Floor nurse seeking guidance

[abooker]

I'm having trouble communicating with management.

One of the 27 residents on my hall had been having what all of us assumed was a psych issue all night. She was agitated and hallucinating and had a psych history, so nobody apparently had thought to do the head to toe assessment thing. I had two med passes and two other residents I needed to call doctors on, so I dragged the nurse manager out of her office so she could help me with this. I was most likely rude to her. She kept telling me what I could theoretically do for the resident, when what I wanted was practical, hands-on assistance dealing with the issue. Apparently, the NM didn't do the head to toe assessment thing, or check her vitals. I'd assumed it was done on night shift and by the NM, and I did it at the end of my shift just so I could chart it. This lady's oxygen saturation was 84% on room air.

I rushed to get an oxygen tank.

There were no nasal cannulas for oxygen in the clean utility room.

I went back to our Med A unit.

I was told to check a different supply room on the Alzheimer’s unit, and that I’d need to find a key. Many nurses on Med A don’t share resources with LTC. Various nurses, several times, have reminded me that we’re a drain on their resources because they make a profit and we don’t.

I hunted down the nurse on our Alzheimer’s unit, who opened the supply room for me.

There were no nasal cannulas in that room, either. The nurse explained that since our supply person was out, we didn’t have many supplies. I didn't know our supply person was out. When I've had similar problems before, our supply lady has told me we nurses take everything and hoard it, and then accuse her of not stocking it.

I went back to other halls, and ransacked until I found a nasal cannula. There was one stashed in a pocket of a laundry cart, between the antifungal cream and the toothbrushes.

I returned to the clean utility room for an oxygen tank, and discovered there was no valve I could put on the tank.

I went to another resident’s room who used oxygen for meals, and took the valve from his tank, since he was using his concentrator while in his room. His tank was completely empty, or I would’ve used that.

The green seal from the new tank did not fit the valve from the resident’s old tank, so I couldn’t put it on. (The night shift supervisor showed me quite recently that there are different sized seals; they’re not all interchangeable).

I went to another resident’s room who was out in the dining room with a tank, so I borrowed her concentrator.

I put the hallucinating resident on 2 liters of O2 via nasal cannula, and her sats went up to 96% on 2 liters. She calmed down and began making sense.

I gave the nurse manager the vitals I’d collected. I’d started to chart them myself, but got flustered when I noted no vitals had been charted since I’d taken them, four days ago. About this time, the DON came by and asked if we needed any supplies. I assume the nurse from the Alzheimer’s unit had called her.

The resident whose concentrator I’d borrowed needed it back, so I asked the ADON about a valve for a tank. She had a new one under her desk. It sounded like she had a whole box of them under there. I put the new valve on, but it didn’t come with the green “Christmas tree” cone to connect the cannula to. I went back to the ADON who said she’d seen a little bag of them somewhere in the clean utility room. I found the bag I hadn’t seen before – it was opaque -, applied the oxygen, returned the concentrator. At some point, I gave the resident whose valve I’d tried to borrow a new tank of oxygen and hooked it up with his old valve, after digging through the trash to find the old seal.

This morning, I went to our administrator to tell her this story. I was hoping she'd be willing or able to address the scarcity issue that has been explained as a series of isolated incidents. I’ve done the “chain of command” thing before, and the nursing folks seem to view the problem as how I handle stress. I have an “external locus of control”, and maybe I should talk to an EAP counselor and do a little Cognitive Behavioral Therapy.

The administrator said something similar. This was an isolated incident. She understood how I might feel stressed, and pointed out that I could’ve used some equipment on the crash cart.

I know I screwed up. Nursing Fundamentals – first semester, second lab. Always, always do a head-to-toe assessment, first thing, with any change in behavior. I got caught up in the med passes. And I guess I could have used the equipment on the crash cart. I’d assumed it was for true medical emergencies - the 911 kind. And I shouldn’t have expressed frustration to the NM, the ADON, the DON and the Administrator. We only like HAPPY nurses.

