Thinking of working at Vanderbilt Children's Hospital?

Nurses General Nursing

Published

Here are some reasons to think twice.

First, let me just say that I know that many of the issues I am raising are epidemic in today's hospitals across the board. I know the grass is not always greener. But the thing than motivates me to vent like this is the fact that the institution I am about to leave, markets itself to nurses one way, but is essentially the same as everywhere else. If they say they are going to be special and different, if they say they want to be the best and want to stand out above every place else, then I would think that some type of real effort would go into that promise. Anything short of that effort is little more than hypocrisy and lies.

They, (VCH), do not make more than a feeble attempt to market themselves too, or recruit experienced Nurses. An occasional experienced pediatric RN may fall out of the sky and into their lap, but the vast majority of your new co-workers are going to be new grads. One bonus for the new grads was that they raised the pay by a dollar an hour for an entry level RN. But they did not adjust the rest of the pay scale accordingly. One way to look at it would be to think that everything was being done to get more nurses on the floor. Another way to look at it would be that an increase in value was being placed on those who never got paid to care for a patient as opposed to those that are already here. You, the reader may decide.

Their pay sucks. It is at the bottom of the market. (A base of $21.00 and change per hour for my years of pediatric experience.) The powers that be will tell you that it is in line with their market surveys. But speak to nurses at other hospitals and compare wages. You will find that VCH is at on near the bottom. Also missing from their pay consideration is the fact that services offered are specialized and one would think professionals would be paid for that specialty.

Vanderbilt is a very academic institution. The work that needs to be done by the floor nurses is not academic, it is procedure orientated on a day to day, hour to hour basis. However, the typical RN's performance is judged by some far off, academic standards that do not apply to what one does on a day to day basis.

When it comes time for your annual performance evaluation, it will be done by yourself and your peers only. Management will not write an evaluation on their own. They will tally up the numbers and summarize what has been said about you and your compensation will be based solely upon that. You will have no recourse on this matter, you will have no way to challenge a person on what they have said about you. A very cowardly and lazy approach from my perspective. Also, if you grade yourself or someone else too high, you will be essentially told to change it by being given an impossible set of criteria to meet in order to justify those high marks.

The performance evaluation criteria are exactly the same for everyone. From the PICU nurses to the ER nurses to the regular floor nurses. You get no extra points for being skilled with IV starts, chemo certification or running ECMO for example. It's a one size fits all, cookie cutter approach that totally disregards what ever subspecialty one might develop skills, expertise and a real passion for.

On the last round of performance evaluations, the manager of one unit knocked points off everyone's eval. because the unit scored poorly on an in-house inspection because there was equipment in the hallway. Never mind the fact that there was not, (and still not for that matter), any place to store it. It did not matter if you were off that night, were on vacation or had not even been hired when that inspection had taken place, points were deducted. Sort of flies against the face of an individual performance review in my opinion.

The managers manage numbers, not people. The "kudos"/"awe craps" are geared around things like patient satisfaction surveys and general statistics. A great day for a manager is when the FTE to patient ratio improves by a tenth of a point. Never mind that some poor nurse was overwhelmed by an exceptional high acuity patient load. That never sees to matter. If one complains about it or tries to ask for more help, the stock answer starts along the lines of, "Well, the numbers...."

I respect the fact that patient satisfaction surveys are important and a useful tool to measure quality of the service. But that is only one facet of measuring the quality of care given. It also has no way of disregarding the absolute unrealistic expectations some parents may have as well as the true mental cases that might complain as well. When the kitchen and cafeteria are closed at night, it is still the nurses fault that a patient could not get a hot meal at 2:00am when they were finally admitted. If an ortho. doc comes in to consult 3 hours late, it's the nurses fault. It's the nurses fault when little Bubba does not get his popsicle in a timely manner because the staff was preoccupied by working a code on Bubba's next door neighbor. (All of these have actually happened.)

VCH staffs by the numbers, not by the mission. VCH has a brand new, beautiful, state of the art hospital which they market to the hilt. They promise to be the first, last and best place for children anywhere in the country. But they don't staff it accordingly. There are almost always beds closed due to staffing issues which generally boil down to either lack of available staff or trying to save a few bucks. If your child suffers a traumatic brain injury which requires immediate surgery, it's best if he or she does it during daylight hours, during the week. At least then there is a surgical team in the house.

