Unsafe practices

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    i will apologize now for the lengthy post- i want everyone to have a very clear picture of the situation. i guess this is really just a vent or maybe profound disappointment on my part. i know what i need to do but i have such an overwhelming sense of guilt and disloyalty, that i feel i just can't leave.

    i have been a nurse for 3 years and an icu nurse for 2 years. i worked in every aspect of nursing cna, huc, mt, and icu tech prior to becoming a nurse. i saw alot, kept my mouth shut and listened to many great nurses- so when i became a nurse, i wanted to be the best nurse i could be. i signed up for every nursing magazine, joined organizations, and of course found an. i believe i am a very good nurse. i just passed ccrn on july 27th and truly do think i have good critical thinking skills and am an asset to our little icu.

    i have worked at this hospital for 6 years ( and across town at our competitor for 7 years prior to that as an icu tech)- we are a small community hospital with a larger sister hospital about 12 miles away. we were owned and mismanaged by a "board of trustees" that had a very conservative and somewhat inept view of nursing. though we were constantly understaffed and many times didn't have the things we needed- we were mostly happy with our jobs and the people that work at this hospital- right down to the housekeepers and dietary workers- all are great people and are the main reason why many of us stayed.

    last october a large national "health management company" bought our little hospital out. it has been nothing but hell since that day. now don't get me wrong- maybe not all- but most of the employees saw this as a positive possibility for us to now get what we truly need staff and supplies and md's for coverage (many times we have to divert due to not having cardio, neuro..etc or the patient sits there over the weekend and waits until monday to be seen). however, this did not happen...for 2 months nothing happened- all jobs were frozen due to a changeover to their human resources division. now- 6 months later- though there are jobs posted- there are few applicants (qualified at least).

    so now on to me and the point of this whole post. though many of us stay due to one another- numerous changes including termination of the entire management throughout the hospital have taken a few of our core staff out of the equation by first promoting them to management- then firing them - so it's been rough but i have tried to hang in because of multiple reasons. i am per diem- but work full time hours. it is close to my house (about 10 minutes) and since i have a teenager- i like to be closer if something comes up.

    this past monday i came into work- i'm in charge with 3 other nurses who are not so strong - 1 a traveler, 1 new hire- who thinks she knows everything, knows little and does little and an older nurse who knows a lot but is so disorganized, it boggles the mind that she can manage to get much done. it's ok for the first hour- i mean i'm busy- we have no ancillary staff- no huc scheduled- no tech just 4 rn with 8 pts. there are 4 vents and i have an unstable stemi that infarcted his anterolateral plus septal wall- is continuing to have active chest pain ( a stent was placed to a 100% stenosed lad ) pressure is in the toilet and is going into cardiogenic shock. i won't bore you with the details but over the next 3 hours we get 3 more admissions with no additional help. i transfer my other patient out in order to get a post op- with my stemi still unstable. so last straw was house sup calls and says there's a respiratory distress on the floor needs to tx to icu- i am the only one with 2 pt's that could absorb another (so i'm told by house sup- however, older rn has 2 vented pt's) - my stemi has gone into rv failure- he is truly in resp distress- so i tell house sup- i will not take the patient that it is unsafe. i am told i cannot refuse a patient and must take it. i told sup- i'm not taking it- they can assign- i will not take report.fire me if you want-but i'm not taking it. my stemi ends up on a vent and getting a balloon pump...house sup talks older rn into taking 3 rd pt from the floor- here's the kicker-- this resp distress pt that was in such bad shape that they would endanger the life of my stemi and post op pts- she came in talking on her phone, no o2, and asking to get up to go the bathroom!!!it's not the point that ,ok- well she would have been a no brainer and you could have absorbed her without problem- the problem is-then she takes valuable time and care away from my patient that truly need my care. and this is ok with them! someone is going to die!!!

    so my dilemma is...4 or 5 of us still work here that are loyal to one another and if we leave then the problem of short staffing is only exacerbated, they run shorter and shorter- days are worse and worse- and patients are the ones that end up getting horrible care.

    in the 6 years that i have worked at this hospital- no matter how bad the day was- i never let it get to me so bad that i allowed myself to lose control and cry. last monday, i did....i cried and cried and hated myself for allowing them to push me to the point that i was at. i just felt so overwhelmed...i felt i couldn't give my patient the care that they deserve....this 50 year old stemi is the same age as my husband..what if it were my husband- would i want the nurse taking care of him to have 3 or more patients...this guy should have been a 1:1....i left charting until after the night shift came in...i was there until 11:00 pm charting....i love being a nurse....i am so proud to be a nurse....but not this way....

    i could have a job at one of the large hospitals in orlando that is 45 minutes away...i just don't know what to do
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  3. 8 Comments so far...

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    Just keep this in mind.....it's not just your facility. The ratio for critical care is quickly turning to 3pt assignments.
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    Sounds like you either need to learn to deal with it, or find another job. 3:1 is not an insane staffing ratio for any ICU, but nonetheless dangerous. Ours is 2:1 no matter what, and if any supervisor tried to make anyone 3:1, we'd have our manager all over them.

    If I were in your shoes, I'd be looking elsewhere. You've got a strong resume for an ICU nurse, take it someplace where it's appreciated.
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    Unfortunately, there is a whole business model for buying a facility and running it into the ground. I hate it for you because I can sense that you are really a good nurse and I appreciate your loyalty to fellow workers. I have nothing to offer but support and to say not to allow yourself to become a victim of this situation. I realize that you are there to help, but if you burn out, you can't help anyone. A person does reach a point in life where they deserve to be able to just go to work and enjoy what they do. I hope you can find that and I wish you well.
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    You nurses need to band together and say "No, we will not take three ICU patients, that is unsafe." Make sure that this issue is addressed in your staff meeting minutes for future reference.

    Why not transfer to the sister hospital?
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    I don't mean to neglect the point about unsafe staffing. I totally agree. As a new ICU though I was just wondering how the unstable STEMI ended up doing? Do you guys maintain the patient on a Heparin protocol and provide supportive care for the cardiogenic shock? IVF, arythmic management, pressors if need be?
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    Quote from catamounts303
    i don't mean to neglect the point about unsafe staffing. i totally agree. as a new icu though i was just wondering how the unstable stemi ended up doing? do you guys maintain the patient on a heparin protocol and provide supportive care for the cardiogenic shock? ivf, arythmic management, pressors if need be?
    he ended up doing fine and was discharged like 4 or 5 days later- he initially he been put on integrelin- but then was maintained on heparin. he did not end up with a balloon pump- i was able to diurese him and get dobutrex and dopamine up and manage his failure. both the dopamine and dobutrex helped his pressure- so he ended up fine...the staffing...not so much....
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    Good work laurel
  11. 0
    Quote from meandragonbrett
    Just keep this in mind.....it's not just your facility. The ratio for critical care is quickly turning to 3pt assignments.
    Why is this happening?

    Shouldn't be too hard to show with evidence that this is a bad idea, but hospitals that have those ratios probably don't want to support such studies.


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