I Just REALLY Need To Vent....

Nurses General Nursing

Published

OK... how to do this and maintain confidentiality??

screw it....

got a patient from ER... the report was pretty benign, post partum a couple weeks, c/o pain for a week, n/v past few days. No mention of a temp. Gets to our med-surg floor... within 10 minutes, my CNA reports she's "blue...shaking." Sure enough, she looks like hell... room air sat 82%, cyanotic, shaking uncontrollably, temp 103, bp 90's/50's and dropping and pulse 170 (YES).

call admitting doc immediately and get an order to send this gal to ICU, now.

call ICU... whereupon the charge proceeds to grill me..."what do you mean she's "blue"..."what do you mean you're running her fluids wide open, why are you doing that?"..."did you crank her O2 up?"... all of this after I've given a brief report and indicated why I've done the things I've done... "Gee miss ICU CHARGE... I dunno, do you think maybe cuz her pulse is 170 she's not perfusing well and THAT could be why she's cyanotic??" "Gee miss ICU CHARGE... her bp keeps dropping and her pulse is racing... do ya think bolusing her with fluids is a good idea?" You get the general idea.

about 15 minutes later... the ICU Charge come to LOOK at this patient... Nevermind I've already said the doctor ORDERED ICU. For some reason, it seems that doctors orders no longer mean squat if ICU doesn't think the patient meets criteria. :confused: I'm asked if Telemetry would be OK to send her to... at that moment the doc arrives and I run it past him... he says fine.. but he wants her on a monitored floor NOW.

So I give report...20 MINUTES LATER... to Tele... who decide this patient (the one who ISNT unstable enough for ICU)... is TOO unstable for Telemetry.... :rolleyes:

Something magical must have happened... because an ICU bed mysteriously becomes available... and FINALLY.... 2 HOURS AFTER THE ORIGINAL ORDER... my patient is taken to ICU. But even then, the nurses taking her looked and spoke to me as if I didn't know what the hell I was doing.

Now I understand that occasionally a nurse might just be uncomfortable with a patient and feels they would be better off in ICU or somewhere similar... but I'm an RN with over 7 years experience and besides that... this patients SYMPTOMS SCREAMED for more intensive interventions. What if I had been some namby pamby nurse who lacked the self confidence to PUSH for this patient to be moved? Hell, a THOUSAND what if's....

Even if I had been told that, in all honesty, there just wasn't a bed available for this patient... but had been given SUPPORT by my fellow nurses from ICU... I could have dealt with that. But in all sincerity... I feel as if my own assessment was being questioned and this patient's needs were severely jeopardized by the lackadaisical way this entire event was handled.

There...all off my chest now.

Lori, I am so sorry this happened to you, and I can certainly understand how hopeless and frustrated you must have felt. :eek: Speaking from both sides, I just finished intervening a few nights ago when a Med-surg nurse desperately wanted to send an elderly DNR to the unit because she was unstable (yes, she was, but she would never be stable again for the remainder of her life) and she needed more care than the Med-surg nurses could provide (yes, she did, but still couldn't justify using an ICU bed for an elderly DNR when a more viable patient might need it). I've also jet-propelled an unstable Med-surg patient, full code, in septic shock to the ICU (lost the pumps and pearls somewhere along the way), while instructing the nurses to direct Dr. Sphinctermuscle to talk to ME when he complained that he was all set up ready to put the central line in ON THE FLOOR (he shut up when the patient coded five minutes later). There is NOTHING that beats the intuition of a good nurse and Lori, you sound like an excellent nurse. As an ICU nurse, I would have accepted your patient without hesitation.

That said, the ICU charge nurse in question probably didn't know you from Adam, and may have just been burned with "crashing" patients propelled to her unit who turned out just to need some extra O's, reassurance, and maybe a gentle dose of "vitamin A". What Should have been done, if course, was that if the nurse had doubts she should have come IMMEDIATELY to assess, or else the House Officer (Supervisor, whatever) should have intervened. I don't know what was happening in her unit at the time. And when those beds "magically" appear, it's usually because another, more "stable" patient, has been hurricaned to another unit, then someone polished the floor with spit in 30 seconds before accepting yours.

Whew! I needed to vent too. Thanks for bringing this to the forefront so that we can all understand how the other side feels!:(

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Specializes in ER, ICU, L&D, OR.