You have to pay to park there. Sorry, that is a minor issue that sticks in my craw every time I go there. One should NEVER have to pay to park where they work.

Like virtually everyplace else, they use "Enron" style accounting logic when giving out benefits. When one signs on there, one is told that they get 7 paid holiday off per year. And that is absolutely correct. IF you work a 9 - 5er, 5 days a week. If you are a nurse who works the typical 3, 12 hour shifts per week, you get paid 7.2 hours of those holidays. Ditto for the vacation days. (Apparently, the logic goes, number of hours in a work day are 8. Since a nurse works 36 hours in a week as opposed to 40, they work 90% of a work week. That would equal 7.2 hours of an 8 hour day.)

Charge Nurse candidates are not chosen for their potential leadership skills or their experience, they are selected on their likelihood of going along, unquestioningly, with every lamebrain idea that comes down the pike. It is astonishing to me sometimes to see a coworker get elevated to the level of charge nurse and in a few short months, they absolutely forget where they came from and what they did while they attempt justify some of the most idiotic ideas that are promulgated by upper management. (How much for the soul of a nurse? A mere $3.00/hour or there abouts at VCH.)

VCH is very big about paying lip service to the concerns of the staff. If enough people complain, the solution is to form a committee of nurses to study it, identify the problem and find solutions. Then it is kicked up to the administrators where, if it will cost a bloody cent, it will die a slow and agonizing death. (The number 1 activity for nurses week? "Blessing Of The Hands" by the Chaplin twice a day. PLEASE!!!) (Although, I am sure it sounds great from a marketing standpoint when they announce the schedule for the blessing of the hands every other hour over the hospital wide PA system. Can anyone say, "CRASS PANDERING?")

I went to VCH over 3 years ago. I watched with growing excitement as they new hospital was being built. I thought it was going to be a special place to work where things like experience, leadership, education, commitment to excellence would not only be cultivated, it would be valued. Instead, and it pains me to say this, it's just like any other place here in good ole corporate America. It is run by accountants with the eye always and only on the bottom line. The difference is that Vanderbilt operates on a pile of cash. They sit on a billion dollar plus endowment. It does not have to be like any other place. It could actually be special. But for whatever reason, it is not.

I will be leaving shortly. There are still some good, RN friendly, pediatric facilities out there. I have done my homework this time instead of just being awed by the "Vanderbilt" name and assuming that it will be a great place to work. To the people that work there, I say, "Take care!" You guys are great. To the people that manage that place, I say, "Good luck." Because, stay on this same path and it will be luck alone that will preserve the reputation of VCH, especially as word gets out and more and more people realize just the kind of operation you are running.

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to the people that work there, i say, “take care!” you guys are great. to the people that manage that place, i say, “good luck.” because, stay on this same path and it will be luck alone that will preserve the reputation of vch, especially as word gets out and more and more people realize just the kind of operation you are running.

there are alot of excellent hospitals in the nashville area that are very very patient safety centered and employee centered.an example is baptist hospital.....where is "the" place that people want to give birth at?its baptist! if you like high acquity areas they have those too i have heard.i have also "heard" that they are a place where experienced nurses gravitate to....and stay once there.i have also "heard" that their pay exceeds vch...and that the environment is a nice patient safety centered well staffed environment.

child....dont compromise yourself.if you feel that this hcf is failing the nurses and the patients...leave.dont compromise what you know and feel in your heart is not "the place" you should be.money...can come and go...but your character...your ethical standards is something that isnt for sale.you will form new cooworker relationships at whatever institution you choose to go to...but call the nurse recruiter at baptist.i think they'd welcome a nurse like you with open arms.fyi- they dont take new grads in high acquity areas.hope this helps.....and like i said.....dont change your character for any institution.

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Awesome post, workingforskies.

Good luck to you.

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Specializes in Geriatrics, Cardiac, ICU.

You, as an employee had to pay to park? I was a volunteer at VCH and I never paid. Weird.

