Published Jun 29, 2009
I had 5 patients last night though not all at the same time. We have a limited ratio in California of 1:4.
So here's my night. I was floated to another cardiac PCU. It was my very first time floating but I have been around for a year and a half and I certainly was up for the challenge.
I start out with 3 patients.
1930 Pt#1 Goes into afib RVR sustaining in the 130's. day nurse is otta there.
So between 2000 and 0000 I get her under control then assess, medicate, do dressing changes, check RBS and treat my other pt's. So far the night is going ok. Slightly rough start for not knowing my way around here but not bad. Now I have time for all my charting, give scheduled meds and keep a close eye on my peeps.
0000 Admit Pt #4. No problem he's stable. I take a lunch break. Pt #1 is still in afib but marginally controlled in the high 90's low 100's.
0230 Pt #1 Goes into acute respiratory distress. Desats to 60. RT is hemming and hawing (different story). While I've got doc on phone she desats to 40 and doc tells me to call a code. Of course that stirs up the wrath of the ICU nurses but I don't care I have a patient who is quite literally dying.
0500 Pt#5 I admit new patient from med-surg. She is non-response with hepatic encephalopathy. Only upon assessment I note her non-reactive pupils are roving back and forth in a slow motion. Then within an hour she starts a sustained heart rate in the 130's
0600 Stat CT for Pt#5 with several more calls to get an order for sedation and clarify wrong dosage given to me for Indural. Then Pt#2 goes into afib RVR requiring cardizem gtt set-up and more phone calls etc.
To sum it up I had a total of 5 patients, 3 of them unstable causing 4 different episodes requiring emergent attention, one of them being a transfer to ICU.
Please note, on top of all this, I had numerous family calls to make and one family member shows up in person crying and needing attention. And at one time I actually had a chart in each hand, my shoulder holding a phone to my ear and another phone on hold talking to 2 MD's with a 3rd MD call coming in on another line.
Of course people offered to help. One nurse did all my a.m. blood sugars. Another nurse entered some vitals for me and hung a vanco. My coworkers all came up to me at one time or another telling me I was doing a great job and they were amazed at how well I was handling myself and even smiling and being very courteous and calm while dealing with it all.
I am on their unit until 1000 charting. The day charge actually has the gall to say to me "it wasn't that bad, you only had 2 unstable patients". That was the last thing I heard when I walked out the door. Of course I suppose the manager will hear all about me, the nurse who couldn't handle 2 unstable patients and called a code when it should have been a rapid response. It IS all about time management isn't it?
And I am sure you would love to hear about what happened in the room when both the RR AND the code team show up. But I really can't go into that here cuz...well...
I am sitting here feeling like a bad nurse. Another part of me feels like I am a great nurse because I did handle myself so well and did everything I should have.
Thanks for listening. I still feel new at this.
I think you did quite well under some very trying circumstances. If I were you, I'd feel triumphant, having survived the shift. Many nurses could learn from your example of prioritizing and implementing as things change on a dime. If someone is criticizing you, I can't figure out why. You ahve my total respect for doing what you did. Good Job!
Kudos to you...
cherrybreeze, ADN, RN
It sounds to me like you did a fantastic job. ANYone, a new RN or a seasoned one, would be there that late charting....I know I would be, and if there's one thing I can do well it's wrap things up and get out of there on time even if I've been busy, I can get through my charting usually very quickly, but a night like that, yea, I'd be there a couple hours too!
I AM curious to know what happened in response to the call for the code....sats in the 40's is beyond the RR realm, IMO, and I would have gone straight for the Code 4 also and not called RR. In our facility, at least, it used to be that the hospitalist also responded to the RR within 15 minutes (and RT and an ICU nurse within 5), but now the hospitalist only comes if the ICU nurse feels it's necessary......with sats in the 40's you do NOT have that kind of time...even the five minute response time allowance of the ICU nurse is too long, and they can't intubate the patient or anything on their own. I firmly believe you did all the right things. Bravo.
