Two ICU Vent Patients placed on a med/surg floor with no charge nurse....

[Magsulfate, BSN, RN]

I'm just going to throw this out there.. I'm a little worried about my job, and my license. Nothing has happened YET to harm me or my license.. But let me just explain what is going on. (and hope this whole time that my employer does not read this)

Where I work, I was hired as an ICU nurse. The facility is new and the ICU is not open yet. They told me in December when I was hired that it would open in January, in the meantime I'm working on the only floor that is open, med/surg. It is an LTAC. Everyone is nice there, but that really doesn't go far when you've got the problems that this hospital has.

The last few weekends I have been having a terrible time at work. I have been dubbed the unofficial charge nurse of this place and on the weekends I am, again, the unofficial "house supervisor" while having a few patients myself.

It didn't really bother me at first because I knew that someone needed to do it and really the patients were not that ill. I mean, they were ill, but stable and not getting worse or better.

But, now we have a house full of patients that can go either way in a heartbeat. Two weeks ago I had a terrible day and BEGGED the manager to come in. She basically told me to deal with it, she wasn't coming in, she had better things to do and that the nurses need to be more independent.. WHAT??! Okay, so I dealt with it.

Then, the other day, we had a patient code. He coded for several hours and we saved his life. Now he's on a vent, in the med/surg unit. Now, this floor is not condusive to an ICU patient AT ALL. The patient is at THE END OF THE HALLWAY. The powers that be seem to think that if we have an ICU nurse then we are able to handle it.

Well, it is madness. There is no backup for the ICU nurse, and that first day I found myself leaving my vent patient and walking all the way down to the nursing desk just to take a pee break, or to BEG SOMEONE to break me out,, only to see all the nurses scatter from the desk like they are cochroaches and I just turned on the lightswitch.

So, anyway, this morning my back was hurting sooo bad that I called in. I made sure there was enough staff to take care of the patients first, and then I told them I wasn't coming. I didn't get into trouble and this is not the issue. But I found out just now that they had the day from hell up there. That there was NO leadership, no charge nurse and the powers that be still seem to think we can be alright like this. She even announced that we will be admitting another ICU patient tomorrow into the med/surg floor.... a patient on a vent. Again, as long as we have one ICU nurse, we are alright.

NOT.

I don't know about you other ICU nurses, but with me, I can't work alone. I always like there to be atleast one other ICU nurse there so we can meld our thoughts and think through things. I find it scary to EVEN THINK about having two vent patients, alone, on a med/surg floor. How can you be in two rooms at once???? It's not possible. It is just not. And you can't leave your ICU patients alone, by themselves!!

On top of all this, I am assumed to take the leadership role. The nurses will all come to me with their charge nurse stuff, and I will be feeling too guilty to turn them away, where else will they be able to go to if they need help?? No one. There is no one else, that is why it was such a bad day today.

I was advised by a very good friend of mine that works there also to call in again tomorrow. I don't know what to do. I know that I want to protect my license. That is my number one goal. But I also feel sorry for these patients!

What in the world should I do???!?! Help me... someone, please... You all have given me good advice before... I need it now. Thanks :)

[youknowho]

If you can get another job, then run fast. I know in this economy its easier said than done. If you need to stay here, and it sounds just dangerous, do you have an ethics or compliance department you can call for a complaint. I was informed today during my new hire orientation that JCAHO has a toll free number to call and report patient safety issues if problems aren't resolved and your facility is accredited. This sounds serious enough to report to everyone.

[Magsulfate, BSN, RN]

If you can get another job, then run fast. I know in this economy its easier said than done. If you need to stay here, and it sounds just dangerous, do you have an ethics or compliance department you can call for a complaint. I was informed today during my new hire orientation that JCAHO has a toll free number to call and report patient safety issues if problems aren't resolved and your facility is accredited. This sounds serious enough to report to everyone.

I think I will be looking up that phone number right now on the joint commission website. Thanks.. :)

And, no, we do not have a compliance department to speak of. The hospital is so small.. I think there is one lady that does this but she also does so many other things too. Right now there are twenty something patients there.... They treat the nurses like they are NOTHING... and the suits have bankers hours.. never come up to the floor to see what's going on,, they think it will just run, without any problems.

[FloridaGirl23]

I don't have any advice for you as I'm not a nurse YET, but I just wanted to tell you I am so sorry you are stuck in such a bad situation! I hope it gets better for you and some wise words of wisdom come soon!