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Workingforskies...I work at the adult side of Vanderbilt and it is not any better there either.My nurse manager does whatever she wants to do with our VPNPP too.It is all about the budget.We are just peons.Crazy things happen here and I dont see how in the world they get by with them.I have only been here a year but I am ready to go.People have no idea what goes on here.It makes me so mad some of the things that these managers get away with doing to us.I mean are there not like laws against stuff like this?WE get like penalized bc some moron left a cart out in the hallway during a mock drill.I want to say EXcuse me I was busy taking care of patients something you care nothing about.

Our whole unit is like all new grad nurses.I mean there is no one there to help because they are all new.Management doesnt want to hear it because it affects our precious budget.They could care less that it isnt safe .And it isnt fair to us.

The morale is so low here because of all their crap. Some nurses they treat great and the nurse sucks.Some they hate and they are the best nurse in the world.But they dont see the stuff that matters.They see bottom line you are right.

Here are some reasons to think twice.

First, let me just say that I know that many of the issues I am raising are epidemic in today's hospitals across the board. I know the grass is not always greener. But the thing than motivates me to vent like this is the fact that the institution I am about to leave, markets itself to nurses one way, but is essentially the same as everywhere else. If they say they are going to be special and different, if they say they want to be the best and want to stand out above every place else, then I would think that some type of real effort would go into that promise. Anything short of that effort is little more than hypocrisy and lies.

They, (VCH), do not make more than a feeble attempt to market themselves too, or recruit experienced Nurses. An occasional experienced pediatric RN may fall out of the sky and into their lap, but the vast majority of your new co-workers are going to be new grads. One bonus for the new grads was that they raised the pay by a dollar an hour for an entry level RN. But they did not adjust the rest of the pay scale accordingly. One way to look at it would be to think that everything was being done to get more nurses on the floor. Another way to look at it would be that an increase in value was being placed on those who never got paid to care for a patient as opposed to those that are already here. You, the reader may decide.

Their pay sucks. It is at the bottom of the market. (A base of $21.00 and change per hour for my years of pediatric experience.) The powers that be will tell you that it is in line with their market surveys. But speak to nurses at other hospitals and compare wages. You will find that VCH is at on near the bottom. Also missing from their pay consideration is the fact that services offered are specialized and one would think professionals would be paid for that specialty.

Vanderbilt is a very academic institution. The work that needs to be done by the floor nurses is not academic, it is procedure orientated on a day to day, hour to hour basis. However, the typical RN's performance is judged by some far off, academic standards that do not apply to what one does on a day to day basis.

When it comes time for your annual performance evaluation, it will be done by yourself and your peers only. Management will not write an evaluation on their own. They will tally up the numbers and summarize what has been said about you and your compensation will be based solely upon that. You will have no recourse on this matter, you will have no way to challenge a person on what they have said about you. A very cowardly and lazy approach from my perspective. Also, if you grade yourself or someone else too high, you will be essentially told to change it by being given an impossible set of criteria to meet in order to justify those high marks.

The performance evaluation criteria are exactly the same for everyone. From the PICU nurses to the ER nurses to the regular floor nurses. You get no extra points for being skilled with IV starts, chemo certification or running ECMO for example. It's a one size fits all, cookie cutter approach that totally disregards what ever subspecialty one might develop skills, expertise and a real passion for.

On the last round of performance evaluations, the manager of one unit knocked points off everyone's eval. because the unit scored poorly on an in-house inspection because there was equipment in the hallway. Never mind the fact that there was not, (and still not for that matter), any place to store it. It did not matter if you were off that night, were on vacation or had not even been hired when that inspection had taken place, points were deducted. Sort of flies against the face of an individual performance review in my opinion.

The managers manage numbers, not people. The "kudos"/"awe craps" are geared around things like patient satisfaction surveys and general statistics. A great day for a manager is when the FTE to patient ratio improves by a tenth of a point. Never mind that some poor nurse was overwhelmed by an exceptional high acuity patient load. That never sees to matter. If one complains about it or tries to ask for more help, the stock answer starts along the lines of, "Well, the numbers...."

I respect the fact that patient satisfaction surveys are important and a useful tool to measure quality of the service. But that is only one facet of measuring the quality of care given. It also has no way of disregarding the absolute unrealistic expectations some parents may have as well as the true mental cases that might complain as well. When the kitchen and cafeteria are closed at night, it is still the nurses fault that a patient could not get a hot meal at 2:00am when they were finally admitted. If an ortho. doc comes in to consult 3 hours late, it's the nurses fault. It's the nurses fault when little Bubba does not get his popsicle in a timely manner because the staff was preoccupied by working a code on Bubba's next door neighbor. (All of these have actually happened.)