DolceVita, ADN, BSN, RN
The day charge sounds like she needs the stick surgically removed from........
Oh my sounds like a night from you know where. You handled it well I think. Glad some of the nurses pitched in. I might say something to the manager about the day charge though. I would be a little hesitant to float there if the day charge is like that to you.
i'm thinking supernurse. i want to cry after reading about your day. or have a drink or 3. great job. look, the nurse who minimized your night wasn't going thru what you went thru. you want i should have her taken care of? i know people. just kidding. don't waste one more second doubting your fabulousness. we nurses can be tough to impress. if you did twice as much, she would have seen that t you forgot to cross. and made sure she told you about it. congratulations for doing some serious nursing action.
It sounds to me like you did a fantastic job. ANYone, a new RN or a seasoned one, would be there that late charting....I know I would be, and if there's one thing I can do well it's wrap things up and get out of there on time even if I've been busy, I can get through my charting usually very quickly, but a night like that, yea, I'd be there a couple hours too! I AM curious to know what happened in response to the call for the code....sats in the 40's is beyond the RR realm, IMO, and I would have gone straight for the Code 4 also and not called RR. In our facility, at least, it used to be that the hospitalist also responded to the RR within 15 minutes (and RT and an ICU nurse within 5), but now the hospitalist only comes if the ICU nurse feels it's necessary......with sats in the 40's you do NOT have that kind of time...even the five minute response time allowance of the ICU nurse is too long, and they can't intubate the patient or anything on their own. I firmly believe you did all the right things. Bravo.
RT took 10 minutes to get there. They actually passed the phone around deciding who HAD to come to our unit. When the room was filled up with 3 RT and some ICU nurses it turned out both teams had responded and weren't sure what "jurisdiction" to operate under. There were three very long minutes of RT trying several O2 routes with no relief to my patient. Nobody was saying much at all; the room was quiet. I literally walked over to my charge and whispered loudly "I am not ESO (our hospital version of ACLS) certified but why is everybody just standing here staring at my patient? And why doesn't anybody appear to be taking charge?" I literally said this verbatim! It was then that an ICU nurse started barking orders and we began transferring her.
She didn't get intubated and did stablize in ICU.
I have not experienced enough rapid responses (2) or codes (0) to be of much use other then be available as a resource for info regarding my patient and advocate, but I am just really uncomfortable with how this whole thing went. My past rapid response I handled went so well I actually had a very experienced ICU nurse write a glowing complement to my boss. This one was horrible. It felt like hospital politics took priority. My night charge that night actually told me after that I never should have called a code because it looks bad for the unit. I am not sure I get that.
I would def say your a super nurse......All you patients were taken care of plus some. You did exactly what you should have done and could have done. Geesh that lady needs to cut you a break....I don't know what you could have done differently....Congrats feel proud!
PostOpPrincess, BSN, RN
You did good.
You will just have to learn to be let certain idiotic comments like that slide. It's hard doing all of that AND being a new nurse--cut yourself some slack. Hopefully, someday you will feel more confident--sooner than later.
Be proud of yourself. Excellent work.
I think you did an amazing job...and I think that no matter how well we do it is in our nature to go back and reflect and think of how we could have done things differently even though we know we did the best we could..dont be too hard on yourself, you did what any prudent nurse would have done, and should a similar situation arise you will know what you need to do..chalk it up to experience and move on...that day was definitely not your worst and not your best to come, each day is different...Dont listen to anyone on here with negativity, we can only go on what we read since we were not walking in your shoes.
Sounds to me like you did great! The bottom line is that you followed what you felt was the best course of action for the pt at that time, and that's what it's all about. The day nurse might have it another way, and I another than that, and someone else yet another, and so on. You helped save the pt. How it was done (in terms of rounding up the help you required) is semantics. Good job.
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