Is it me or does this sound completely off the wall???

  1. Today I started off my 7a-7p shift with 5 pts: 1. Pt on a trach collar tolerating PMV, with unsuccessful attempts to cap...very anxious and crying...high maintenance but, not too complex 2. unresponsive pt with hx of spiking temps, and a new PNA 3. Pt weaning from vent on PSV, who had chest pain tx to ICU 4. Pt with capped trach, with new onset seizures, hx of spina bifida 5. stable pt, hx of sepsis on 5week IV vanco...d/c to nursing home at the same time pt #3 is being transported to ICU...who got stuck in the elevator while being bagged. After losing these two pts, it was now 2pm...sat down to chart on all five of these pts...find out that at 3p, we have one nurse going home and the remaining three of us are going to split her assignment. So, I pick up a fourth pt...but now the 6th I've taking report on. But, things were still in control...it was 4pm, trying to finish up all my lose ends. At 5pm, supervisor starts shifting pts all over the building...I'm sure there was some rationale behind her madness but, had no time to figure it out. I ended up with a 5th pt at 6p...now the 7th of the day to take report on with no notice...while trying to wind up the day. While this is all taking place, she has CNAs cleaning up precaution rooms (no housekeeping available)...furniture and equipment going up and down the halls...CNAs not not available to do their own pt care. While trying to get report on my 7th pt and make sense of his orders and hx...my supervisor walks into one of my pts rooms and says that I need stop what I'm doing to give her a report. Is this crazy? or is it me? I have been working as a nurse for 9 months...so, I am still considered new. I have nothing to compare this to. Is this the way things are everywhere or is this crazy? BTW, while my vented pt was having chest pain, our doc on call was not available and when I called this same supervisor for help...she acted so annoyed that I needed help and kept saying "do you still need me???" We do not have tele on this floor; I put him on our portable monitor...he was having multiple PVCs...bigeminal, trigeminal...a run of 5...prolonged QT interval on his EKG and was a full code...I was scared that he would code at any moment and she was trying so hard to get back to whatever she was up to. Again is this crazy or is this me? I just need feedback.
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    About Lisky90

    Joined: Apr '05; Posts: 69; Likes: 4

    12 Comments

  3. by   reesern63
    My feedback, as someone with many years of experience, is you need to get out of there before your license is compromised further. That is so far beyond unsafe and insane. I have no idea how you managed that as a new nurse; it gave me chest pain just reading it.

    It's not supposed to be like that.
  4. by   GingerSue
    sounds hectic

    nursing staff doing cleaning - therefore can't do patient care?
  5. by   greenjanell
    You have pts on a vent with no tele?? thats insane!!
  6. by   ERRNTraveler
    Quote from greenjanell
    You have pts on a vent with no tele?? thats insane!!
    I agree- vented patients belong in ICU, on monitors.
  7. by   RNKITTY04
    I work in a vent dependent 60 some bed hospital, that I would say maybe 60% of our patients are not on tele. Is there some kind of protocal I am unaware of?
    Seriously? When I have asked about this I am told that they have pulse ox on, and it will alarm if something is going on.

    Sorry not trying to hi-jack thread, was just wondering if I too am in a an unsafe place.

    As far as the original poster, I think the patient with the chest pain should have been shipped outta there ASAP. And the supervisor ignoring pleas for help should be shot.
  8. by   TrudyRN
    I am realizing how far removed I am from what sounds like ICU. Can someone tell me what all the abbreviations are?

    PMV PSV PNA

    As far as how safe or reasonable it all was - it sounds wrong to expect CNA's to houseclean and other staff (nurses) to have to cover for them.

    Vents but no monitors? Don't know what the standard is.

    Sorry I can't be more help but haven't had to deal with such so don't know.
  9. by   crawlyberry
    Hi...student nurse here...Can someone tell me what the abbreviations PMV, PSV, and PNA stand for?....Thanks.
  10. by   bigsyis
    Quote from reesern63
    my feedback, as someone with many years of experience, is you need to get out of there before your license is compromised further. that is so far beyond unsafe and insane. i have no idea how you managed that as a new nurse; it gave me chest pain just reading it.

    it's not supposed to be like that.

    i agree absolutely! document like the dickens, keep a record at home, and get out of dodge, while your license (and your sanity) is still intact!
  11. by   kellyskitties
    I got turned around just trying to read your post! We have terrible nights sometimes. I'm told we can fill out an occurence report for such instances to demonstrate the nurse was overwhelmed just in case something bad comes of it.

    You can always ask the higher ups to help out and should - that's not wrong - even if it upsets them. Your pts welfare is 1st - not their mood or lashing out at you.

    What kind of unit are you on? We take care of sepsis and trachs on my med surg - but no vents! We don't do vents.

    Medical staff on rare occasions do clean rooms. We try not to, but HE&& night happens sometimes.
  12. by   Lisky90
    Good morning...thank you to everyone who posted. I really needed some honest answers...to know if this is this crazy or if I am just new and slow...or whiney...lol. After I reflected back on the day...what seemed the most crazy to me was the timing...why would a supervisor want to tx pts from floor to floor while we're all getting ready to change shifts??? Why would she try to take report at the same time??? I get the impression that she waits until the last minute to take care of her responsibilities so that it appears to the oncoming shift that she did something all day...all the while wrecking havoc on the staff...leaving things feeling insane but so unsafe...I hated the feeling of getting a pt at the end of my shift, who I was now responsible for that I knew nothing about...thank God nothing happened. But complaining about it falls on deaf ears which leaves me feeling new and whiney, and wondering if this is the norm or not. So, thank you to all for your input.

    Re: vents and monitors...I agree that many of these pts belong on tele...but many of them are chronic, and no longer need it...they are alert, watching tv, do PT/OT while vented. Think of Christopher Reeves...he was vented.

    PMV: Passy muir valve
    PSV: pressure support ventilation...like CPAP, a weaning mode on the vent, where the pt does more of the work than with AC, which is full vent support
    PNA: pneumonia
    Sorry...I just start tossing in abbreviations when I start "nurse talk"...good to always ask for clarification, though...what might be an abbreviation in one area of nursing can mean something completely different in another area.
  13. by   miko014
    That sounds insane!! And unsafe! There are bad days/nights everywhere, but when something like that happens, you should (like others have said) document your butt off!!! Keep track of everything and CYA! If you feel it was serious enough to write it up, then do it. Pt safety is the number one priority, and if that sup is going to pull stuff like that, it needs to be dealt with before someone gets hurt.

    That said, we are supposed to have 5 pts at a time, but my 6th showed up before the 5th one was d/c'd. She was a direct admit (so of course, no IV) there for IV heparin. Plus I had IVIG to hang, plts to give, and chemo to hang. And that was all at 4pm...I got out of report at 3:30. It was one of those shifts where you can't get one thing done without two other people asking for (sometimes demanding) things from you. So it happens everywhere. I didn't get caught up until 11:15 (thank goodness I was out at 11:30!).
  14. by   ERRNTraveler
    Perhaps if the vented pts are alert & chronically vented, that is a different story. Being from a critical care/ER background, the vented pts I see are sedated and paralyzed, and definetly require monitoring.

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