VCH staffs by the numbers, not by the mission. VCH has a brand new, beautiful, state of the art hospital which they market to the hilt. They promise to be the first, last and best place for children anywhere in the country. But they don't staff it accordingly. There are almost always beds closed due to staffing issues which generally boil down to either lack of available staff or trying to save a few bucks. If your child suffers a traumatic brain injury which requires immediate surgery, it's best if he or she does it during daylight hours, during the week. At least then there is a surgical team in the house.

You have to pay to park there. Sorry, that is a minor issue that sticks in my craw every time I go there. One should NEVER have to pay to park where they work.

Like virtually everyplace else, they use "Enron" style accounting logic when giving out benefits. When one signs on there, one is told that they get 7 paid holiday off per year. And that is absolutely correct. IF you work a 9 - 5er, 5 days a week. If you are a nurse who works the typical 3, 12 hour shifts per week, you get paid 7.2 hours of those holidays. Ditto for the vacation days. (Apparently, the logic goes, number of hours in a work day are 8. Since a nurse works 36 hours in a week as opposed to 40, they work 90% of a work week. That would equal 7.2 hours of an 8 hour day.)

Charge Nurse candidates are not chosen for their potential leadership skills or their experience, they are selected on their likelihood of going along, unquestioningly, with every lamebrain idea that comes down the pike. It is astonishing to me sometimes to see a coworker get elevated to the level of charge nurse and in a few short months, they absolutely forget where they came from and what they did while they attempt justify some of the most idiotic ideas that are promulgated by upper management. (How much for the soul of a nurse? A mere $3.00/hour or there abouts at VCH.)

VCH is very big about paying lip service to the concerns of the staff. If enough people complain, the solution is to form a committee of nurses to study it, identify the problem and find solutions. Then it is kicked up to the administrators where, if it will cost a bloody cent, it will die a slow and agonizing death. (The number 1 activity for nurses week? "Blessing Of The Hands" by the Chaplin twice a day. PLEASE!!!) (Although, I am sure it sounds great from a marketing standpoint when they announce the schedule for the blessing of the hands every other hour over the hospital wide PA system. Can anyone say, "CRASS PANDERING?")

I went to VCH over 3 years ago. I watched with growing excitement as they new hospital was being built. I thought it was going to be a special place to work where things like experience, leadership, education, commitment to excellence would not only be cultivated, it would be valued. Instead, and it pains me to say this, it's just like any other place here in good ole corporate America. It is run by accountants with the eye always and only on the bottom line. The difference is that Vanderbilt operates on a pile of cash. They sit on a billion dollar plus endowment. It does not have to be like any other place. It could actually be special. But for whatever reason, it is not.

I will be leaving shortly. There are still some good, RN friendly, pediatric facilities out there. I have done my homework this time instead of just being awed by the "Vanderbilt" name and assuming that it will be a great place to work. To the people that work there, I say, "Take care!" You guys are great. To the people that manage that place, I say, "Good luck." Because, stay on this same path and it will be luck alone that will preserve the reputation of VCH, especially as word gets out and more and more people realize just the kind of operation you are running.

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Specializes in Geriatrics, Cardiac, ICU.

When did things get so bad? I worked at Vanderbilt Stallworth as a tech for agency and I had a wonderful experience.

I only had 6 patients at night on the neuro floor. The nurses did rounds with me and even showed me how to insert a catheter.

I felt very appreciated and I thought things ran very smoothly. That's just my experience though.

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Workingforskies...I work at the adult side of Vanderbilt and it is not any better there either.My nurse manager does whatever she wants to do with our VPNPP too.It is all about the budget.We are just peons.Crazy things happen here and I dont see how in the world they get by with them.I have only been here a year but I am ready to go.People have no idea what goes on here.It makes me so mad some of the things that these managers get away with doing to us.I mean are there not like laws against stuff like this?WE get like penalized bc some moron left a cart out in the hallway during a mock drill.I want to say EXcuse me I was busy taking care of patients something you care nothing about.

