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Rapid response systems are put in place to allow nurses to access potentially life-saving resources for their patients in a hurry, including the expertise of critical care RNs. At least that's my understanding. But whenever I call one I get push-back from the nurses responding. They act like a competent nurse should be able to handle any situation on their own no matter what. One of them took a passive-aggressive swipe at me today asking me, "Are you new?" & later told me if I didn't like the way the situation played out I should write myself up for causing a delay in care. I know ICU & ER RNs think of themselves as the only "real" nurses but when you scrap collegiality in favor of boosting your egos at Med-Surg nurses expense you also harm patients by making your fellow nurse leary of calling for help, fearing they'll get spit on by Super Nurse.
A lot of times how you get treated as a med-surg RN calling a RR depends on if your instinc turns out to be right. If you're right you're rewarded with an upgrade for your patient & you won't have to endure criticism. If it turns out you're just being overly cautious a.k.a. wrong, you get to endure silent scorn if you're luck & open ridicule if you're not. Moral of the story, you better be straight psychic if you're calling a RR or have thick skin.
On 10/24/2019 at 3:26 PM, PeakRN said:Knowing code status is a basic tenant of competency when taking care of the patients you have assumed care for in the inpatient setting, especially when there are any end of life considerations. Knowing your orders is also absolutely mandatory in the acute care setting.
With due respect, there's a big difference between "knowing your orders" for 1-2 patients in critical care vs 5-8 patients in med-surg. It's not a matter of competency; it's a matter of what will reasonably fit in a person's working memory for 8-12 hours. And obviously, it's not a static amount of information, but a constantly revolving and updating pile of information to take in, analyze, and act on.
On 10/24/2019 at 3:26 PM, PeakRN said:I think that those who don't have good high acuity critical care experience can't really understand the specific stress that we are under on a daily basis, and I've tried to explain that. I'm not saying that floor nursing is not stressful, but it isn't the same.
It's not the same KIND, but it's not LESS THAN. It isn't the heart-pounding adrenaline of frequent rapid responses and codes (hopefully), and it isn't close monitoring of seriously unstable patients. It IS trying to give care to too many patients with too many distractions. It's trying to get the mandated, and ever-multiplying assigned tasks done and orders fulfilled, while trying to juggle fall-risks with dementia, unreasonable family members, and, increasingly, very sick people. It's advocating for those sick people with inexperienced residents who are afraid to escalate a matter. So when a floor nurse makes a judgment call, she's doing so in the context of trying to assess a patient's condition that might be a bit out of his/her scope, while also trying to drown out all the "noise" of everything going on around him/her.
And by "noise," I'm talking about all the distractions but also literal noise. Our phones ring with not only our call bells but every bed/chair alarm. When I'm unlucky enough to have an assignment that covers both sides of the unit, I get every.single.bed/chair alarm ringing immediately through to my phone for all 40 patients. Do you have any idea how many times my thought process is interrupted by my phone ringing? Can you imagine how those constant interruptions wreak havoc on focus, memory, and critical thinking?
Please take a minute to consider that what you consider a "basic tenant of competency" is actually a lot harder on a med-surg floor than in critical care. Remembering code status is not necessarily a reflection on the relative competency of critical care vs med-surg nurse but a reflection of the different types of stress in each environment.
36 minutes ago, turtlesRcool said:With due respect, there's a big difference between "knowing your orders" for 1-2 patients in critical care vs 5-8 patients in med-surg. It's not a matter of competency; it's a matter of what will reasonably fit in a person's working memory for 8-12 hours. And obviously, it's not a static amount of information, but a constantly revolving and updating pile of information to take in, analyze, and act on.
It's not the same KIND, but it's not LESS THAN. It isn't the heart-pounding adrenaline of frequent rapid responses and codes (hopefully), and it isn't close monitoring of seriously unstable patients. It IS trying to give care to too many patients with too many distractions. It's trying to get the mandated, and ever-multiplying assigned tasks done and orders fulfilled, while trying to juggle fall-risks with dementia, unreasonable family members, and, increasingly, very sick people. It's advocating for those sick people with inexperienced residents who are afraid to escalate a matter. So when a floor nurse makes a judgment call, she's doing so in the context of trying to assess a patient's condition that might be a bit out of his/her scope, while also trying to drown out all the "noise" of everything going on around him/her.
