hi there, it has been a wild weekend at my facility's maternity center. mostly because they continue to float from us imappropriately to staff other areas. and the new thing is to get all the newer people over to delivery and leave us "old timers" in the nursery or post partum. that wouldn't be so terrible if we weren't also responsible for checking on and overseeing delivery staff, who are in a whole other area., supervised via central monitoring...how much supervision is possible when there is one pp nurse (me, in this case) and one nursery nurse? our lpn was floated to pedi because god forbid there should only be one nurse for a few patients (even though i had 7 of my own with no backup). come to think of it, no one on our floor had any backup....i arrive and realize i will be alone on the floor. not too bad i decide. two fresh sections but both are moving well. one fresh hyst who cannot believe they have elected to discontinue her pca (dialaudid 0.2mg with a 0.2mg basal). she was switched to 800 motrin qid on day two. not a happy camper and, so i was told, had thrown just about every nurse who cared for her, out of her room.....thankfully, she remembered me from the night before and liked me....there was a pretermer, an old c/s and some vag deliveries to round out my crew. delivery had 3 patients with one pushing , at the time. who could watch the screen? not me...enter the nursery nurse, who was trying to do hearing screens and breast feeding teaching to all our tired shell shocked primips.....we decided to alternate babysitting duties at the desk, which i hate because i don't like having new borns out at the nursing station for reasons so obvious i am sure i don't have to go into them in great detail....any way, i got a post op back at change of shift who had had a vag hyst 2 weeks ago and began to bleed profusely while at the hairdressers. she was brought in and a tear in her vaginal cuff was repaired....at 0100 she complained of a tight squeezing band of pain starting under both breasts going around to her back and up to her shoulders and neck...gas, right? an option for sure, but she was clutching her chest (age 38 with no cardiac hx), so i gave her a mylicon and tried to calm her down....i had noticed her pulse was in the 40s so elected to do an ap, all along assuring her it was probably not serious but better to err on the side of caution, etc...during the episode her pulse was irregular, so i grabbed the code cart monitor and put her on it just to see if anything would pick up, and it looked as though she was going in and out of afib....finally the episode eased up and i went to call the doc, who actually hung up on me upon finding i had put her on the monitor...he went to do a delivery and i went to find him, mentioning i had ordered an ekg and the results were abnormal, showing an anterior infarct, question of age....he told me they "always said that." incredulous i told him that indeed they did not. he got frustrated and asked me what i wanted him to do so i told him i wanted him to be nice to me and let me order the labs i needed....all sorts of nutty things happened with the other patients, and the one person i was supposed to take a foley out of at midnight was a new breast feeding primip who wanted her sleep. by the time i was done with the events i just described, it was around 3 am..no way was i taking a foley out of a person with a major 4th degree lac/surgical repair unless and until there was someone besides me to either help her up or put the foley back in...in the morning they brought a delivered pt over and i just happened to walk in to the room at the same time, just in time to help get her out of the wc to bed. all of a suddenly she tells us she is going to pass out, and did.....the labor nurse and i looked at each other and burst out laughing. "oh christ", she said, what the hell else could happen ?" ( never a good question to ask in any hospital setting). between all three areas it was crazy......too many other idiotic and scary things occurred that didn't have to be so dramatic if we had had help. in the middle of it all the er called to have us go do a fetal heart. i tell them i have no one to send and they get miffed! i direct them to pedi and tell them to ask my lpn to go down and she refuses because the pedi rn wasn't comfortable being alone with 4 patients! so, of course, delivery had to do it....by the morning we were all slap happy. including the poor patient who had passed out and woke up to the sound of us laughing....boy, she says innocently, you girls are a really happy group! that set us off again...of course, we did apologize and explained we weren't laughing at her...in the morning i chastised the doc who gave me such a hard time because he is always so grouchy....uggghhhh. why does it always have to be such a struggle and then the day shift gets help! what is up with that????does anyone really think patients s:eep at night??? is it me???????
Mar 12, '02
Wow....that's a bad night......Our staffing is somewhat better but we get the royal screw turned on us "experienced" ones on holidays because all the least senior are new and they won't staff the unit for the day with them because they do not have enough experience....meaning that we with 15 to 20 years experience have to work the holiday that we should have off after working them through the years as we climbed up the ladder but new management said it was ok then but not now!!!!
Mar 12, '02
That doesn't seem right at all. Around here we had a similar situation and then came to an agreememt that people were staggered so that some experienced/some new did every other holiday.....I hope things work out for you because it seems pretty unfair what they are doing to you people who have been there. But, I hear you with the newer person situation......
Mar 31, '02
Is your manager approachable? Do you have a Risk Manager who is involved with L&D (your Manager and Risk Manager should be best buds)......
You can maintain credibility if you approach this problem from a risk management perspective--especially floating out of your area if you are not experienced in the area of nursing you are being floated to. The other way to address this is by discussing nursing retention--with the current and worsening nursing shortage, retention should be the primary focus. If nurses are routinely floated out of their area of practice they WILL go looking at other area hospitals. Also, it is not safe practice for less experienced staff to be "supervised" by a nurse from a different geographical location--Risk Management can validate that concern.
I hope you can get some support and generate some ideas to resolve some of these issues..................
What a crazy night!!! Thank goodness they're not always like that. Does your unit utilize "on-call" in L&D? I wouldn't work somewhere that didn't because of nights like the one you describe.