Our whole unit is like all new grad nurses.I mean there is no one there to help because they are all new.Management doesnt want to hear it because it affects our precious budget.They could care less that it isnt safe .And it isnt fair to us.

The morale is so low here because of all their crap. Some nurses they treat great and the nurse sucks.Some they hate and they are the best nurse in the world.But they dont see the stuff that matters.They see bottom line you are right.

And the truley sad part is that your department head is also the president of the Emergency Nurses Association. So on the one hand, the person who is head of an organization that is supposed to be the voice of emergency nurses is also the head of a department that allows her nurses to be treated like little more than sides of meat. Sort of says something about where nursing is going, doesn't it?

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and the truley sad part is that your department head is also the president of the emergency nurses association. so on the one hand, the person who is head of an organization that is supposed to be the voice of emergency nurses is also the head of a department that allows her nurses to be treated like little more than sides of meat. sort of says something about where nursing is going, doesn't it?

can i say....i am not shocked by this?this hcf started actively recruiting new grads for high acquity areas a couple years back.experienced nurses were really something they did not want around....and you guys are probabaly right.it is probably due to budget issues.you would think...that with a name like vumc....that they would be more prone to go with the experienced nurses bc all the research studies have shown lower m&m rates with experienced nurses on duty.but...alas....this isnt what alot of hcf are looking at.they are looking at the bottom line versus patient safety, and nurse retention. i think...when you can bring new grads into high acquity areas in "small" numbers it is great. but when you hoard them in like cattle it isnt fair to them.what kind of environment have you placed them in? i mean.....i read an excellent post the other day that said that new grads are brought in bc they are more compliant to "go along" and not question questionable occurances. it is the managers "cheap labor" ticket to meeting their budget.

as far as stallowrth-vanderbilt. it is not actually part of vumc.they are not offered the vumc/vch benefits.stallworth is a "joint venture" between a corporation like (hca-or something) and vanderbilt. but again...not a vumc/vch institution and not granted the same benefits...bc....it is truly not vumc. perhaps thats why you liked the environment at satllworth.

and as far as the staff / resident being great at stallworth and vch/vumc i dont think there is any question that it appears that both the nurse at vch and vumc really like their coworkers and the residents/attendings. i think there main underlying issue seems to be the fact that management at this hcf has run amuck and disregarding alot of things like the value of these two nurses,it is sad when a hcf is more concerned with the "bottom line" than the other issues that the above nurses have described. i still dont understand....is it legal for them to "dock" you guys raise for an event that occurred when you were not on duty ...or were tied up rendering care to a actual patient when this "mock drill" occurred?????:stone :o

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and the truley sad part is that your department head is also the president of the emergency nurses association. so on the one hand, the person who is head of an organization that is supposed to be the voice of emergency nurses is also the head of a department that allows her nurses to be treated like little more than sides of meat. sort of says something about where nursing is going, doesn't it?

sides of meat is pretty accurate.and when you say "the truely sad part is that your dept head is also the president of the emergency nurses association and also allws nurses to be treated like side of meat".thats like contagious here. its like do you remember "nurses take your break campaign" that was on not long ago?i mean that's something that the dept heads came up with along with the nurse managers.my nurse manager might say for us to take a break in public while she smiles for the camera.. to portray that image. but that is not what she means.she means she could care less that i have been standing here for 12 hours and havent taken a break or even gone to the bathroom.i can never figure out which face she has on each day. she has two or three of them.

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Well, you know what? If I need to pee I'm going to pee. If I get so stressed out I need to take a few minutes to step outside I'm going to do it.

If that gets me fired all the more reason I wouldn't work for a place like that.

How can they tell you bold faced that it is your right to take lunch/breaks then expect you not to do it?

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The situation everybody mentioned about VUMC is happening all over .As long as nurses are not united and part of a bargaining unit, ie union, things like these are bound to happen.It's just so familiar and everything you described was almost what happened in our hospital .

