Experienced critical care nurse 10+ years. I worked in step-down unit for the last 3 years and pulling occasional shifts in the ICU and CCU. I've been on a new job for about 1 1/2 weeks now on nights in a 24 bed ICU unit on a 3 month seasonal contract. A couple of nights ago, had patient on vent plugging off ETT w/SPO2 dec. to 70's, HR inc. to 160-170's; started bagging/lavaging/Sx ; co-nurses/RT showed up. I am slowly learning who all the dr's are and have to take note during report who the dr's and their specialty. While I'm at the bedside working on this patient, the charge nurse called the hospitalist on nights and put me on the phone with her. When the dr. started asking me about the patient's doctors, I asked the charge nurse to speak to her and she took the phone. We got the pt. stabilized. At the end of the shift, as the charge nurse is rounding the unit and in this patients room, I ask her if there is anything I can answer for her. It turns out that she was very upset with me for handing her the phone when I should have spoke to the doctor myself about this patient. She explained that she has to oversee 24 patients and it would not be possible for her to know the details of every patient in the unit. She told me she was very upset about it and did not want to say anything in the room. I told her that I appreciated her speaking to me about this and that I understand and if in a situation where the dr. needed to be called, I will speak to them myself and not put her in that situation again and that I was sorry about it. I thought everything was ok until I ran into the manager this morning who inquired with me if everything was going ok and mentioned about the dr. situation, that this charge nurse spoke to her about it. I told her that the charge nurse spoke to me about it and that I completely understand and next time I will speak to the dr. myself. I said to her that my learning the dr's names/specialties/flow of the unit is taking some time. I feel like the charge nurse threw me under the bus. I am trying so hard to do my best with care of my patients, fit in with the staff, be a team player. I was hoping to cont. to be in good standing with management. I just don't feel it was necessary for her to take it a step farther after her and I having a long discussion about it. She was weird with me last night when she was in charge. I was thinking of staying on with this hospital but definately having second thoughts about it now after getting started off this way with not even two weeks on the job.
May 4, '11
I kind of agree with you if this would be your assigned unit. Why ask for more of the same treatment on a neverending basis?
May 4, '11
I can see it from both perspectives. On one hand you have a patient in distress and trying to stabilize, but on the other you can't really expect the charge nurse to know everything about your patients like who their doctors are. I know you didn't do it on purpose, but how do you think the charge nurse felt when the doctor is asking you questions and you just throw her on the phone to answer them? If I were in her situation I would be upset too because now she is on the phone looking like an ass because no one can answer the questions.
Personally it sounds like the situation is straightened out and that maybe this charge nurse is just left with a sour taste in her mouth. You are only 2 weeks into the assignment so it's pretty early. I say see how it goes in the upcoming weeks. If you feel like it is getting better and the staff is receptive to you and creating a favorable work environment, than stay. If not and you feel like you are being targeted than get out after the 3 months. Good luck.
May 4, '11
Tuff situation. If the hospitalist was the attending, then that's all you really need in a crunch, tell him/her what the situation is and get the orders you need. Stablilize the patient, then find out of there is a pulmonologist on board. You can always call them after, update them on what happened, and then they can bronch the patient or whatever. In our unit, part of the report we got at the beginning of the shift was a list of all the consults. There might be someone else on-call at anyone time, but at least we knew if there was a specialist on board. Sounds like you took care of the patient properly, so they can't fault you for that!
May 5, '11
Lucky for me per schedule this nurse is not in charge on the nights I'm working for the next month. So, I may be at some point working along side her. After working with her and offering help, I am hoping she can get a different opinion of me. I'll be respectful and nice with her and ride it out there for the next couple months and see what happens.
May 5, '11
You just can't please some people. Try your best, but don't make it obvious. I've only been on my unit 2 years and there's a few people in every discipline I've learned to just do the bare minimum with as nothing you do will ever change their opinion.
