How do you handle the rest of your assignment during a code?

[Ativan]

How do you handle the rest of your assignment when you have one patient in a critical situation, like a code or rapid response? I've had this happen a few times where one patient is unstable, I'm basically 1-1 with that patient giving meds and monitoring them, and I'm waiting for a bed on a higher level of care, but the unit secretary and other staff are paging me about my other 2-4 patients needing pain medicine, blood sugar checks, etc. Plus I have their routine meds to give, so during the (way too long) time it takes to get a bed on a tele or ICU floor, I am neglecting and getting way behind on my other patients. There is usually a critical care float nurse who stays with the patient, but I feel bad completely ditching her with my patient and asking her to give all the meds.

This happened to me the other day on med-surg, it took 1.5 hours to get a tele bed for a rapid response patient, and during that time, I was busy trying to put a Foley in him (unable, that was part of the problem), give meds, communicate with the doctors and the family, and monitor his pressures and rhythm from the crash cart (HR was in the 150s). The charge nurse (who doesn't have an assignment) was irritated at me for asking her for help with my other patients and said I should just leave him with the critical care float (who was busy filling out her paperwork on the code and monitoring the patient, not watching for orders and carrying them out, so I would have had to explain to the nurse I transferred him to why none of his orders were carried out). Another nurse took pity on me and offered her help. I'm a float nurse, so I don't really know many people on any given unit, so it's tough to get support.

My question is, how could I handle this situation better? Is it OK to leave my patient with the critical care float and ask her to basically take over the care? Is it normal and acceptable to ask the charge nurse to either help out herself or request other nurses help me with my assignment? Should I directly ask other nurses to do things for me, like pass routine meds? Or should I stay late catching up on my other patients?

[turnforthenurse, MSN, NP]

Yes it is normal to ask the charge nurse to help out. The charge nurse usually serves as a resource person on the unit. I luckily have worked in places where my coworkers and I really believe in teamwork. I have had very critical patients that should be a 1:1 and I have had my fellow coworkers or charge nurse help me with my other tasks on my other patients. Never be afraid to ask for help when you need it.

[Do-over, ASN, RN]

I am thinking I wouldn't feel too badly about leaving the patient with the critical care nurse... He or she is one-to-one with the patient at that point, correct? It is no mystery that you have other patients to take care of.

If we respond to an RRT we wouldn't leave without taking the patient with us, unless the patient was stable and not going to move. A Code patient would be moved ASAP, and we wouldn't leave without them - no doubt they are tubed and on some drips at that point anyway. And, we are not floats - we are leaving an assignment to respond.

[Kipahni, RN]

It is tough being float staff. It is the job of the charge to act as a resource. Especially if they do not have an area. That being said I do not think it is so bad if you have to give meds late. If a pt needs a PRN then you can ask for help. . Also be kind with yourself- Nursing is a 24 hour care, if there are orders that were not completed on your floor make sure you just report that to the floor that is taking them.

[NurseKatie08, MSN]

One more reason why I love the teamwork on my floor. Whenever one nurse is in a rapid response situation, everyone else always goes to them and asks what they can do for the rest of their group. No one would ever be paging me during my time with a patient in a rapid response because one of my other patients needed a PRN---someone would just medicate them for me.

[classicdame, MSN, EdD]

the charge nurse needs to step in and either take over your coding patient or take care/re-assign the others.

[KariZayBSN]

As a float (in the past), you have to communicate well. The charge nurse should have assisted you with having your assignment covered if you still were expected to care for the critical patient. If the float critical care nurse was there to care for the pt, you should have given her report and allowed her to take care of the patient and provided assist as needed. She was one to one with the patient. Don't feel bad for leaving the patient in quite capable hands. The critical care RN would have transferred the pt correct? The ICU nurses could have cath'd the pt as well.

[Ativan]

Thanks everyone for your responses! I think the message I'm getting is that I just need to learn to hand over responsibility sometimes and not try to do it all myself (sounds obvious, but sometimes hard to do in practice). I should have handed over more tasks to the critical care float nurse without feeling guilty, and I should have asked the charge nurse more directly to help with specific tasks rather than expecting her to be aware that I needed help and offering it. Some are better than others!

I think the hardest thing for me in nursing is asking people to do things without feeling bad. Sometimes you can't get EVERYTHING done by yourself and wrap up each patient in a nice little bow right at 7:00. But I hate feeling like I'm getting an eye roll or a dirty look when I pass something on or ask for help, so I guess I'll just have to get over it.

[HyperSaurus, RN, BSN]

Usually, the rest of the nurses on the floor would pitch in and help--either they would put in orders for you for the code, take over recording, answer call lights, pass prn meds, ect. We had a good team. Everyone knew you can't survive without teamwork, so you wouldn't necessarily have needed to ask for help covering your patients. However, if they don't volunteer, you need to ask. They might assume you've got everything at hand, and if you don't, it's up to you to clarify that.

[BluegrassRN]

The flip side of this is that, when you have a. Fellow coworker whose pt has coded, you should touch base with them and ask what you can do to help. If your charge doesn't take pts, they absolutely should be stepping in to take over some of your pt care.