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.