[glasgow3]

Well, they told you the ICU would open in January, but here we are in the last days of February and it's still not open. Call me Mr. Cynical but don't be too shocked if it doesn't open in March or later with the economy being what it is. And it's painfully obvious the powers that be will continue to admit what they consider to be ICU patients in the meantime.

Equally clear is that when things "hit the fan" you will not find support from your manager; meanwhile, your co-workers are either unable or unwilling to even relieve you for breaks.

Now I could focus on details: Are these really ICU patients, are the vents properly equipped so the vent alarms trigger the call light system in the halls, are the ICU patient's heart rhythms being monitored centrally in some manner etc.? But that would be missing the point. It doesn't matter whether I think the situation is safe. All that really matters is that YOU don't feel the situation is safe.

I certainly wouldn't be waiting for JCAHO to assist you; those clowns are famous for coming in only AFTER disaster has struck even though they were given ample early warning.

I would not expect things to improve in the near term especially. Likely as not they will get worse. If I felt as you do, my advice would be to find another job if at all possible.

[APRN., DNP, RN, APRN, NP]

that's a toughie easttexasnurse31.

i've been to a lot of places, and have found that a vent does not an icu patient make. stable vents can go to a long term floor with the caveat that no weaning is happening! these patients would be considered as long term vents.

if i just get a newly intubated patient up from er and they wind up in a m/s bed - i would have a big problem with that.

[casi, ASN, RN]

that's a toughie easttexasnurse31.

i've been to a lot of places, and have found that a vent does not an icu patient make. stable vents can go to a long term floor with the caveat that no weaning is happening! these patients would be considered as long term vents.

if i just get a newly intubated patient up from er and they wind up in a m/s bed - i would have a big problem with that.

at least the first patient wasn't a stable vent patient. they coded him on the med/surg floor, intubated him, and just kept him there.

i'm sorry, but if the facility doesn't have icu capabilities, these patients need to get transfered to a hospital that can handle them.

[britgirl37]

It seems to me you are answering your own question: you know it's your license on the line, you know it's a dangerous situation and you KNOW management are not going to do anything about it, unless some major disaster happens - and it sounds like you'll be right in the middle of it when it does.. Management are depending on you and playing on your sympathies to just go along with the whole situation. Easy for me to say I know, but I think you're better off in another job. Reporting it to JCAHCO sounds good too,(they've got to be good for something).

[by_stander22, LPN]

that's a toughie easttexasnurse31.

i've been to a lot of places, and have found that a vent does not an icu patient make. stable vents can go to a long term floor with the caveat that no weaning is happening! these patients would be considered as long term vents.

if i just get a newly intubated patient up from er and they wind up in a m/s bed - i would have a big problem with that.

i agree!

[by_stander22, LPN]

At least the first patient wasn't a stable vent patient. They coded him on the med/surg floor, intubated him, and just kept him there.

I'm sorry, but if the facility doesn't have ICU capabilities, these patients need to get transfered to a hospital that can handle them.

Maybe, the patient's family can't afford the hospital rates (especially ICU rates) of sophisticated hospitals coz if I'm in a family member's shoes, I wouldn't admit my loved one to a hospital who lacks facilities. Risking a family member's life without uncontrollable reason is creepy! This is a concern of the attending physicians. It is their duty to talk to the family regarding referral to an appropriate hospital and let them sign a waiver if they want to stay. If attendings aren't concern of this, well, the nurse should open this concern to them. It's better to be assertive than to keep silent while risking your blood and sweat obtained license.

[ghillbert, MSN, NP]

As long as you're willing to do it, management will be willing to have you do it. Put your foot down. I would probably try speaking to someone, then I'd advise them to transfer those patients out, then I'd leave.

[Straydandelion]

Having worked in a lot of areas but NOT ICU, I would refuse to take care of a vent patient feeling totally unqualified. Your license is on the line and you DId agree to work on med surg until the ICU opened...which can possibly be assumed you were willing to take more acute patients. However, as the only ICU nurse there.... I would sit down and make some demands of the facillity, and let them know you are discussing safe conditions.

Get all potential ICU patients by the desk.

Orient 1-2 more nurses to help.

Another nurse will have to be charge/sup any day you have an ICU patient because that is all you will be able to handle.

And any other conditions needed to adaquetly take care of the patient or suggest the patient be transferred to a facillity that is equipped.

Having worked in a small hospital before, my guess is they are all just "feeling their way" in this situation for now. If you can't get good information/help from the manager, go to the DON.

In the mean time, like the others said and a "just in case" I would be looking for another job.