I’m hoping for some constructive feedback here. From my perspective, it seems as if “I need help" = “trouble coping emotionally” and that’s it … end of issue. The DON explains many of my concerns as “communication problems”. The fact that my co-workers and I often don’t have access to the physical resources to do our job (they’re locked up in the basement or under a manager’s desk somewhere) doesn’t seem to factor into the equation at all.

So … communication problem. Is there an appropriate way for me, as a low level employee, to approach management the next time I have "trouble coping emotionally" with an issue that might have a negative impact on patient care? I don't have a desk to hoard things under.

[nightmare, RN]

I love the way management passes the buck as you're not coping emotionally! I would be more than a bit stressed in that situation I think suggesting a trolley set up with the sort of equipment you described may be a good starting point.Write it all down.In fact you have written it here.Your problem trying to locate pieces of equipment in different locations highlights a lack of forethought in this type of situation.Suggest it as something you will undertake,point it out as a learning process based on your reflection of the situation,something which will benefit yourself and the rest of the staff and patients on the unit.Good luck with this,I hope you succeed.

[adrienurse, LPN]

wow you're giving me stress flashbacks

Wouldn't it be nice if you could actually find respiratory supplies when you need them?

[BEDPAN76]

Bless Your Heart. Brought Back Bad Memories For Me, Too. Now That I Have Survived 32 Years As An Rn, I Would Simply Call 911 For Low Sats And Altered Mental Status. Running From One Place To Another Is Just Crazy. (take It From One Who Has Been There, Done That.) Start Looking For Another Job, And Make Sure Your Malpractice Is Paid Up! Good Luck Dear..

[oramar]

This scavaging that you are doing just to treat your patients correctly is typical of nursing homes. It is why I won't work in nursing homes. I wonder if the NM knows that hoarding critical supplies under her desk in hopes that no one will use them(to cut cost) is tatamount to murder.

[abooker]

Ghaaaa! I don't want to believe the hoarding might be a cost-cutting issue. I've heard there are facilities like that, but thankfully mine isn't one of them. From my standpoint, it looks like a supply chain issue. After my scavenging expedition, I'd be tempted to hoard critical supplies under my desk, too. A comfort measure, so they'd be there if I and mine needed them. I'm thankful to whichever coworker stashed a cannula in with the personal supplies so I could get the job done. Gotta remember to put another one back there.

I have lots and lots of supplies today, just where they should be. My resident is in the hospital, but doing fine. Life is good (today).

Thank you all for your words of support.

[CoffeeRTC, BSN, RN]

Take a deep breath. REally. I've been in the exact same position (er nightmare) that you were in that shift. Take a deep breath before talking with the supervisors etc. Trust me...I've wanted to just loose it, but really, what would that solve.

Seems like suppy issues are common. For the most part, ours is because we have a non nurse person ordering supplies. They are clueless as to what things are used for, so how would they know how much to order....Yeah...you would think that the notes and notes and notes would help, huh?

I would make a non emergent emergency supply thingy up for things like this (yeah...kinda hiding a little hoard)

[CapeCodMermaid, RN]

wow---sounds like the managers there need to go to EAP for something. If I see one of my nurses running around looking stressed, I go up and ask what I can do to help...cripes, especially if it's an emergency. In my building, the managers don't hide things, the staff does...I think it's left over from when the previous administration refused to spend money. It's like the old people who hoard food because they remember the depression.

The only way to get through the day in LTC whether skilled or not is TOGETHER. The management can't expect the staff nurses to be able to do it all without a little help now and then...AND the supplies to do it with.

[spaniel]

Oh my! That surely is a case of psychobabble from the administrator. When the Titanic did not have enough lifeboats, that was not a "external locus of control" problem of those who were frustrated trying to rescue people.

I would ask- has the administorator of DON followed up on the issues of inadequate supplies?