I don't know if every time I call I end up catching a nurse whose been a having a bad day or is not feeling well, but of the times I've called every time I have called I've gotten the worst kind of attitude. I almost feel as if, perhaps, it is because the nurses that gave me attitude feel as if I'm ruining their day by adding one more patient.
I get it, it sucks. No one enjoys the current state of staffing ratios. I worked the floor and understand. However just as much as I'm going to be an adult and try my best to not take your displaced frustrations personally, also please try to take me sending you a patient not personal.
If it is is any consolation, by the time I return to my unit - my empty room will be clean already and that means time to prepare it for the next train wreck coming my way. I most likely will not go back and have time to relax. Maybe a quick lunch, as my next train wreck is life flighted to me or your next rapid response ends up here.
Just know we are all in the same business. Never anything personal. If my charge nurse ever calls your unit to expedite a transfer, know she's not doing it to be mean. It's because someone out there really needs that ICU bed. What if it was your mom or dad or friend?
When I worked the floor and was busy as can be, of course I would be a little uneasy when I was getting 5 calls because receiving report was delayed 10 minutes because I was doing wound care etc. So yes I get it. This post was intended as a neither side of the grass is greener kinda post. If I have a floor status patient in the ICU with transfer orders and I know there's no one in need of a room or we have other empty rooms, I will call you report and and ask you "Hey floor nurse, have you had lunch? Go eat and then I'll take you the transfer, ok?" Let's be kind and look out for each other!
I don't mind taking report on the phone but please tell me things that are relevant. I got report today from a floor nurse who was transferring her pt. up to ICU...all I got on the phone was "shortness of breath, can't keep her sats above 80, history of drug use and anemia"...come to find out she was in ARDS from sepsis, on top of having a COPD exacerbation. I'm a new grad so I admit I probably should've asked her a few more questions as to why she was getting sent to ICU for SOB but it was our 3rd patient and I was a bit flustered lol but I also felt like those were pretty big "no brainers". Also when the patient got up to the unit, we were trying to get her situated and the floor nurse had the chart in her hand and was talking to me but I didn't quite hear her so I said "What is it?" (as in "what did you say?") and she shook the chart in my face and said "this is the patients chart!" yikes lol
I don't mind taking report on the phone but please tell me things that are relevant. I got report today from a floor nurse who was transferring her pt. up to ICU...all I got on the phone was "shortness of breath, can't keep her sats above 80, history of drug use and anemia"...come to find out she was in ARDS from sepsis, on top of having a COPD exacerbation. I'm a new grad so I admit I probably should've asked her a few more questions as to why she was getting sent to ICU for SOB but it was our 3rd patient and I was a bit flustered lol but I also felt like those were pretty big "no brainers". Also when the patient got up to the unit, we were trying to get her situated and the floor nurse had the chart in her hand and was talking to me but I didn't quite hear her so I said "What is it?" (as in "what did you say?") and she shook the chart in my face and said "this is the patients chart!" yikes lol
Hey Peachy,
You are a new grad in the ICU, so I am guessing you've never worked the floor in independent RN capacity. I never once had a patient with ARDS on the floor. I don't see how the floor nurse was suppose relay this diagnosis to you? The floor nurse told you what she or he knew about the patient and let me tell you something, when you have six or seven patients you can only know the minimum and detailed reports of past medical histories and details unfortunately get lost. I worked both ICU and the floor as a side note, I do have a fairly good idea of the expectations.
I also have to add that this RN was probably busy trying to keep this patient from going sour, having even less time to sift through the chart. Cut the floor nurse some slack. You are the ICU Nurse and you are responsible for being a direct clinician in the care critically ill patients, this means speaking constantly with your pulmonary or anesthesia faculty - because diagnoses in the ICU are not static and one dimensional.
7 to 8 or above is adequate for an open heart depending on the surgeon. All the surgeons I worked always said 7-8 or above.
How do you know the stockings weren't on and maybe were taken off at some point to let the patient to breathe out their legs, and it coincided with the transfer to your unit?
Unless the graft sites are draining, there's no indication for covering them up.
We dont send patients to the floor with an insulin gtt. That's ridiculous. Insulin drips require hourly monitoring of glucose and monitoring the an ion gap and other electrolytes closely, about every 2 to 4 hour BMPs. No floor nurse should have to do all that on top of the already 5 or 6 patients they have. What the heck?
Thanks for thinking so, but we have to do insulin gtts on my transplant med surg floor all the time. Bane of my existence!
For the most part I agree! What bugs me is when we get a ICU downgrade who is ONLY being downgraded because they are ready to pass! The put the patient in the room and within a couple of hours the patient die? WTH. We have even had patients die in route in the hallway while being transferred. How on earth is that ok? I know if that happened to my loved one all hell would break loose.
