ED room assignment, stressed at job, vent!!!

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Specializes in Emergency.

Where I work our nursing assignment is by rooms, not pt acuity - and it is awful. I'll have a new patient put into one of my rooms and not even know it; according to management, it is our responsibility to frequently look at the tracking board and monitor our rooms. Sure, I'll get alerted if I'm getting a med unit or PNB...but that isn't enough.

Anyways, I work 12-hr shifts (245pm - 315am) and often at the change of shift (1045pm-1115pm) I'll get a whole new room assignment (again, it is awful). This happened last night - my assignment was completely changing so I was finishing up with my 4 rooms and preparing for change of shift. At 1050pm I am literally "hunted down" by the nurse I need to get report from (2 major rooms, 1 pelvic room, 1 "anything goes" room). She gives me report on an 89-year old patient who came in complaining of sudden onset low back pain. No trauma, A/0x3. The patient had a history of renal stents, kyphosis, scoliosis, HTN, COPD...and "oops, forgot to mention they have a diagnosed AAA with stent".

The nurse said that an EKG was done and she didn't put in an IV because the patient didn't have belly pain (and I'm thinking "um, who cares"). The nurse asked me if I want her to put in an IV - I replied "You saw the patient, so you need to make that decision; if you think they need an IV then I would appreciate it if you would put one while I give report to the nurse taking over my old rooms". Its now 1055pm, and the nurse jets out the door and did not put in an IV (her shift technically ends at 1115pm)...

First thing I do is grab the chart and I notice the patient has been in the ED for 45 minutes. And, their BP=210/120 (previous nurse left that out of her report). I walk into the room and the patient looked very uncomfortable. States her pain was 10/10, sudden "crushing" onset that morning, and says she didn't take any of her BP meds because she felt nauseated. I start cycling her BP, explain that I will need to put in an IV and draw blood, and I stepped out of the room and grabbed a doctor. He looks at the chart and says he'll see the patient right away.

I put in an IV, draw labs, and the doc comes in. After his assessment he expresses concern regarding the patient's condition and orders vasotec and dilaudid. I give the vasotec and dilaudid, and the patient's blood pressure came down nicely from 212/119 to 143/73. The patient went for an immediate CT. Results showed that her aneurysm had increased in size from 6.13cm to 7.14cm from when it was last measured (I'm not sure when this was). It also showed that there was blood leaking between the stent and the wall of the artery. My shift ended, so I dont know what the end result was for this patient.

Sorry, I just have to vent! I feel like I always get a patient load where the previous nurse did NOTHING for them, and I end up running around like mad cleaning up someone else's mess. Is it not common sense to put in an IV for a patient like the one I described? 89-years old, AAA, high BP, sudden onset of "crushing" back pain? There are so many nurses that I work with who do awful assessments and provide awful care that it is sickening.

And how is it ok to be assigned to rooms? It's unsafe, does not provide continuity of care (perfect example above - switching all my rooms after 8 hours), and I often find that I'll have all of my rooms filled while other nurses have one patient and sit around and talk.

On a side note, I got "scolded" yesterday while I was cleaning up yet another mess that the previous nurse left me. I had 4 things going on at once (while 3 nurses were sitting around talking) and the charge nurse comes up to me and says "When are you getting rid of room X?" (wow, would have been nice to say "What can i do to HELP you discharge room X"). I firmly but confidently say "As soon as I can". So, the charge nurse yells at me for being snippy and another nurse calls my attitude "snotty" and huffs and puffs down the hall. I've given up asking for help because management approached me back in August and said that one of my coworkers felt that I ask for too much help (oh really - if you are sitting around talking while I have a full assignment, then why shouldn't I ask for help if I need it; aren't we supposed to be a team?).

This turned into way more than I had originally meant it to be, but I need some encouragement and advice before I walk into work tomorrow...

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Specializes in Utilization Management.

Wow. I don't think I could work in a place like that. You have my sympathies.

