I'm a relatively new nurse (a little over 1.5 years) working at a small rural hospital in Northern California. I work med surg night shift. We have no ward clerk, 1 aid (approx 40 pts) and one respiratory therapist for the entire hospital (ER, OB, ICU, Peds, and med/surg). Our average pt load is 5 (which I know is ridiculously low for most states, but it's the legal max in CA) and I've never personally had to take care of more than 7.
I recieved report that I had 2 pts that were supposed to go to ICU but we didn't have any ICU beds so they sent them to the floor. One is respiratory distress, the other is a recently converted from SVT blind elderly mentally challenged combative male. I'm also getting an Enemas 'till clear psych pt and an icu transfer (right at shift change) CHF COPD mildly confused female.
All are full codes.
I check my resp distress and she's on a 50% venti mask and satting in low 70's. I call RT STAT, get her on 100% NRB and now she's really struggling, satting in low 80's and attempting to rip off o2. Notified supervisor and MD. MD tells me that he knows she needs to be in ICU and vented, but we don't have any ICU beds and to call him when she codes.
I'll spare the blow by blow details. But here's a basic: resp distress eventually ends up sedated and on 100% o2 BiPap (way out of parameters for floor) with sats that unexpectedly plumet into low 70"s but never get higher than 88% (also has to be transferred to different room because the hall I'm in is dependent upon portable O2 takns due to remodeling). My SVT starts having chest pains, rips out his IV, and keeps spitting Nitro pills while attempting to beat staff to a bloody pulp. My 350+ lb psych pt alternates between screaming her head off and rolling on bed snoring and laughing, my ICU transfer gets even MORE confused and, frightened by BiPap alarming and psych pt, attempts to make a run for it. I recieve an ER pt (no report by the way) vag bleed that needs blood and is weeping hysterically. ER also attempts to send me a confused parapelegic enemas till clear. EVERYONE is incontinent.
Two of these pts were KNOWINGLY placed on floor despite that their conditions required ICU levels of monitoring and care. There are two large hospitals (one owned by the same company that owns my hospital) less than an hours drive away. Neither were on diversion, both had staff and facilities to handle these guys.
I gave report to a day shift RN that is ACLS certified, has over 10 years experience on me, and frequently floats to ICU. She recieved only 2 pts, was PROMISED that she would recieve no others unless they were transferred, and she would be paid as though she was in ICU as that was the level of care they required (this was after I finally got them both stable).
I however, recieved a brief lecture on the importance of better organizing my time because I had not clocked out for a lunch break.
I know, it could have been worse. There could have been 12 pts not just 5. But why is it ok to place ICU pts on the floor? Why was it ok to give ME those pts but not the more experienced day shift nurse?
I've never been so terrified since I started working. The MD and charge nurse knew how unstable these pts were and admitted them to the floor anyway. Charge knew I'm relatively new and gave me this load anyway. I keep telling myself it could have been worse. But it just makes me so angry and frightened feeling that "it could have been worse" is the best I can do. I'm supposed to be taking care of these people, not just madly dashing about attempting to keep their heads above water while I drown.
Is this a normal practice to put ICU pts on the floor? Am I totally out of line for being upset?
