advice needed, safety concerns

[ICURN2424]

Our unit has experienced a lot of turnover the past year or so, we lost a lot of senior very knowledgable staff due to being run out by new management. We have had a lot of new nurses come in, a lot with med surg experience...and they just keep saying they are just learning...??? I understand that but giving b/p meds to a patient on vasoconstrictors is not acceptable and she tells me she doesnt have time to look up the meds...

Management tells us that we need to address these things with the new nurses so they can learn, but management doesnt do anything with the concerns...I am totally stuck, I dont even know what to do...this is becoming a crazy environment and I feel like its going to be a patient dying before something is done...everything is being swept under the rug, granted I know we ALLLLL make mistakes, I am learning myself I have only been there for 2 years, but I need to know what I need to do...we have some very sick patients in the unit that depend on us!!

[Esme12, ASN, BSN, RN]

This is the example of what I have said would be coming all along. You can't chase out seasoned nurses and expect quality care. I worry about the future right now but it can be changed.

Where is your educator? What about your preceptors?

I know this will probably not make you popular and of course it will be said amongst the new nurses to the unit that you are one of "those" ICU nurses and they will cry NETY...but you need to speak up.

Stop them and tell them...IN ICU things are very different from the floor. We are counted upon to do the critical thinking for the care of these complex patients. If your patient is on pressors (medicine to keep the blood pressure up) it is very likely that they DO NOT need the blood pressure medicine to keep the blood pressure down. The reason there are more nurses in the ICU is because we are supposed to look things up we don't know....these patients depend on us. I know if it was my family member I would expect the ICU nurse to know to look up what she doesn't know...what would you do if this was YOUR family member? Let me show you what I mean.....

If they do it anyhow...write it up. If they don't give it write it up as a near miss.

While they are called "incident reports" they are occurrence reports...they are SUPPOSED to be used for systems issues and help in identifying areas necessary for quality improvement. Most nurses do not take the time...well...here is one example of making the time. Having a paper trail that will end up in administration/quality control and utilization review/risk management...WILL get their attention.

You can also make an anonymous report to the Joint Commission.

If you REALLY want to make a difference it is going to take some work on your part...or start looking for another job as this is not a good environment.

[iluvivt, BSN, RN]

I am "just leaning" is NOT an acceptable excuse for negligent care. Every one of those nurses with RN behind their name should be and will be held to the acceptable standard of care. Yes..You should be concerned if they are using excuses instead of critical thinking and their assessments to make nursing decisions. If anything should happen to one of those patients because of negligent nursing care the "I am just learning" will not legally hold up just as "I was busy" will not.. In the example you gave they just "checked off" a task to be done without thinking. You as a patient advocate must now do something about it. It is Management that MUST also tackle this problem and I agree with Esme you have build a paper trail and then management will be forced to solve the problem if they are no currently taking it on! Great example of what happens when you drive the expert nurse away usually to cut labor costs! You end up paying dearly in other ways!

[icuRNmaggie, BSN, RN]

I am curious if the new staff received any CC courses or completed ECCO or have a resource nurse.

Your management officials want you to take care of your assignment plus monitor the inexperienced and possibly negligent staff.

Totally unreasonable and a recipe for a disaster.

[ausrnurse]

I would expect any nurse to know better than to give blood pressure tablets to a patient who is hypotensive. I find it really unacceptable for people to say "well, I'm new" when it is a basic NURSING skill, not a specialty skill. By all means, people should be receiving the support they deserve in a new area and in specialist skills, but looking up a drug before you give it should be done by all nurses in all areas.

[calivianya, BSN, RN]

Scary, scary, scary! I agree with writing these people up when you catch them in things. Anyone who'd give a BP med to somebody on pressors is just dangerous. It either means they don't know what pressors are or they don't know what BP meds are. I'd understand not knowing what some random once in a lifetime chemo drug is (though I'd look it up before giving), or something like that - but everybody in the world gets BP meds. The nurses should understand what those are. And pressors are so common in the ICU that everyone should know what those are, too, and heck - it wouldn't take long to learn because these meds are seen so often!

[Here.I.Stand, BSN, RN]

I know, right? Which drugs do they have "no time" to look up (i.e. which drugs do they NOT KNOW)... The critical drip? Or the metoprolol that any nursing student knows?

It either means they don't know what pressors are or they don't know what BP meds are. I'd understand not knowing what some random once in a lifetime chemo drug is (though I'd look it up before giving), or something like that - but everybody in the world gets BP meds. The nurses should understand what those are. And pressors are so common in the ICU that everyone should know what those are, too, and heck - it wouldn't take long to learn because these meds are seen so often!