Howdy Yall

From deep in the heart of Texas

Some of those Icu nurse can get pretty rough. But thats ok, I had a meeting of the minds with them, and ever since Ive never had any further problems, with them. Helps to develop a reputation, but isnt it a shame we have to resort to that

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Hi Lori,

As an ED Nurse in Australia, (or ER over there), I used to hate having to escort patients to ICU mainly because thay wouldn't listen and more often than not they would just totally ignore you. So I think that the ICU Manager thing is probably a worldwide phenominum.

As for ED, I wonder how the patient was looking both physically and haemodynamically prior to them transferring her to your unit? The last ED that I worked at would never have transferred a patient to a ward that looked as though they were going to crash. I don't think you mentioned her age and general level of fitness and health but younger, fitter and generally healthy patients can compensate, haemodynamically, for longer periods.

Another thing that I have noted in ED is that you can triage a patient, and even if you send them straight into ED, their history will be completely different from what they told you less than 1 minute ago.

Anyway, sounds to me like you were doing all of the right things at the time, and can now look back and feel great about your actions.

regards

Patrick

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Hi Lori,

As an ED Nurse in Australia, (or ER over there), I used to hate having to escort patients to ICU mainly because thay wouldn't listen and more often than not they would just totally ignore you. So I think that the ICU Manager thing is probably a worldwide phenominum.

As for ED, I wonder how the patient was looking both physically and haemodynamically prior to them transferring her to your unit? The last ED that I worked at would never have transferred a patient to a ward that looked as though they were going to crash. I don't think you mentioned her age and general level of fitness and health but younger, fitter and generally healthy patients can compensate, haemodynamically, for longer periods.

Another thing that I have noted in ED is that you can triage a patient, and even if you send them straight into ED, their history will be completely different from what they told you less than 1 minute ago.

Anyway, sounds to me like you were doing all of the right things at the time, and can now look back and feel great about your actions.

regards

Patrick

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And ... by the way Lori ... who took care of your other patients while you spent so much time on this admission/assessment/transfer? We all know/feel your pain.

Good for you for following through. You ultimately saved her life.

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Originally posted by susanmary

And ... by the way Lori ... who took care of your other patients while you spent so much time on this admission/assessment/transfer? We all know/feel your pain.

Good for you for following through. You ultimately saved her life.

There were several factors that were in this patient's favor. First, I'm an experienced Med-Surg nurse of 7 years... I've had *some* ICU experience and can handle just about anything a patient can toss my way (except certain drips, i suppose)...I'm ACLS and have been an instructor for many years in CPR... and I had just discharged a couple patient's. so my load at the time of this 23 year old's arrival was 3. (It was a VERY slow day).

I had 3 other RN's on the floor as well, one a Traveler orienting her very first day on our floor. She was a godsend and answered lights, changed IV bags, gave pain meds, etc... while the other 2 RN's assisted me with bolusing, monitoring the patients sats, set her up for cardiac monitoring with the one on our crash cart. (I've already written up one of our Hospitals "Thank you" cards for all of them, to let management know how truly amazing the group of people I work with ARE!!

Mom is doing fine... she was (as i suspected) septic and shocky at the time of her arrival to my floor. After multiple antibiotics, fluids and some rest, she is up and about, caring for her adorable newborn. I was close to tears as I left her room, thinking about how much better her initial admission should have been... but also thankful that it hadn't turned in the other direction, which could have been even worse.

Thank you, everyone, for your kind words, anecdotes and encouragement.

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Lori, glad to hear she's doing well. She was lucky to have had you as a nurse -- even if for only a few minutes.

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Lori, As an ICU nurse for 10 years now, I can tell you that this patient screamed ICU. Tele wouldn't have been enough for what she was going thru. You did the right thing. That is one thing I like about where I work. We get the occassional OB patient in ICU and occassionally the OB patient goes bad while still in OB and we and our OB nurses support each other very well. Sure there are some prima donnas who don't help anyone and that sounds like the charge nurse you were dealing with, but we have had good experiences. I know zippo about fundi and I'd assume the OB crew knows zippo about treating a hr of 170 and a falling BP. This is why we have different specialties. You did good Lori. Keep on advocating and I hope someday you get to deal with some of the ICU nurses like myself who would have gladly took this patient in a heartbeat. Now, inappropriate admissions I will fight to the death over because they take up the beds that patients like yours need!

Hope she did well and hope if I ever have a kid I have a nurse like you looking out for me!;)

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