I have a question about my patient assignment last night. I have been a RN for 9mths, doing float nursing the entire time. Last night I floated to a Rehab unit where it was myself and a LPN. We had a patient on a ventilator. In our hospital Ventilators can only be in this Rehab unit and in ICU. I had never taken care of a Vent pt. much less that this pt was 12yrs old and her parents were very, very particular. Our policy is that LPNs cannot care for a Vent pt. Also in my orientation they never once mentioned that I would take care of Vent pts and had absolutley no orientation. I immediately called the House Supervisor and told her that I was not comfortable but knew there was no staffing to help cover the shift. The LPN had volunteered to help me out as much as possible, but overall it was still my responsibility. I was extremely nervous almost to the point of tears of what would I do if something went wrong. I had six other patients as well. The house super called in the unit manager to cover the pt, which she was upset about. Did I do the right thing. I didn't actually refuse to take the pt, but if I would've if I thought there was anyone else to cover. Did I do the right thing?? I did spend the night trying to find info on vent. pts but would still not feel comfortable taking care of one. Our policy and procedure basically states respiratory takes care of the pt, if alarms sound call resp. stat and manually bag the pt. If alarms were not sounding there was no other policy for assessments I should be doing. What should I do if I am in put in this position again??
Apr 27, '06
Without a proper orientation to vents, I'd have refused, too. my unit has 2 vents (trach's, not endotracheal vents). THey often have to be suctioned. If you didn't know how to suction a vent pt, are you supposed to bag them until resp comes? that won't help.
you did the right thing. they can get pissy all they want, butyou have your license to worry about.
suppose you did take care of her and something happened. in court, you know, they ask you what any prudent nurse would do. but, ifyou've never taken care of a vent, you wouldn't even know what a prudent nurse would do in said situation.
you did the right thing.
Apr 27, '06
I think you did the right thing. I would've felt very uncomfortable taking care of a vent patient without proper orientation. Even with orientation I was scared to death to take care of a vented patient and that was an adult one. I can't imagine a peds patient with parents around.
You really need to know what you're doing when something alarms or if they pull the vent off. What kind of a place do you work at where resp takes care of the pt when the vent alarms and you manually bag til they get there. Our resp suctions the patient when the round but we also are expected to suction. We also fix them when they alarm and if we have a real problem we page respiratory to come take a look at the vent and the patient.
If you're a regular float as a new grad I'd make sure someone oriented you to vents because it's more then likely you'll come across one again. Or else make sure what exactly the policy says about you being able to take vented patients. I'd assume that since you float you'd be expected to take care of patients like that. YOu were right to ask for someone to help you considering you've had no orientation.
Apr 27, '06
You also need to put it in writing that you were very uncomfortable with the assignment and give it to the head nurse of that unit.
I do not agree with new grads taking float positions. How can you get an orientation to all the floors you are going to? Our new grads are hired into a specific unit and then get 3 months of orientation to that area. They also have to pass a vent competency test about the vents we use. I'd call Education and training and inquire about what type of orientation you should have received, esp if you are floating around like that!
May 1, '06
If I could do it all over I would never take a float position again as a new grad. Way too much information overload. Extremely stressful. I had approximately 3 mths. total orientation to the hospital and the 6 areas I float too. Sad part is the only nurses who have vent pts are supposed to be rehab or ICU nurses and the rehab nurses do not take competency tests. Not sure about ICU. During orientation no one bothered to tell me they could even take Vent pt's down there. much less teach me a thing about them. This is the first they've had in over a year. I talked to my manager about it and she told me we'll just make sure it never happens again. I don't believe that but like I'm looking for a "home" floor anyways.
May 1, '06
"Just bag the patient" Hoo boy!! I love adminstrative ignorance. It is actually not that difficult to cause the patient an awful lot of problems if you do NOT bag them correctly. You certainly need to be shown how to bag a 12 year old child - too easy to do the wrong thing!!!
I have seen a tension pnuemothorax (this was many, many moons ago) on a young 16 year old that had been bagged during transport - the only reason that it did not kill the kid outright is that he did have a fit cardiovascular system.
shame on those who diminish nursing responsiblities - you did EXACTLY the right thing!!
May 8, '06
You didn't do anything wrong. First of all, the unit manager has 24 hour responsibility for her unit. That includes making sure the unit is properly staffed. I don't know the reason you were floated to her unit, but it doesn't matter. The nursing supervisors did the best they could to cover the hole in this unit's staffing. It wasn't your fault you didn't know what to do with a ventilator. The nursing supervisor was absolutely correct to call the unit manager in. I know, I was a unit manager and this kind of thing happens occassionally. I got paged one Sunday evening while I was at the movies and had to go to the hospital and work because one of the staff called off and a replacement couldn't be found. The fact that the unit manager was miffed was her problem, not yours. What a biddy! I wouldn't want to work for her.
Aug 23, '11
Ask your supervisor to schedule aVent Care orientation for you to attend as soon as possible. Since your hospital is now admitting vent patients, there is no question that you will find yourself in that same 'situation' a lot, and, sooner than later. After the orientation you will be able to care for vent patients with confidence backed up by knowing what to do through study. If an orientation is not available where you work, google or yahoo "Ventilator nursing orientation classes in- (your zip code). Go back to your Med-Surge Nursing textbooks and review everything about Respiration. Don't forget to visit www.respitatorynursingsociety.org
. There you will find links to EVERYTHING, and EVERYONE respiratory. Best of luck, and, this is important: You DON'T have to apologize for your insecurity. It would be best if you kept it to yourself, as a new RN, team member, care giver and person. Ponder that free nugget of wisdom.
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