Nurses need to get educated about unions. Get a worthwhile union that would show you how to protect

your jobs , your future and nursing practice. What is your Board of Nursing doing? If they allow other disciplines

to encroach into your scope of practice there would come a day where we won't have our RN practice because we will be part of an endangered species. In California they started to re-engineer our hospitals in the 90's in response to the bottomline of HMOs. Hospital corporations' CEOs were buying and vacationing in exotic places and getting ridiculous amounts of compensation

while their hospitals are staffed inadequately and patients

are not cared right.For profit corporations are buying hospitals(mergers and acquisitions) and laying off longtime employees,sending a message to the young

students that nursing is not such a career to get into

nowadays. This was the beginning of our nursing shortage. HMOs did not take care of our patients. Patients

were discharged too soon from hospitals, they were not followed up well outside of the hospitals and they get readmitted in even worse condition.

California Nurses Association , as a union, disaffiliated from ANA, because the same powers that be in the ANA were the same nursing administrators in charge of hospitals who were re-engineering and deskilling the RNs

and replaced them with unlicensed personnels.

CNA decided to educate non union nurses and organized them,expose HMOs and CEOs(Tenet healthcare) excessess . CNA fought to get RN to Patient Staffing Ratio

and took them more than 10 years to finally get it.

Now it has ore than 65,000 members and counting. Our nursing registration is slowly going up and a lot of nurses

are coming back to the bedside.CNA union nurses are enjoying some of the highest salaries in CA. We still have

problems but it's nothing that we can not handle.

I would have gotten out of nursing yrs ago if not for CNA

giving me back my inspiration and motivated me to fight

for my patients and my profession.

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well, you know what? if i need to pee i'm going to pee. if i get so stressed out i need to take a few minutes to step outside i'm going to do it.

if that gets me fired all the more reason i wouldn't work for a place like that.

how can they tell you bold faced that it is your right to take lunch/breaks then expect you not to do it?

[color=darkslategray]well....i suspect what summerakrn meant was probably the availability of staff to relive them. safe staffing levels are a big issue and in case anyone missed the news there is a nursing shortage out there. they might say to take your breaks....but if they work in high acquity areas like this....and another nurse is watching their own 2 busy patients.what then? they dont "spit out" relief nurses for you to take your "break". they might "tell" you the politically correct answer-take a break....but then not provide you enough staff to be able to do that."thats" how it works. these nurses ethical core make them postphone bathroom breaks till its almost too late!lol....and in the real world...its not uncommon to not get a luch break at all...or not get it till almost the end of your shift....esp in high acquity areas like picu and er....and icu's. "that"...is the real world.lets play this out: you work on the same ed unit as workingforskies.....you have 2 patients at 7 pm...but by 9:30pm you have just gotten them to their assigned floor for the night and just get told you are needed in trauma bay 1 bc your new patient ( patient 1) just arrived.no time for a bathroom break! here is your trauma patient below:

1.patient #1-one has had a mva multiple facial fractures,intubated, rib fractures, blood pressure keeps dropping and you have given boluses ns, crit is dropping,chest tube is in both lungs, pulse is stable at 130 and sbp is hanging out at 80-90 on this 21 year old female.trauma has no open beds so this one will be your patient overnight in the ed.you have to take them to ct scan. they are still having hemodynamic instability issues .now you find out they have ordered a mri and they need the patient "now". no bathroom break and it is 11:40pm. by the way......your charge nurse just told you that you will be getting a transfer patient in from another hospital....but dont worry they are suppost to be "somewhat stable" just some mild respiratory issues! they are 45 minutes out! dont worry you are told!!! you have time for patient 1's mri so dont fret. you go to mri and are biting your nails bc you have been there in mri for 50 minutes. mri is done....and you wheel patient 1 back into their bay as the door flies open with patient #2.its 12:55am now...and youve had no bathroom break!!!!! but.....its caotic what in the world is going on with your new second admit - patient #2???(4th patient for the night really)!

