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Amber Does the Unthinkable

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Nurse Beth Nurse Beth, MSN (Columnist)

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

Her name is Amber and she’s been a nurse for 3 years. Recently while working as Shift Leader in the ED Holding unit on a crazy day, Amber did the unthinkable. You are reading page 2 of Amber Does the Unthinkable. If you want to start from the beginning Go to First Page.

OneDuckyRN

Specializes in ICU. Has 3 years experience.

I agree with *what* Amber did, but I don't necessarily agree with *how* she did it. Yes, she needed 10 minutes to regroup. However, she should have told the ER nurse she'd call her back in 10 minutes instead of just hanging up. The next move would have been to call the supervisor. The new nurse needs to stop the assessment and come back to it, and help others catch up (yes, I get the tunnel vision thing, but right now she's got to help out where it's most needed). Get the blood hung and the other patient to their assigned bed, then take a deep breath and take the 2 new patients.

For what it's worth, some of these pts sound a little too sick to be in ER holding. Chest tube? Get that person a bed, STAT. Maybe even in ICU...after all, there will probably be some sedation involved. I don't know how many beds or what other resources this facility has, but it seems like if a trauma room is available, that might be another good option for a chest tube. Once the tube's in, MAYBE they can sit in holding for a little while. But now you're asking that one of your 3 already overstretched nurses devote all their attention to this one patient for the duration of the procedure, not to mention afterward. It's inappropriate to expect that this is even OK.

Idaho_nurse

Has 18 years experience.

I think she did what she had to do in the moment, which is commendable. Would I have handled it that way or would any of us? who is to say unless we have walked in that moment at that time. Without the adequate staffing, I would like to think that I would have called in reinforcements prior to it spinning this far out of control and asking for a back up nurse, or trading out "Tiffany" the less experienced nurse for one with more experience in stressful situations. Its not a dis on "Tiffany" but in this situation, a well experienced staff could have pooled together quicker. As for it being a "holding" area, all critical procedures should have been completed in the ED, and I would not have taken a plural effusion if a chest tube was needed until it was done. Maybe the ED should have been consulted as well and given a heads up on the staffing shortage if they already didnt know, and better communication between the two area's. I am glad she did take a 10 minute pow wow for the benefit of all involved. Good on her for making a command decision.

I wish I had the guts to do what she did.

She considered patient safety first. Bravo.

paidmydues

Has 11 years experience.

Will you mentor me Amber? A lot of us don't take no krap no more because there are enough studies to prove that it is unsafe! Good girl!

Tenebrae, BSN, RN

Specializes in Mental Health, Gerontology, Palliative. Has 8 years experience.

Amber did the right thing IMO

IMO she did the right thing, as the one responder mentioned, the hospital is quick to throw the individual nurses under the bus, often after staffing is inadequate and workflow too overwhelming for patient safety. Cripes, this kind of stuff can cause PTSD in staff, this is also why nurses leave the profession, and patients get hurt. Also wonder why a brand new graduate would be working in this area. Often nurses who speak up are reviled by admin, even other nurses who should know better. Why would any millenials want to go into a profession where this is now the norm?

BuckyBadgerRN, ASN, RN

Specializes in HH, Peds, Rehab, Clinical. Has 4 years experience.

Amber should know that an exclusively breastfed baby CAN nurse, even if NPO

whichone'spink, BSN, RN

Has 3 years experience.

Why would any millenials want to go into a profession where this is now the norm?

Yeah, this. And this millenial is working on getting out, or at least away from the bedside. When I make money and make a college fund for my children, I will list conditions for them to be able to draw from the fund. No useless liberal arts major, and absolutely NO nursing major. That's how strongly I am against nursing. I wish my parents imposed that condition on me, for my own good.

klcrn1987

Specializes in med/surg---long term---pvt duty. Has 30 years experience.

I have done exactly what Amber did.... I was asked to come in on my day off to man the "overflow" unit for the main Med-Surg unit. They were holding patients in the ER and needed to clear them ASAP so within 15 mins of me hitting the floor at 7PM, I had 4 admissions... by myself, not even a CNA to take vitals and help settle the patients... luckily, none of them were critical. Each admission from start to finish takes about 45 mins if you really push (mostly paperwork :p ) so that was 3 hrs right there, plus meds, IV's etc. It was getting to be about 9PM with the next nurse coming in at 11PM. I still had one more patient to admit and they called and wanted to send 3 more patients up ASAP (wanted to have them admitted by 12AM so they could charge the extra day!!) I flat out told them NO!!! I felt I could not properly admit and handle 7 patients without help and the safety and well being of my patients came first. The Supervisor and ER staff were not happy with me but they also knew that I wasn't a "slacker" and if I said I couldn't do it that I was truly doing the best I could. I finished my last admission and had them send 1 of the new patients up and was working on it when the next nurse came in.... I stayed to help and we had everything cleared up and settled by about 12:30am..... 7 full admissions in 5-1/2 hrs.... I thought we did pretty good!! :D

Edited by klcrn1987

I don't think this is really an unusual situation; as others have said, it just depends on how you word it. I think as a charge nurse I've probably said "Okay, give me a few minutes to figure this out and I'll call you back" multiple times. Not frequently, but occasionally. And knowing those five or ten minutes were possibly hellish for the people waiting; you don't want to overdo it.