And by "noise," I'm talking about all the distractions but also literal noise. Our phones ring with not only our call bells but every bed/chair alarm. When I'm unlucky enough to have an assignment that covers both sides of the unit, I get every.single.bed/chair alarm ringing immediately through to my phone for all 40 patients. Do you have any idea how many times my thought process is interrupted by my phone ringing? Can you imagine how those constant interruptions wreak havoc on focus, memory, and critical thinking?
Please take a minute to consider that what you consider a "basic tenant of competency" is actually a lot harder on a med-surg floor than in critical care. Remembering code status is not necessarily a reflection on the relative competency of critical care vs med-surg nurse but a reflection of the different types of stress in each environment.
I disagree with most of your points. I've had had up to 9 patients at the same time in the ED more than once, and we typically have at least 5. I knew all of their code statuses, I knew all of their orders. These were ESI 2 or 3 patients. If you cannot give safe and efficacious care you should not accept those patients. You are failing them as a nurse.
On 10/23/2019 at 12:21 PM, RNNPICU said:From your previous posting about the Crisis Nurse asking you what you thought is actually very appropriate. The Crisis Nurse was trying to help you think about your patient a little more critically. Take some time now to think about it, what labs could be appropriate for a post ictal patient who has an altered baseline.
Perhaps if you had approached the situation by saying, " I have a question and want to run something by you. I feel like there might be more monitoring needed. I was thinking of suggesting a sodium level, and an ABG, (or insert what ever lab you had thought of). But I am not completely sure, is there anything else you think I should recommend, I am new at this, (or this is my first experience with this, etc)."
Starting off with your assessment and your thoughts at least let someone know you are thinking about your patient and have some knowledge about your patient and have put some thought into your patient's care. If you are just asking for someone to feed you the information, you haven't really thought about your patient.
Rapid Responses can be great teaching moments, but you need to be able to state your thoughts first, you had been caring for that patient and know their history. The crisis nurse wasn't quizzing you rather trying to see what knowledge you have and as a way to guide you to find the answer yourself.
Thank you! I actually followed up with the crisis nurse regarding the situation. He basically told me he wanted me to tell him more of what I was thinking so he could better assist me.
On 10/27/2019 at 10:07 PM, PeakRN said:I disagree with most of your points. I've had had up to 9 patients at the same time in the ED more than once, and we typically have at least 5. I knew all of their code statuses, I knew all of their orders. These were ESI 2 or 3 patients. If you cannot give safe and efficacious care you should not accept those patients. You are failing them as a nurse.
Whoa there. What I needed to know about my patients in ER was dwarfed by what I needed to know about them on the MS floor. Especially on a day shift.
On 10/20/2019 at 2:02 PM, PeakRN said:What is it that you are calling rapid responses on?
If I respond to something ridiculous I don't guarantee that my facial expressions are going to be polite. Calls for low blood pressures when the cuff is an inappropriate size, hypoxia when the patient's cannula isn't actually hooked up to the wall, oversedation when there is already an order for narcan, hypoglycemia when there is already an order for IV glucose, et cetera are some of the more frustrating calls we get.
I've also gone to bat and had very tense discussions with the doc for our floor nurses when they won't take the bedside nurses seriously. If there is a real concern I will back up and fight for our nurses and patients. I've called surgeons in the middle of the night when the bedside nurse cried from the last time she paged and was belittled for real concerns.
The thing about critical care nurses (whether it be flight, ED, ICU, PICU, NICU, L&D, or whatever else) is that we have a lot of baggage despite our often tough demeanor. There is a good change I've already coded a kid in the PICU or told a patient that they have cancer in the ED. That adult ICU nurse may have just withdrew care on a patient who twenty four hours ago were alive and healthy in front of the wife who no longer has a husband and kids who no longer have a father. The flight nurse may have just come back from a field trauma and already knows that her patient isn't going to make it outside of the OR. We deal with a lot of tragedy and still have to manage to care for our other critically ill patients, and dealing with nonsense is incredibly frustrating.
There is a level of camaraderie between critical care nurses and the other critical care clinicians (whether it be providers, RTs, perfusionists, and so on) that doesn't exist with lower acuity services. I think it often isn't so much a matter of being a snob, but rather a proverbial bond between the soldiers who have fought death and disease in a way that non-critical care clinicians don't.
As an ER and rapid response nurse, I really hope I never start sounding like this. Please, people, call me if you feel it necessary. Even if it ends up being something "stupid" I'd rather that than have you hesitate.
Wuzzie
5,238 Posts
I hope things get better for you soon. ?