I Just REALLY Need To Vent....

  1. 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 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.
    Last edit by Fgr8Out on Jul 10, '02
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  2. 31 Comments

  3. by   Rustyhammer
    I hate it when that happens.
  4. by   ceecel.dee
    I was just reading in the 'gut feelings' thread....your gut feeling probably saved some newborn's mama!

    Keep up the great work!
  5. by   Sleepyeyes
    Originally posted by Rustyhammer
    I hate it when that happens.
    I second that, Rusty. There's a way to ask. And then there's a way to bully.
    You got a bully. :stone:
  6. by   l.rae
    l hate power struggles......why do people feel they have to do this??????? Really great for the ''nursing'' image.....LR
  7. by   CANRN
    HOw sad, but it happens all too frequently! What would have ticked me off, the doc backed down on this one! I guess miss ICU CHARGE was the boss.

    That patient was lucky to have YOU as her nurse!
  8. by   Fgr8Out
    Originally posted by CANRN
    HOw sad, but it happens all too frequently! What would have ticked me off, the doc backed down on this one! I guess miss ICU CHARGE was the boss.

    That patient was lucky to have YOU as her nurse!
    actually the physician was there just long enough to assess her... he ASSUMED she was going to ICU/Telemetry... he had a delivery to go to.... I'm sure he wouldn't be thrilled to know it took so long......

    and thank you to everyone for the kind words****
  9. by   hoolahan
    Thank God you didn't begin to doubt yourself, and advocated for that pt to be where she needed to be!!!

    :angel2: :kiss
  10. by   ERNurse752
    This one falls back on the ER...they didn't give you a complete enough report, b/c if they had actually given you an accurate clinical picture, you would have known before any of this ever happened that she should be an ICU pt.
    The ER should have pushed for an ICU admit...I agree that she was too unstable for tele as well.
    Heck, she shouldn't have even left the ER that unstable! Did they even do anything for her?
    Good job to you, for getting her the appropriate level of care...keep us posted on how she's doing if you hear anything!
  11. by   Fgr8Out
    Originally posted by ERNurse752
    This one falls back on the ER...they didn't give you a complete enough report, b/c if they had actually given you an accurate clinical picture, you would have known before any of this ever happened that she should be an ICU pt.
    The ER should have pushed for an ICU admit...I agree that she was too unstable for tele as well.
    Heck, she shouldn't have even left the ER that unstable! Did they even do anything for her?
    Good job to you, for getting her the appropriate level of care...keep us posted on how she's doing if you hear anything!
    it was suggested to me that ER acted exactly that way... however, the report I received was NOTHING like what I saw. To be fair... she wasn't in that state upon arrival, but became so within 5 minutes of getting her settled into bed.

    I was told that "some ER" personele have sent patients in sad shape though.. because they have been unable to get an ICU bed for them... and that they seem to think that by sending a patient to the floor... there will be faster results. I won't say any of this is true... it's just heresay. And I would hope and pray that wasn't the case with this little gal.

    thank you for your thoughts.
  12. by   misti_z
    We need to trust each other's instincts. Especially after reading the 'Gut feeling' thread most of us are gifted!! We need to stick together. That stuff makes sick.

    Good job!
  13. by   live4today
    Fgr8Out....I'm so glad you stuck to your guns on that one or some tiny baby might be without his/her Mamma right now. Man.....the gall of ICU! Were there any famly members witnessing any of this? Poor thing! I do pray she makes it so she can return home healthy and be with her family, especially that new little one. :kiss
  14. by   OBNURSEHEATHER
    Good for you Lori for seeing it through and getting her where she needed to be!

    Any word on how things turned out?

    Heather

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