I have always been the friendly supportive person at work. I never offered unsolicited advice (and still don’t) and have NEVER imposed myself or my views on someone else’s situation, or tried to show just exactly what and how much knowledge I had, as many nurses do. I have always freely and constructively given advice and information if it was sought from me. I have always had high expectations of my own nursing practice, and I never expected everyone to nurse like I do. For the most part, all of my coworkers gave good care. Some were average and some were exceptional—but all appreciated and respected the exceptional care. I never gave anyone grief in report for not knowing something or not doing something—until recently.
It is lately seeming to me that many ICU nurses these days are giving the absolute minimum allowable. And the allowable minimum seems to be rapidly increasing. Much of the ICU care I see these days is sub-standard—yet it is becoming the standard. Many ICU nurses now don’t seem to understand the importance of prevention and the impact their care (or lack there of) can have. Many ICU nurses today couldn’t tell you their patient’s medical history, or current problems/issues with the patient or plan of care. I’ve gotten report form some nurses who couldn’t even tell me what kind of belly surgery the patient had this stay and when. How does one critically think and work through rapidly developing problems and changes without knowing the patient’s medical history, why they are here (some nurses couldn’t tell you that one either), and other new and current issues/complications/concerns they have going on (like an NSTEMI, or thrombocytopenia, or coagulapathies, renal failure, DVT, PE, new onset afib, etc. etc. etc)? While I think that critical care nursing is so much more than following orders, some don’t even know the orders.
I have learned to turn a blind eye and not say a word. I have doubted myself (am I doing too much? Do I worry about unnecessary stuff?). I have repeatedly told myself that I expect too much. But when I am forced to come out my isolation room to check a triple alarm, only to find the patient’s nurse reading a book right in front of his room and in the face of his monitor that has been emergently ringing for quite some time—I do start to get annoyed. Especially when I have both my patients screens up in my room and KNOW it is not my patient, but stop what I am doing because someone may not be able to get away to check their other patient (we have had some sentinel events related to unanswered alarms)—and still they are ignored. Then I get report from the prior shift and they cannot tell me who the docs are, why a patient is on a particular drip they are responsible for titrating, or any of the patient’s medical history, or where they want the sats, or why is renal on the case, or why is cardiology on the case, did not know they had an MI this stay, or that the new and most important concern is that he may have an ischemic bowel, or do not even stop to question why they had to titrate the patient’s O2 all the way up to 15 LNRM with sats of only at 90% and are happily reporting off on a “stable patient”….. And these same nurses seem to have a disdain for those of us that understand the importance of knowing all that stuff about our patients and acting on it when we should….
It is affecting my care, because I find myself frantically searching through charts to find out information when I come onto crumping patients. And it is becoming the norm, because these nurses are role models to newer nurses and they are being taught to have disdain for those that bust their ass on the job.
Last night I came onto a calmly delivered report by not a new nurse on a supposedly nothing patient (although the report was that she was anxious). The nurse did report to me that her sats kept dipping into the 80’s all day, but I had to look in the room to see she was on a 15LNRM and had to ask her, “She’s been sating like that on a 15LNRM all day”?? Yep! And now she is sating 79% for me—whoopie!!! Also, I find from looking through the chart that she was supposed to be on BIPAP continuously and I ask the nurse and she says—“it was making her anxious” (no call to the doc). The day nurse knew nothing—who was pulmonary, who was cardiology, was she in for pneumonia, CHF, COPD, PE???? –let alone her medical history. So I started my shift frantically searching her chart before I could even figure out where to begin with her. Of course we ended up tubing and lining and paralyzing, etc.etc. And I know that I became rude. And I know that I am becoming negative. And I find myself angry at work so often theses days, because last night’s situation is becoming a common occurrence. And the up-and-coming nurses are learning to practice like these nurses. An actual recent quote from a brand new grad just off orientation in ICU on my unit “Don’t tell me all that stuff! Just tell me what I have to do”!
I know there are those who may flame me for this, but I need to vent. I am tired, and starting to realize that I am the minority at work now days. Is there anyone who understands where I am coming from?
