This is why I am an anxious wreck... - page 2

Going to work always makes me anxious. You know, when you can't sleep, eat, or enjoy life. When your brain is consumed by what will happen and how you will handle it all.Granted, some days go well, and it actually feels like I... Read More

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    Ive hadsomany shifts latley were i'm treding water trying to get from handover to handover without anything bad happnening to my patients. I know that only some prioty care is getitng given. However my who ward feels liek it too much. I work a neuro surgical ward(floor) have 7-9 patients with trachey, Log=roll, EVD. fresh from threare of stepdown from critical care.
    it is mad and unsafe and i cope as best as i could.
    we hada ward meeting yesterdya were everyone said it was unsafe and out ward mamager will take a staff nurses workload to see how it feels. maybe we will get 2 nurses per patient team then.
    We now have hourly rounding 4P, with asking the patient if we can get them anything and letitng them knwo we will be back.. msot staf canot do this as we don't have time we try to enure they are ok and have everything so that they are comfortable.

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    If they do send the patient anyway, then you write an incident report if the relationships have deteriorated that far. Usually there is a space on the incident report for explanation and you can explain your rationale, putting the patients needs over yours in your explanation. Words fail me here but I think you get the jist.

    Eventually the "norm" will change but you may have to be the one to initiate it, and also the one that takes the crap for it in the beginning. Just be professional, listen patiently to their tantrum and tell them you don't like it either but that's the way it has to be on your end. Tactfully and patiently is the key here. Expect it because it's going to happen but know that you'll be giving the best care that you can and remember it's your responsibility to act as patient advocate.

    Also, I was thinking - regarding the 20mg of morphine given. PACU rarely keeps them over an hour and if that patient were going to ICU or step down, that dose would be acceptable but to send a patient to a med-surg floor after given that much in such a short time is not kosher. Just because it's on the protocol list does not mean it should be given taking into consideration where the pt. would be transfered to. Of course respiratory depression would happen. I'm not saying the patient didn't need it, just that the transfer should have been to another unit for monitoring even for a few hours.

    There are different acuity levels in hospitals - one ICU or step-down isn't like another. Some ICU's in rural or community hospitals would be equal to a step-down(or even med-surg) in a trauma 1 center. Yet we become accostomed to a 1:2 or 1:3 ratio when in fact, it isn't necessary. Therefore, the nurses resist. I've been there also so can understand.

    Mind you, it might take 6 months to 12 but the sooner you change things, the sooner you won't feel this way at the end of the shift.

    One last thought - I'm not advocating refusing patients just because you are busy or.....just because. You're still running your butt off but you're following the protocol for new surgical patients. You could also start keeping track of the time it takes you to do each of these tasks for these patients and then ask management where the extra man hours are coming from....again, hard to put into words but hope you understand what I'm trying to say.

    All of this is based on safe patient care - remember that. It's not how the nurses are feeling so stressed (which you definitely would be) or that you're running your butt off (and you are) because in their eyes, that's what you're suppose to be doing. All explanations have to relate to safe patient care.


    Don't feel bad though about that shift. Sounds like you handled it fantastically. Sometimes we don't know the alternatives open to us and this is one good reason this board is so important.

    Just one more thought - do you ever get direct admits? That is one admit you can't "schedule" for lack of a better word at the moment. ER nurses (who I was) always keep the unknown in mind - what would happen if you had one (a direct admit) at the same time? Happens and there is nothing you can do about it at the time because they're coming regardless. Would have been even more of a disaster and another reason to be assertive and an advocate.

    Good luck to you
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    I too got a little anxious reading this as well. I have been a nurse for almost 2 years now. I have finally learned to take a deep breath, and as long as all my patients are safe, I don't care what else gets done. Again, I say, as long as I know they are safe, a non urgent med can be late, charting can be late (I usually get this done early in shift anyway) and anything else can go to the next shift.
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    we can NEVER tell pacu or er to wait at our facility, in fact there are policies in place forbiding this once the patient has been assigned a room and approved by a doctor to go to the floor. you can argue for higher level of care but the pt will be on their way to you by then.
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    A wait of 15 to 30 minutes isn't a long time, it's not unheard of and most will do it if you ask - once you have a working relationship with the other units. Granted, it takes time to get that kind of relationship but it can be done. Furthermore, that kind of relationship is necessary and worth working toward IMHO. It also goes both ways. I was ER and ICU so I'm not advocating for med-surg specifically but advocating for safe patient care - which I had a reputation for.

    I don't mean to be argumentative but I would read that policy again - and also your floor policies. Many times we are so busy the actual policies that regulate our behavior are the last thing we are able to become familiar with. Policies have a way of being transmitted through conversations and not verified by the very people they effect.

    It wouldn't be such a big deal if in fact the supervisor was there to help, staffing was adequate and the nursing mix was right but accommodations have to be made for the increased acuity and staffing problems.

    I'm not saying it's going to be easy or readily accepted, especially by the other units at first. It's an option for optimal patient care. What's the alternative?

    This is becoming quite the discussion, isn't it?
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    I will be having discussions with my supervisor. I am obviously newer to the game and will learn from my experiences. However, I did precisely what I was told to do the last time I was in an overwhelming situation. Asked coworkers for help and called the supervisor. We all know how that went. Now you tell me...if you have done what you have been instructed to do and no help it me or the system? I can learn to play the game better, but why are we playing a game in the first place? I am mad. It all seems to fall back on me.
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    You ..and your patients are in an UNMANAGEABLE situation. This facility will try to force you to manage an impossible assignment, then make you question yourself when you do not fulfill these impossible requirements.

    This is all about the almighty dollar.

    It WILL not change.. get out now.
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    Quote from Been there,done that
    You ..and your patients are in an UNMANAGEABLE situation. This facility will try to force you to manage an impossible assignment, then make you question yourself when you do not fulfill these impossible requirements.This is all about the almighty dollar.It WILL not change.. get out now.
    Unfortunately, I am getting the vibe that you are right. I asked about what I can and cannot do in regard to asking PACU to hold a patient. What I was told is that we cannot do that because patients are charged for the amount of time they spend in PACU. Therefore, it is allegedly frowned upon to practice in such a way. Basically I get the impression that the higher ups are just listening and don't care. They have to listen, but don't have anything to offer other than to say tough luck.So, the next time this happens its me against the world I guess. I will be long gone the next opportunity I get, but I can't count on that happening too soon. Two kids, loans, guess I gotta grin and bear it.
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    I would like to know why PACU brought up a pt that had just been recently Narc'd? You know once that dose wears off the pt was going to be circling again. I think that was unfair of them to dump like that, knowing that pt was going to have issues. They should have kept the pt until he was completely stable..not sort of stable.

    Is this standard practice? We have an 80/20 rule. We know that 20% of the time it's going to hit the fan no matter how hard we try. The 80% should be a decent day with no problems.

    My former hospital had me feeling unsafe virtually every day. I tolerated that for years until I burned out. At my current facility, it's more like a 80/20 rule, but borders more on 90/10.

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