I worked in a hospital that did this frequently. It was extremely frustrating to get an admission/transfer who was expected to die within a few hours (or less). And as soon as they passed on, the next admit was waiting to come up ....before you even had a chance to call the funeral home.
It was also a poor situation for the family. The patient went from having a lot of attention in ICU to being practically neglected in med/surg. They frequently had a stream of relatives coming and going with lots of complicated questions that were difficult or impossible to answer.
That being said, ICU care is not required for what's become a hospice patient. They cleared out those ICU beds ASAP for the next arriving disaster (who could also end up being one of your loved ones).
Bedside surgery? Nobody gives a rat's patooty about sterile environment?
No! Some are too unstable to transport off ventilator, bagging, a lot of bumping around etc when you can hardly suction them without huge desats, can't turn them without decompensation and so on. etc...
I think sometimes floor nurses get pegged with an assignment of 4-5 high acuity patients and some may take the stress out on others. It is tough to take another patient when you already have a fresh post op who keeps vomiting and pain is not under control, a patient who keeps jumping out of bed, one with a critical H&H and needs to be transfused, etc. then add another one who is coming straight from the unit.
I agree that they shouldn't take their frustrations out on you, but don't get offended if it sounds like they are angry with you because they most definitely aren't (its stress). If I have a bad assignment I will take report nicely and then tell my charge nurse I think certain assignments need to be broken up for patient safety. There have been times where I had to transfer a patient to another floor, or to the CCU, or to telemetry and not one nurse sounded thrilled for the admission. We're all in it together though
I think sometimes floor nurses get pegged with an assignment of 4-5 high acuity patients and some may take the stress out on others. It is tough to take another patient when you already have a fresh post op who keeps vomiting and pain is not under control, a patient who keeps jumping out of bed, one with a critical H&H and needs to be transfused, etc. then add another one who is coming straight from the unit.
I agree that they shouldn't take their frustrations out on you, but don't get offended if it sounds like they are angry with you because they most definitely aren't (its stress). If I have a bad assignment I will take report nicely and then tell my charge nurse I think certain assignments need to be broken up for patient safety. There have been times where I had to transfer a patient to another floor, or to the CCU, or to telemetry and not one nurse sounded thrilled for the admission. We're all in it together though
For some reason I hate the confused/jumping out of bed/elderly patients the most. How can a 90 year old that can hardly stand move so dang fast?
sorry! I know it's not relevant, but I've been considering this question a lot lately.
Specializes in Tele, Interventional Pain Management, OR.
For some reason I hate the confused/jumping out of bed/elderly patients the most. How can a 90 year old that can hardly stand move so dang fast?
sorry! I know it's not relevant, but I've been considering this question a lot lately.
The other night, three of my six patients were on bed alarms. One was able to use the call light appropriately (kinda), one was not and the third...well, she would just rip out her IV when she needed help.
The charge that night is one who pays more attention to "geography" (i.e. making sure your assigned patients are on the same hall) rather than acuity when preparing the assignment. So at least all of my bed alarm peeps were one-two-three right in a row...?
The ICU nurse who called report to give me a transfer may not have gotten the warm fuzzies from me now that I think about it. To the ICU nurse: I'm sorry!
We don't usually transfer patients that are ABOUT TO DIE. As in they are hypotensive with a lactic acid of 12 and a PEEP of 15 and FiO2 of 100 with sat in the 70/80s and the family has withdrawn care and we know they'll die within minutes to maybe an hour of disconnecting.
We will tranfer those expected to live a few days or weeks for eventual transfer from the floor to hospice etc.
Right... we transfer ours to a non-monitored private floor room if they are still alive a few hours after withdrawing. It's more privacy/quiet for the family, and frankly we need to have unnecessary ICU beds open for admissions; we're a level 1 trauma and comprehensive stroke facility so admissions may come at any moment. We've had people die a whole day or more after withdrawing, during which that time the pt is not receiving ICU care. One needs an ICU bed for ICU care -- not comfort care.
peachypurple
28 Posts
I don't mind taking report on the phone but please tell me things that are relevant. I got report today from a floor nurse who was transferring her pt. up to ICU...all I got on the phone was "shortness of breath, can't keep her sats above 80, history of drug use and anemia"...come to find out she was in ARDS from sepsis, on top of having a COPD exacerbation. I'm a new grad so I admit I probably should've asked her a few more questions as to why she was getting sent to ICU for SOB but it was our 3rd patient and I was a bit flustered lol but I also felt like those were pretty big "no brainers". Also when the patient got up to the unit, we were trying to get her situated and the floor nurse had the chart in her hand and was talking to me but I didn't quite hear her so I said "What is it?" (as in "what did you say?") and she shook the chart in my face and said "this is the patients chart!" yikes lol