And kudos to you for taking such good care of your patients.

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Specializes in ER.

Been there, totally understand, the best you can do is document what you receive and when you find out about it on the chart. It's up to the previous nurse to leave the patiet in a decent condition, you can't be blamed for their ineptitude.

"As soon as I can." Sounds fine to me, especially considering you were busy. If someone wants things done faster or differently they are welcome to do it themselves. Don't sweat it.

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Specializes in Med-Surg, HH, Tele, Geriatrics, Psych.

Wow!! Do we work at the same place!! This happens a lot where I am currently working. One nurse running around like a chicken with her head cut off while the others sit at the desk.

You are doing a great job! Don't let anyone tell you otherwise!

Following another nurse who does not care is frustrating. It also sounds as if the management is not going to be of any help. Maybe transfer to another department?

Hang in there! :)

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Been there, done that...very frustrating.

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Specializes in Med Surg/Tele/ER.

You sound like a really good nurse, working in a really crappy place! Maybe its time to look for a new place to work! :)

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Specializes in ER, Infusion therapy, Oncology.

Sorry to hear you had such a bad night. :icon_hug: The last ER I worked in was seperated into major trauma and medical. The nurses in the front where the ambulances came in would triage them and if they were not a CPR, are close, it came to the back. There were days when you had every septic workup, seizure, psych, ect.. and they would all be sitting in the front with teir feet propped up or playing on the computer. It is very fustrating. If I worked the trauma rooms and there was nothing going on I would go to the back and get the patient started or at least find out what kind of help they needed. What it comes down to is some nurses are in it for the patients and some just want to do their time and go home. You can usually tell which is which. The management also has a lot to do with it. We changed ours and the new management decided if their was one nurse working there better not be anyone sitting with their feet propped up. I would suggest during your next staff meeting bring it up as an issue and see if that helps. Good luck.

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Specializes in ED, ICU, PSYCH, PP, CEN.

I have worked at both kinds of EDs. One where everyone helps everyone, and one where they don't. The good news is nice places do exist. I would make sure you document carefully, do incident reports if necessary and keep trying to talk to management about the situation.

Perhaps you could find an ER job somewhere else.

Don't let them bring you down. There are lazy careless nurses in every dept. Just keep setting a good example. One thing I've learned over the years is everything changes.

In the 3 years I have been in my ER almost a complete turnover of nurses and new management x 2.

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Specializes in ER.

I am so sorry you are having to deal with this:o

I give you a TON of credit for going in to work every day....ER is stressful enough when you have a crew that understands TEAM WORK. It would be absolute torture without!

Is there a different charge nurse or the unit manager that you would be able to discuss these concerns with? If not, I would suggest looking for a new ER.

Assigning nurses by room doesn't have to be a nightmare, we do it that way, BUT we have a team that takes acuity into consideration when triaging and placing pts in rooms...and if one of us is getting hammered, others notice and help out....if there is a chart up needing something done, (MOST) others who are not busy will grab it and jump in.

Hang in there. And remember that there is NOTHING wrong with voicing you concerns in a professional manner. It is not safe for you OR the pts to have the unit functioning this way. If this place completely unreceptive to change, then find a new home.

Take care

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Specializes in SICU.

A couple of things stick out.

Do NOT take report on your new rooms until you have given report to the nurse that is taking over your rooms. Say no to the nurse that hunted you down, because at that point you had an 8 room assignment.

When she asked if you wanted to put an IV in, do not give an option of not putting one in. If she didn't "feel" like putting one in before what made you think she would after giving you report. Once report has been given then her responsibility has ended. Which is why you shouldn't get report until your ready.

You don't ask for help because someone complained before. If you need help, ask for it. Never mind what others think.

I think you did a great job in a place that does not seem to support you or your patients.

