Floating/Circulating in the ED

JKL33 · May 9, 2019

11 hours ago, gemmi999 said:
Another nurse literally saw me triaging one of his patients at 1820 and then did not show up again until after shift change. The patient came in with a complete heart block, r/out head bleed vs hyperkalemia. He didn't even check on them. I ended up doing everything, including stat CT head, etc.

Hm.

It sounds like one of his four patients required 1:1 attention. I get the criticism of him not showing a need to get involved with a critical patient.

The de facto "plan," though, is usually that the (primary) nurse goes to the critical patient, and also retains responsibility for the rest of his/her patients that can no longer be actively attend to. For long stretches of time. Sure, some one else might do things here and there to keep them on the assembly line and ultimately discharge them, but then the primary nurse has the deficit of not having completed the assessments and charting if pulled away never to return.

Could the remainder of your time after triaging heart-block guy have been better spent because there was a more urgent need in one of the other assignments? If so, then call this primary nurse and say "I need to give you a quick report on this [third-degree block] guy, I have another ambulance..." [or whatever]. That's fine.

But if there was no real matter more urgent than third-degree-block guy, then you're just picking at principles and ideals that are already out the window. If it's a matter of "other nurses need help, too..." - to that I say "maybe." If one of their patients is sicker/higher risk than 3*HB guy.

11 hours ago, gemmi999 said:
I don't mind floating/helping but at what point are you not just the float but doing the other RNs entire run for them? When do you say "enough" and have the nurse start picking up their own slack? I don't mean this in a mean way, but how can you learn to manage 4 patients (or one critical patient) if you let the circulator do everything?

If someone is objectively an outlier by repeatedly making very little effort to attend to one of their rooms even when not attending to more critical matters, or are objectively not able to keep up a reasonable pace and prioritize correctly, then simply don't keep doing everything. Not difficult. Triage their patient and go do something else as long as the patient you're leaving isn't high-priority. Let them worry about prioritizing their own assignment. What you are doing is deciding that some part of their assignment should be higher priority than what they believe it to be, and then you are doing it for them.

To that I say, if you are correct and the thing you are doing should objectively be prioritized higher than every other pending task in their assignment right then - okay then yes, the two of you should work it out. If it isn't higher priority than every other pending task they have and scenario they are already involved in, though, they they have already prioritized correctly. ??‍♀️ Let it go. Go find someone else who has a more urgent task you can help with.