a few nights ago when a Med-surg nurse desperately wanted to send an elderly DNR to the unit because she was unstable (yes, she was, but she would never be stable again for the remainder of her life) and she needed more care than the Med-surg nurses could provide (yes, she did, but still couldn't justify using an ICU bed for an elderly DNR when a more viable patient might need it). I've also jet-propelled an unstable Med-surg patient, full code, in septic shock to the ICU (lost the pumps and pearls somewhere along the way), while instructing the nurses to direct Dr. Sphinctermuscle to talk to ME when he complained that he was all set up ready to put the central line in ON THE FLOOR (he shut up when the patient coded five minutes later). There is NOTHING that beats the intuition of a good nurse and Lori, you sound like an excellent nurse. As an ICU nurse, I would have accepted your patient without hesitation.
That said, the ICU charge nurse in question probably didn't know you from Adam, and may have just been burned with "crashing" patients propelled to her unit who turned out just to need some extra O's, reassurance, and maybe a gentle dose of "vitamin A". What Should have been done, if course, was that if the nurse had doubts she should have come IMMEDIATELY to assess, or else the House Officer (Supervisor, whatever) should have intervened. I don't know what was happening in her unit at the time. And when those beds "magically" appear, it's usually because another, more "stable" patient, has been hurricaned to another unit, then someone polished the floor with spit in 30 seconds before accepting yours.
Whew! I needed to vent too. Thanks for bringing this to the forefront so that we can all understand how the other side feels!
Jul 12, '02Howdy Yall
From deep in the heart of Texas
Some of those Icu nurse can get pretty rough. But thats ok, I had a meeting of the minds with them, and ever since Ive never had any further problems, with them. Helps to develop a reputation, but isnt it a shame we have to resort to that