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Discussion

Assignment Karma!

So here's what went down: last night I came in and went straight into an inservice. As I made my way out, into the break room, several people came up to me and said "Oooh, you've got the VIP!" Now, I don't have a single clue what they're talking about. I go into the break room to get my assignment and my charge nurse tells me I've got the relative of a very famous person. Let's just say that dealing with families is not my strong suit at the best of times - I (semi) joke that I've got a case of Asperger's. The idea of having this much scrutiny on me turns me pale, then red and breathless, according to those who were present. So I turned to the nurse nearest me and beg her to switch. She doesn't seem to care, so we all go on our merry ways. I have no idea what's wrong with the pt; I figure it's nothing big.

Cut to a short time later, when VIP is crashing and that poor girl is getting slammed, and I feel really bad, think about all the times I haven't been as nice to her as I should, etc. And then... my whole night goes to the hot place down below. My assignment is fairly busy but fine. My pod-mate goes on break and HER patient promptly crashes. I've got an intern on his first day in the ICU, who has to have the vent and monitor waveforms explained to him, and a fellow who is swamped with crises all over the unit. Then MY kids start acting up; nothing serious, just lots of little piddly things that require immediate attention. Leaking ostomy, a vented kid who would very much like to be suctioned NOW, thank you, lab says my samples weren't labelled properly and have to be resent, and that kind of stuff. Oh, and all three kids (mine and the other one) are on contact isolation. One of those nights where you leave feeling totally inadequate, even though you handled everything as best you could, you know?

So I figure the Assignment Karma gods, which I've just made up, got me. :lol2:

Featured Replies

  • Experts

Our face sheets used to have a notation, "Administrative Interest", but that could mean many things--could be an employee, faculty member, relative of a 'suit', etc.

  • Author

What we were told on orientation is that if you attempt to access the chart of a VIP (whether it's a famous person or someone who works at the hospital or a relative of either) you will get a pop-up window asking if you're SURE you want to look at the chart. The system logs all access, but it's only reviewed for VIP pts or in case of a problem. We've had former presidents and many celebrities in our institution, so they take this very seriously.

  • Experts

I understand that more people are wanting to be looking in a chart of a famous person (the George Clooney thread of a few months ago, anyone?), but it bothers me that admin is more interested in protecting their info than mine. HIPAA applies to everybody, no?

It slapped me right back, Steve. My post-op turned out to be intubated in his right mainstem, which only took seven hours of bradys to the forties and desats to six to figure out. Whee.

SEVEN hours?? and desats to SIX? That's very wrong. Why did the docs wait on this? I would have been jumping down their throats to figure it out, they should have known better then to wait so long.

Can anyone say brain damage??:down:

  • Author
SEVEN hours?? and desats to SIX? That's very wrong. Why did the docs wait on this? I would have been jumping down their throats to figure it out, they should have known better then to wait so long.

Can anyone say brain damage??:down:

Well, not the WHOLE time. There was only one that went that low. After that one was when they finally started listening to me. Before that it was just occasional, mostly to the 60s. They chalked it up to all the vec he got in the OR.

  • Experts

Yeah, all the vec that was preventing the ventilator from breathing for him with 100% O2.....

  • Author

Two words, my friend:

Blue team.

Oh, wait, here are a few more words: They gave him a whole bunch of (gasp) Fentanyl in the OR. Which, as we all know, destroys your respiratory drive to the point that you will desat on a vent. Tewtally.

Kinda off topic...

Fentanyl is what we routinely use for sedation for our vent babies. What does everyone else usually use?

Ive been blessed by the karma gods in the past to the point I now have a rule....I WILL NOT change assignments unless it is the other nurses' idea. I will never ask someone to change assignments or float in my place for that very reason.

  • Author
Kinda off topic...

Fentanyl is what we routinely use for sedation for our vent babies. What does everyone else usually use?

We sort of... don't. Our unit is terrible about undersedation. As an example, I've got a full term kid on an oscillator right now who has only PRN orders for 0.05mg/kg of Versed q4h. Some of us are trying to work on that, but it's pretty deeply ingrained in the culture of the unit.

  • Experts

Liz--I really think you should report them to JACHO. It won't change unless the plebecite revolts, or some big cheese comes in and TELLS them to change. Keep trying!!

Liz--I really think you should report them to JACHO. It won't change unless the plebecite revolts, or some big cheese comes in and TELLS them to change. Keep trying!!

Seriously!!!

It's part of our admit order sets for fentanyl prn (usually just 1mcg/kg/ q2h prn) for any baby under 26 weeks. If they need more than that, our docs have no problem upping the dosage. Whenever a baby is on the HFOV they are always started on a fentanyl drip - and usually more. Our docs usually want then sedated to the point where they're not breathing over the HFOV at all...

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