Do nurses really have any power

[Quaffetti]

I work on a cardiac telemetry unit. We are staffed 4 to 1. We have hospital based protocols which tell us which patients are appropriate for our unit. Some are:

No arterial lines (we do pull femoral sheaths after cath lab however)

No levophed gtts, no neosynephrine, we can only do dobutamine and dopamine at a fixed dose.

No ventilated pts, no patients that require continuous bipap.

No pts with a potassium of less than 2.0

No one on a nitro gtt at greater than 50 mgs

Those are just examples, but I believe the guidelines were set up because at a 4 to 1 ratio, you simply cannot watch a pt closely enough to have the above type of patients.

Now our unit is just arbitrarily deciding to change its' standards. The management wants us to start taking thoracic surgery patients straight from PACU. THese patients will have art lines, need cvp monitoring, be on levophed, neo, bipap and have tubes coming from everywhere.

They seem to have thrown our guidelines out the window. They promise us know that they will staff those of us who have theses type of pts at 3:1 (although our ICU is 2:1). In reality what will probably happen is they will give us one pt like the above, and then say "Oh, your other patients are regular tele pts so you can take three of them plus your one thoracic patient.

If our ER has a pt that needs a bed, our hospital's policy is we take the pt whether we have a nurse to staff that bed or not, so you can see we cannot turn down a pt no matter our staffing.

My point is, after this long story, is that I feel these patients belong in ICU where they can be closely monitored. It's very scary to me. Funnily, it's all us older nurses who are scared ******** about this. The new nurses think it's no problem; I get to learn something new. I guess you have to love their enthusiasm, but I think they just don't know enough to be scared.

Yet after expressing my concerns to management, our clinical educator agrees with me that these patients are not appropriate for our unit but says they have to do something to take the pressure off our critical care unit which is always full.

So in effect, the floor nurses have no way to say I don't feel qualified to take this patient and refuse it, short of quitting and finding another job. (not a great time for that in this economy).

Has anyone face a similar situation and have any success in getting through it?

[Riseupandnurse]

I am scared for you too. Totally inappropriate of management. The only way out is for everyone to stick together and say no. If you can get a doc on your side it would help, but of course there may be punishment for this. This would work as long as no "ringleader"is identified. Would the people in your unit work together respectfully with administration?

[BelleKat, BSN, RN]

Taking CVICU pts on a tele floor are they nuts? You have to be able to see these pts all the time,they have to be closely monitored with frequent labs. I mean are they going to orient you to these pts even?

Wow,your facility is just asking for a mega lawsuit and they usually sacrifice the nurse involved so maybe you can all get something on paper and into risk management before they start? I mean they sure aren't going to want to offer up one of their cardiothoracic surgeons. I understand that many hospitals use the Cardiac surgery to make money but this is not the way to go about it. They need to train and HIRE more CVICU nurses and open more appropriate beds.

BTW,when I was working in CVICU myself if we had a fresh stable post op our other pt was easy,if our post op pt was unstable we only had the ONE pt.

And that was with full icu support,ancillary personnel and a MD on call.(Teaching hospital)

I think a meeting is in order between management and staff and try to get the Drs involved like Jan said above. I don't think they would be for this either.

Good luck!

[Quaffetti]

Well, as I said, our clinical educator thinks this is wrong, but our management just doesn't listen to anything we say. I feel very powerless. We got 8 hours of classroom training on the types of surgery, reading CVP's and of course a good dose of the "pt's pain is what they say it is."

No hands on. If I was to transfer to ICU I would get a minimum of three months preceptorship, yet for this we get nothing.

I don't know how we could band together, as many of the new nurses feel like this is just going to be great. But it is an idea. I know all of the nurses with over 5 years experience think this is a very bad idea.

[ErraticThinker]

yeah that's definitely asking for **** poor morbidity and mortality rates. these patients need pulmonary toileting and they need to walk... a lot. in the step down here, the patients come up from pacu with a-lines and stuff.. but they're 2:1. they stay 2:1 generally for a few days because they need lots of teaching about fluid restrictions and stuff related to the procedure, and they need to get out of bed and walk usually post op day 1. no way can you have a fresh post op as one of four patients and expect them to do well.

not even touching the part mentioned about vasoactive meds on the floor haha if they want to relieve pressure on the ICU's, hire more ICU nurses or stop doing so many surgeries. the joint commission would also love to hear about undertrained staff caring for critical patients

[BelleKat, BSN, RN]

I can imagine how powerless you feel in this work environment and in this economy,I think they're counting on that. If you can somehow get it on record that you have not received adequate training to take these pts,maybe do some research on comparable units in nearby hospitals or hospitals with similar bed availability so you have facts to back yourself up with.

Insist(well maybe strongly suggest) that they have a cvicu reference person available on the floor for a least a week so they can immediately address problems as only they can see because they are used to these pts.

Maybe propose this to management as an effort to make sure this change goes well with no unforeseen errors. Play on their fear of lawsuits,errors,etc while being a "team player".

My suggestion is to have facts at your fingertips regarding staffing of cvicu units in your part of the country. Maybe even pull up the RX info on Levophed and Neo and how closely pt on it need to be monitored. IDK

The trick here is(I'm sure you know this) is how to advocate for the safety of pts in your unit and thus yourselves and your licences without being too much of a neighsayer impediment to their implementing this.

Depending on how it goes it might be a good idea to ask for a transfer to ICU or scope out other hospitals.agencies and so on. It's not worth losing your license.

I hope I helped some,it's a difficult situation. Good luck.

[lamazeteacher]

Depending on the size of your facility, there's usually a legal department on site. Failing that, you can find out by contacting your local court clerk, who represents your hospital.

Then make an appointment with those legal beagles and ask them to dissuade the powers that be. Show them some of the comments on this thread and the results of your research regarding other facilities' staffing policies on units such as yours. Lawyers must maintain confidentiality, so tell them you're expecting that. Whistleblowers, even when they save many, aren't appreciated.

Unfortunately the doctors are just interested in getting beds, any beds for their patients. They aren't likely to be your allies in this respect, unless they're on a committee regarding appropriate patient placement.....

[RN1982]

I think its totally inappropriate of management to place thoracic patients on your unit especially if none of the nurses have the proper training to care for them and to understand hemodynamic monitoring. Those patients should be in the ICU not a tele unit. I would flat out refuse to do what management asked. WHat they are asking for is you to put your license at risk and when something goes wrong they won't be there to back you up?

[Virgo_RN, BSN, RN]

I guess you're not union?

[Roy Fokker, BSN, RN]

Lots of good suggestions here.

I too, second the suggestion to get a few of the docs on board. Believe it or not, they are as concerned about pt. outcomes as much as we are.

Might I also add, if possible - get in touch with your colleagues in the ICU and ask 'em for some help. If management is doing this to you, who knows what they have in store for ICU?

cheers,

[Tait, MSN, RN]

Sounds terrifying. I would take these suggestions to heart and advocate to protect your patients, yourself and your hospitals good name.

Tait

[CathyLew]

I agree that is sounds like a bad idea. I wouln't feel comforatable at all.

are you union? and does your hospital have a protest of assignment form that you can fill out?