Last night shift I worked with 2 of my colleagues one who is one of the units senior staff nurses (SSN). We each have at least 10 yrs experience, she our SSN has about 30 years ICU experience.
we agreed that I would go on break first and our SSN would go last.
I return from break and my colleague goes on break next and gives report on his patients, rooms 7 & 8 to her.
She is notorious for sleeping on the job constantly falls asleep at the desk so when she asks me if she could go to the lounge and take a 15 min break because she is so so tired I shrug and let her go.
The surgical resident then comes by and asks me if I'm covering bed 8, I say no our charge is, but how can I help? He says the patient is more tachycardic and is in pain, could I please medicate him for pain.
As as I go to assess Rm 8 and get some morphine I notice my charge nurse back on the unit, talking with the surgical resident about a medical patient in Rm 7. Curious I go into Rm 7 who looks a bit unstable and the resident asks me to page RT. I go back to desk to page RT (who took forever to come) and then answered a call bell in Rm 3.
I come out of Rm 3 and see my charge nurse sitting down at the desk charting by the tele monitor and apparently the surgical resident went back to the call room. Still curious about bed 7 (who I am technically not covering and know nothing about but hey we're here for every patient ) I ask her what's going on with the patient and she just shrugs and say she doesn't know what wrong with him and let's wait for RT.
I begin to worry and look at Rm 7 on telemetry and his pulse oximeter says 80 and he's still tachycardic to 120s-140s. I go to room and talk to patient asking him if he feels worse, he nods yes, he is diaphoretic, and is using accessory muscles to breath and is also grunting and sounds wet. I immediately increase his fio2 on his high flow to 100 and tell my charge that his saturation is now 75% and that I'm going to page the medical resident who is assigned to him immediately. I speak to the resident and tell him that the patient seems to be deteriorating and will need intubation.
Internal medicine intern comes to unit (with RT running behind him) and debates putting patient on biPap and wants an abg first and I tell him that patient needs imminent intubation, biPap will not help. Back and forth debating with intern while my charge nurse just stands there. Intern decides he wants his seniors opinion. Senior comes to floor and patient ends up intubated within 5 min. I was so irritated at my charge nurse.. how are you here with 30 years ICU experience and leave a deteriorating patient, not call the covering MD and just shrug it off? Couldn't she see the patient was in distress???
This is not the first time she has shown lack of skill or expertise. I had a code recently and she had no clue how to fill out the code sheet and was asking me what to write???
She once had a patient with a subdural hematoma, consistent systolic BP in 200s on nicardipine running at only 2.5 mg!(starting dose) because she didn't know that cardene was a titratable drug. I had to titrate it myself.
She had another extremely critical patient who coded and she was not ready...no defib pads on patient, I ran the code on her patient while she stood by watching. She freezes in code situations.
I feel so unsure now with her covering my patients . I've worked with a lot of awesome nurses with differing amounts of experience but c'mon after 25/30 years how does one still struggle like this? She's a lovely woman but this is so unsafe.