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Specializes in ED, ICU, Heme/Onc.
Where I work our nursing assignment is by rooms, not pt acuity - and it is awful. I'll have a new patient put into one of my rooms and not even know it; according to management, it is our responsibility to frequently look at the tracking board and monitor our rooms. Sure, I'll get alerted if I'm getting a med unit or PNB...but that isn't enough.

Anyways, I work 12-hr shifts (245pm - 315am) and often at the change of shift (1045pm-1115pm) I'll get a whole new room assignment (again, it is awful). This happened last night - my assignment was completely changing so I was finishing up with my 4 rooms and preparing for change of shift. At 1050pm I am literally "hunted down" by the nurse I need to get report from (2 major rooms, 1 pelvic room, 1 "anything goes" room). She gives me report on an 89-year old patient who came in complaining of sudden onset low back pain. No trauma, A/0x3. The patient had a history of renal stents, kyphosis, scoliosis, HTN, COPD...and "oops, forgot to mention they have a diagnosed AAA with stent".

The nurse said that an EKG was done and she didn't put in an IV because the patient didn't have belly pain (and I'm thinking "um, who cares"). The nurse asked me if I want her to put in an IV - I replied "You saw the patient, so you need to make that decision; if you think they need an IV then I would appreciate it if you would put one while I give report to the nurse taking over my old rooms". Its now 1055pm, and the nurse jets out the door and did not put in an IV (her shift technically ends at 1115pm)...

First thing I do is grab the chart and I notice the patient has been in the ED for 45 minutes. And, their BP=210/120 (previous nurse left that out of her report). I walk into the room and the patient looked very uncomfortable. States her pain was 10/10, sudden "crushing" onset that morning, and says she didn't take any of her BP meds because she felt nauseated. I start cycling her BP, explain that I will need to put in an IV and draw blood, and I stepped out of the room and grabbed a doctor. He looks at the chart and says he'll see the patient right away.

I put in an IV, draw labs, and the doc comes in. After his assessment he expresses concern regarding the patient's condition and orders vasotec and dilaudid. I give the vasotec and dilaudid, and the patient's blood pressure came down nicely from 212/119 to 143/73. The patient went for an immediate CT. Results showed that her aneurysm had increased in size from 6.13cm to 7.14cm from when it was last measured (I'm not sure when this was). It also showed that there was blood leaking between the stent and the wall of the artery. My shift ended, so I dont know what the end result was for this patient.

Sorry, I just have to vent! I feel like I always get a patient load where the previous nurse did NOTHING for them, and I end up running around like mad cleaning up someone else's mess. Is it not common sense to put in an IV for a patient like the one I described? 89-years old, AAA, high BP, sudden onset of "crushing" back pain? There are so many nurses that I work with who do awful assessments and provide awful care that it is sickening.

And how is it ok to be assigned to rooms? It's unsafe, does not provide continuity of care (perfect example above - switching all my rooms after 8 hours), and I often find that I'll have all of my rooms filled while other nurses have one patient and sit around and talk.

On a side note, I got "scolded" yesterday while I was cleaning up yet another mess that the previous nurse left me. I had 4 things going on at once (while 3 nurses were sitting around talking) and the charge nurse comes up to me and says "When are you getting rid of room X?" (wow, would have been nice to say "What can i do to HELP you discharge room X"). I firmly but confidently say "As soon as I can". So, the charge nurse yells at me for being snippy and another nurse calls my attitude "snotty" and huffs and puffs down the hall. I've given up asking for help because management approached me back in August and said that one of my coworkers felt that I ask for too much help (oh really - if you are sitting around talking while I have a full assignment, then why shouldn't I ask for help if I need it; aren't we supposed to be a team?).

This turned into way more than I had originally meant it to be, but I need some encouragement and advice before I walk into work tomorrow...

Hey - lots of job openings in my ER and we have a great team. That sort of situation just wouldn't happen. Since we've been through major changes over the past year, those of us who remained or started out new work very well together without the usual workplace drama. PM me and we can talk more.

Blee

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