patient #2-they are ambu bagging your patient #2 that was suppost to be somewhat more stable.physicians are yelling stat orders for this patient 2...they need you to get rt for a vent, they need to place a central line so you need to get the central line, tubing and supplies, grab some drugs for the intubation too!time for a bathroom break????uh....no!your second patient is a 45 year old male that has come in with a pulmonary embolus, you need to draw the coag labs stat ...and if ok start the tpa /skinase .you finally just got patient #2 finally emergently intubated,family is hysterical needing info on patients status,his sbp was 160 on admit.you draw labs, 20 min for a spiral ct for this patient,help with the central line placement, order the xray to verify placement of both the ett and line.it is 1:40am.good grief..you need to go to the bathroom.you quickly look at your patient #2's pressure before heading to the bathroom. omg!!!!now after 30 minutes of the tpa/streptokinase infusion it has shot to 250.you "pause the tpa/skinase...now you have to find the doc who luckily is in the room with another nurses trauma patient they just got in.he gives you orders for labetalol...which you either have to hand write/ or key into the computer for pharmacy....all the while you notice the sbp is now 270.its almost 2:00 am!!! you quickly get labetalol out of the pyxis....give 10 mg.....recycle the bp cuff again......it is still high @210..you give another 10 mg...and recycle the cuff again.omg...patient one's vent is alarming!

you head off to patient #1's room and see the airleak chamber is bubbling!!! you grab some vaseline guaze/or xeroform....wait for them to exhale and place the xeroform to seal the leak.great! no more bubbling!!!!but the bandage looks like crap! gotta redress it now! grab your abd pads. 4x4's and tape.now patient 1 is "fixed......kinda...for the moment.

you head back to quickly check on patient 2's pressure and it is back up to 235.you really need to go the bathroom. my god its 3 am! you still pause the tpa/skinase...find the doc and get an order for a nipride gtt.gotta key in the order quickly. the cuff just recycled....and the sbp is now 265! you grab the nipride out of overide in the pyxis...get your tubing.....stay with the patient as you titrate it till the sbp hits 185. family wants to see the patient and get some info!!!!!meds are also due on both patient too!you still need to go to the bathroom and ask the charge nurse for a relief break.she replies and says "she d love to help.....but they just got another level1 patient in....no one is free and the she is helping with a patient in the midst of a anterolateral huge mi".

you quickly give your meds and then plan to go to the bathroom..........but! the lab just called you with a crisis lab on patient 1 .his crit....is now 13.2. you look and he is tachycardic at 170. you find the doc in the trauma bay with the "new" trauma patient.he give you orders for 4 units prbcs, recheck the crit afterward,and oh yeah rescan his belly(ct). you eneter your orders, hang the blood, and off to ct you go. its 4 am....and someone let the family back!!!!omg....you need to pee! no nurse in sight...but boy oh boy.....that family is so glad to finally get to see the nurse they have a blue million questions and you start by trying to answer question #1 to calm them.you do the 4:30 am meds while talking with the family and hanging the 2nd unit of blood.finally the doc shows up after the family is calm and asks if they have any questions. the family says "no.....the nurse just finished answering our blue millionth question and we are fine!!!!" he .....then leaves after he asks you whats going on with patient #2. omg....you havent checked on them for 20 minutes!!!!!!! you walk in the room with the doc. it is now almost 5 am.tpa has been shut off for hours and one of the patients pupils just "blew".the doc needs another stat ct to r/o a cerebral bleed caused by the tpa/skinase.the patient is headed towards brain death! off to ct you go.

you get back from ct .you do your 6 am meds.its now 6:20 am.omg!!!did you write the verbal orders for the intubation drugs???nope ya didint.you write the orders.the 4th unit of blood is in.gotta redraw that crit! its almost time to give report and leave!by 6:35 the bood /crit is off to the lab, and all orders have been written and checked. what is the day shift nurse doing here????omg you say.....it is 645am.you have had no bathroom breaks...and are no lunch.but...your patients got all the orders and tests done and processed quickly and the have somewhat stabelized for the moment....so it was worth it you rationalize.

do you get the picture? "this" is how it happens. staff is spread too thin for the high acquity patients.its not like the nurses are setting around the desk and the charge nurse has ya roped in at the nsg station and refuses to "open sesame" to let ya go to the bathroom. its busy. i have worked in a large level 1 in the eastern us.this is "how" nurses go without br breaks at times in level 1's. your patients are your #1 priority. it happens.....no lunch...no bathroom break.for those of you who have worked in icu's and busy ed's you know how it works!!!!we have all had those busy busy shifts...and unfortunately we take care of ourselves last........bc our patients are always the 1st priority,i hope this clarifies things....as to how a nurse can be placed in a situation of having no meal or bathroom break during his/her shift.this is why so many states are wanting staffing to acquity laws."this" is what the big deal is over staffing issues.

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