May 6, '11
Totally agree with you - I can not stand passive aggressive people.
May 24, '11
I would put her in her place. If i was busy stabilizing a critical patient certainly don't hand me the phone unless there is someone on the other end giving me orders...not asking me superfluous questions as if that is going to change their acute situation. Was this a transplant patient or some other specialty ICU patient? If not then isn't the doctor who is on shift responsible for all of her care and orders. Is this SICU, or MICU?? Overall, finding out a doctor's name and basic information required her to open a chart... that's it. If your hospital is wired then the hospitalist could of done the same thing. It sounds like in your hospital charge nurse is an actual higher position and I would presume that they get payed more... thus.. i expect them to do more. Its like when the bed nurse calls my unit and asks me how many free beds I have and if I moved such and such a patient yet....they should already know if they take the extra time to open their laptop. Overall she is petty for telling that to your manager... and your manager is petty for bringing that back to you.
May 25, '11
I had every intention of notifying the hospitialist after stabilizing the patient. Kind of irked me a little when she calls right in the middle of it. All in hind sight though. I quit the other day since I hurt my back last week and decided that I will most likely hurt it again after it heals.....not worth my health. The last shift I worked, my pain level started at about a 3-4. I had a walkie talkie pt. and another one on a vent. I had gotten to where I could not focus and concentrate on caring for this patient but didn't realize it until the charge nurse asked me if I did this and that and the answer was very embarrassingly "no". I didn't realize I had fallen so far behind until this moment. My pain was about a 6 at this time. The charge RN helped me get caught up. I was squirming around in the chair trying to chart and was totally messing up on that too. About 8 hours into the shift, I couldn't stand it anymore and the Charge RN asked me if I needed to go home and I said 'yes'. I noticed I was limping around for however long. It was because my left leg strength was considerably less than my right leg; pretty weird feeling and worried me alot too. I could barely drive home. I won't be working in a medical ICU again for sure. I'm thinking about CVICU or CCU but I've not worked in there very much over the last 3 1/2 yrs and my background is MSICU for over 10 years. I don't know if anyone would want a seasoned nurse in my situation. Don't know what I'm gonna do. I can do some lifting without a problem. It's just turning 2-3 patients every 2 hours on a 12 hour shift that kills me.
May 25, '11
Sorry to hear you had to leave your job. Hope your health improves quickly.
May 25, '11
That sounds a the managers and charge nurses of my ICU. I have to pray each night before going to work.
May 25, '11
i know i'm coming rather late to this particular party, but i guess i'd side with the charge nurse. with 24 patients, she can't be on top of the details of every single one of them, and you should have known who the patient's admitting physician was. many times, that makes a difference with what orders the hospitalist can or cannot give you. we have one surgeon that hates oxygen, and will verbally eviscerate anyone who orders (or uses) oxygen on a patient with an o2 saturation greater than 86. i'm not offering that up as a good thing -- it just is.
the charge nurse wasn't being passive-aggressive. she talked to you about it outside the room and not in front of the patient. isn't that what we all say we want? i don't think talking to the manager about it afterward was necessarily out of line. the manager (and charge nurses) quite rightly want to know how you're doing and how you're fitting in. the charge nurse wanted to know if this was an isolated incident or if you have a history of ducking responsibility. if it was an isolated incident, ok, they might cut you some slack but if it's part of a pattern, they may decide on some sort of remediation or further education. and for the manager to mention the situation to you was not passive-aggressive or out of line, either. she wanted to hear your side of the story. isn't this what we want from our managers? to hear our side of the story when someone "complains" about us or passes on some less than positive information?
as a nurse with a back injury, and a nurse with experience in sicu, micu, ccu and cvicu, i can tell you that a move to ccu or cvicu isn't going to be any easier on your back than micu. we get the same heavy adult patients, and they not only have to be turned every two hours, they have to be gotten up into chairs and hauled to their feet so they can walk in the hall. picu or nicu might be easier.
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