Sorry if this post is long, I just really need outsiders opinions on this.
I work on a general internal medicine unit. I had a patient a few days ago that wasn't doing too well. Long story short over my night shift I knew he probably needed ICU care, but he was in that in between stage where he was still stable enough for interventions that could be done on my floor so the MICU would not accept a transfer.
That day, he became more unstable so as I entered work at 1830 that evening he was set to be transferred.
Heres where the problem begins...
I was getting this patient from a nurse I work with that is notoriously lazy. She told me the that "they" I'm assuming she meant the doctors and possibly MICU staff asked her to not transfer the patient until after 2000-2100 so that the patient didnt come until shift change was over
now I'm all for helping others nurses by trying to not call or anything during that time, however I think this calls for some judgement in the fact that it was an icu transfer?
i got very bad report (basically nothing) about what had happened that day, and she tells me to call report at 2000. I'm kind of uncomfortable but as she is my senior nurse I don't really know how to complain that SHE should be calling report since this all occurred on her shift not mine.
So I try to start my shift, check on all my other patients, get them settled and then start to work on getting my transfer patient ready to go as nothing has been done. He needs cleaned up, his stuff pulled together, medicated, to finish a bolus etc. I do all this and call report as quickly as possible.
By this time it is 2000, and she asks me if I want her to stay to help me take the patient to the ICU. of course I do??
So I say let's get him hooked up to the monitor as we always do this for icu transfers.
She makes a comment like maybe we don't need to but I insist and I get him hooked up.
Then I ask if we need to call the physician to escort, which I thought was policy but wasn't sure in this situation since it wasn't a normal emergent transfer like I had in the past.
She says no and I trust her since again, she is my senior. (I have worked a year, and she 10).
We take the patient over, he is stable and get him settled. I go back to my unit and this other senior nurse tells us that we really
should have had the physician to escort. Now I am upset. I asked the other nurse directly about this. I also performed all the tasks of the transfer myself, walking into my shift that way, and she didn't do anything to help. All of the tasks could and should have been completed the moment she got notification that he had a bed in the ICU not an hour later by me, the next shift.
I have thought about going to my manager about this, but I don't want to 1) get myself into trouble for not following the rule of taking the physician with us and 2) my manager and this nurse are close. This isn't the first time this nurse has done things that I would consider negligent, and now she has pulled me into it.
I realize that I also contributed to this mistake by not following up on my intuition about calling the physician. I am okay with taking repercussions on this, I just don't trust my coworker to do the same and not talk her way out of it and place all blame on me.
I can see delaying the transfer of a pt from ICU to floor, but not the other way around. That just reeks of bad nursing to me. If he needed to be in the ICU, he becomes a priority and gets transferred once the order goes in, not several hours later. Am I missing something here? You are right to be wary of this nurse. Do not trust her.
If the patient was stable enough to wait until the next shift, okay to wait for your preliminary rounds, + get cleaned up, packed up and medicated, you probably didn't need a physician escort.
If the patient was stable enough to wait until the next shift, okay to wait for your preliminary rounds, + get cleaned up, packed up and medicated, you probably didn't need a physician escort.
I agree, whenever I sent a patient to ICU it was STAT -not whenever you get a minute. Don't trust your co-worker, you will be going "under the bus."
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Wow, I've never heard of this physician escort. Is this a huge hospital?
Even in small hospitals, it's common to have a provider escort if the patient is going to a higher level of care OR if they're an ICU patient, if they're traveling for tests. Where there's a transport team, they have protocols to cover most emergencies, but if the transport team is unavailable, the ICU staff transports with a provider. And when the patient is going from Med/Surg or stepdown to the ICU, the transport team may come along to provide muscle only -- the provider must come as well.
Wow, I've never heard of this physician escort. Is this a huge hospital?
I have seen physicians from the ED go with the pt to the cath lab, etc., if the pt is that unstable that there is concern that they might code en route.
I have never seen a physician transport for transport from the floor to the ICU. I know the pt was going to the ICU, but they seem relatively stable...I really don't think a physician transport is a wise use of resources in this case.
Specializes in Flight, ER, Transport, ICU/Critical Care.
I've never seen a MD on transports. I've seen a few attendings/residents inadvertently accompany transport somewhere, but not per policy. Sounds either wonderful or depending on the doc's style in an unanticipated crisis could go messy like a soup sandwich.
As for the OP, ICU transfers IMO are a now event, not a well "wait till my relief gets here cause I don't wanna and I'm not gonna, and don't have to much but hang out and grab an hour or two of OT and prolly complain after the fact". Arrrrgh - that nurse. You've been given good counsel so far.
When people show me who they are, I stay very aware of how they practice.
If an issue arises, just state the facts as they happened. Onward.
You sound like you are doing great. Learn to trust your instincts.
Nurse071094
6 Posts
We do. They already knew about this patient and such. They just weren't on the unit anymore by the time I got there.