As for the ED Main nurses gossiping about her--that's going to happen. The floor nurses give it right back to the ED. You have to let it go. We complain about "seriously, the ED nurses couldn't find two minutes to change the patient's bloodsoaked linen?" and that kind of thing. But when it comes to the patients and families complaining that (for instance, I heard this yesterday) no one in the ED cared about cleaning out the patient's abrasion, no one touched it the whole time they were there--we all stand up for the ED nurses, trying to explain (without alienating the patient/family) that the ED responds to the urgent problems knowing we'll have more time to take care of the rest of it on the floor.

It does sound like she was in a little over her head, which happens as a relatively new leader--and occasionally happens to everyone. Nothing to do but use it as a learning experience.

Sounds like a 3rd world country.

I know God is watching and sees all and He judges fairly. He will punish administrators and managers who create these ridiculous working conditions, who seem to care so little about people, only about $$$$.

But Amber and whoever she represents in real life need to demand a replacement secretary and nurse and pharmacist. She should have notified the manager immediately and had him get himself there to work the floor, get better staffing, get the ER shut down until things were more manageable, something. Even having a CNA would have helped.

Even with 3 nurses, the setting would have been like Dante's Inferno.

When the supervisor called, Amber should have said that she needs help & ask that the supervisor come to help or things are not going to get done because there were 3 hot bodies working their fannies off with 14 patients and 1 admission coming through the doors that needed a chest tube. Amber should have refused the pleural effusion patient until the chest tube was inserted in the main ED---that is not a procedure to be done in a holding area. Moreover, a pleural effusion patient needs a more controlled environment, like a step-down or ICU. The supervisor should have been told, in no uncertain terms, that that a bad mistake was in the making due to insufficient staff and it was UNSAFE. I probably would have gone over the supervisor's head----to the chief of the ED or the supervisor's boss. And I also would have taken a couple of minutes to put it into writing and send it to the appropriate people so that if anything happened, the appropriate people had already been made aware of it.

One thing I have learned in my 25+ years of nursing is that you have to protect yourself. You want to provide the best care you can, but you can't provide good, safe care when you are overloaded with patients. And, hospital administration is the first to throw a nurse under the bus when something happens. Accepting an assignment that is not safe, accepting inappropriate patients being dumped on you from other units & TRYING to do it all is a recipe for disaster. Hospital administration will take advantage of the nurses all they can, until the nurses start standing firm & refusing to work under those conditions. Historically, nurses have taken the brunt of all problems in a hospital----the fact that the pharmacy failed to stock the Pyxis is somehow the nurses' fault. The unit secretary calling out sick is somehow the fault of the nurses. Then the nurses have to fend for themselves. The nurses are expected to do the work of the unit secretary----are unit secretaries expected to do the work of a nurse if a nurse calls out sick? Why should nurses be expected to do the work of another employee without being compensated for it? If there is supposed to be a whole other person working in the unit, with their own job for an entire shift, then the nurses that have to do the secretary's job should be paid the secretary's salary for the day. An administrator is not expected to do the work of another employee if that employee calls out sick, so why should a nurse be expected to do it?

It isn't just the secretary's pay. The nurses might not know HOW to do the more technical aspects of the secretary's job, what with all the newfangled equipment and computer programs in use today.

I think she absolutely did the right thing!!! Like a run on sentence, it keeps on going and going if you don't stop it. Screw the other people that say she is not leadership material. They just don't have the balls to do what she did!!

I think Amber did the responsible thing. I learned long ago in Nursing management....STAR Stop, Think, Act and Review. When things are the craziest we need to take a moment to stop and think. Nursing is about critical thinking but we have to be able to know when we need a moment to be able to think.

erniefu, BSN, RN

Has 6 years experience.

What was learned was that the supervisor was the one who couldn't handle the pressure and did not prioritize properly. It seems that the supervisor had no idea what was going on in the holding area (already causing the hold to be over census) and sending an inappropriate patient to the hold (I doubt a hold has proper monitoring equipment and supports like the ER main to do a chest tube insertion). Amber was right to reassess the situation and figure out what to do next. Surgeons take time out during surgeries to ensure that fewer errors are commited.

You sound like some one that never has worked i a ED . Amber should be supported by all nurses

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

She did exactly what was needed. I would not have accepted any patient without a report. Plus having two patients in the hall while being short staffed...no way. Amber, the ER charge and the supervisor need to get together and work this out safely, calling a halt to all movement seems fair until that gets done.

I learned a long time ago that you can only do what you can do. I can't do 10 things at once, you have to prioritize. She prioritized organization in order to make everything that followed flow more smoothly. It shows leadership and responsibility to look forward and anticipate what's going to need to be done first. You can not do that when your brain is slammed. She took 10 minutes to figure out how to use the time more efficiently. Good for Amber.