I graduated with my BSN in May of last year. After applying literally everywhere in Texas, I finally found a job at a small hospital on the outskirts of Houston. I relocated for my job without assistance. It is an ICU/CCU but because it is a small hospital, we don't see all that much. for instance, I've been working for 6 months and only seen chest tubes and arterial lines twice. Our hospital doesn't do open heart surgeries, swanz ganz, PA catheters. We don't have any resident or in house PA, NP, or MD except in the ER.
We don't have nurse aids. It is a 19 bed unit and we do total pt care: drawing all labs, bathing, turning, taking out trash and linens, calling Dr's. That's a huge one: It is apparantly acceptable at this hospital for Dr's to be paged 3-4 times in one night without a response. It is also common to have a 2:1 patient to nurse ratio, even if one of your patients is a new admit on hypothermia protocol, or a one-on-one suicide watch pt. We do not have sitters or nurse aids. We have one secretary that manually has to key in orders written by doctors or verbally recieved.
I recieved a pt with necrotizing faciatis who had been SOB increasingly over the past two days, as evidenced by nurses's notes and MD progress notes. I recieved her on 15L non rebreather, SOB, satting 92%. Her sats would immedietly and dramatically drop if she took her mask off. She did not recieve orders for a pulmonology consult until an hour before my shift started. The preceding nurse told me she called the pulmonologist immedietly, explained the situation, and he said he would see the pt tomorrow. Her charting reflected the same. There was another pulmonolist on the floor at the time who works with the one consulted. I thought about asking him to take a look at the patient, but thought it would be inappropriate since his collegue was already made aware of the pt and said he would see her tomorrow. Six hours later the pt started becoming anxious and picking, desatting. a PRN neb was given and her admitting MD was called twice with no reply and the pulmonologist that was consulted was called three times. My charge nurse told me to call the pulmonologist consulted regardless of who was on call for him. An hour later, the pt became anxious again. This time i called the on call pulmonologist and he was mad. He said he walked by and saw the patient, he should have been consulted days ago (I agree, but it is out of our scope of practice to consult. numerous notes were made about the admitting MD being aware of her poor resp status and chose to do nothing). He said "why were you sitting on it for 12 hours and calling me now?". I explained that we called his collegue right after we rec. the orders for the consult. He said he was there earlier he could have seen the patient and he is on call.
So am I supposed to call the on call MD an hour after the pulmonologist has already been made aware of this consult and said he would see her tomorrow? Am I supposed to chase after a colleague of the MD if I see them on the unit next time? Even though their colleague has been made aware and decided he would wait til tomorrow? I really wanna know what I should have done.
I also want to know if there are any hospitals hiring a RN, BSN with 6 months experience in the Houston area?! It's only a matter of time before they start giving me a patient load that is not safe, and I want to leave before that happens. I'm still new so they don't do it to me yet but do it to everyeone else. I'd prefer to continue working ICU and am eager to learn. Please help
Apr 19, '13
by Inori, ASN, BSN
Well that's the thing ... you cannot quit without a job because then you'll just be a new grad who didn't make it to 1 yr. I'd say start sending resumes out and interviewing BUT keep on working there for as long as you can you need that experience of 1 yr. of course if someone hires you before that point take it. Document everything, if its not documented its not done and if ever called to court you only talk about what was documented and nothing from memory.
REad up on your rights too. union has a form called protest of assignment. talk to your union rep, make sure you have your own malpractice insurance (NSO and few other places sell it)
Last edit by Inori on Apr 19, '13