inappropriate placements, stats that are sometime today and whats normal anymore

[annmariern]

Hi.

Just completed 2 frustrating, long days and am just kind of scratching my head and wondering is it this facilty or normal.

I work non tele med surg. Yesterday the census bombed. At 6pm ( i work 7a-7p) we got an influx of er patients coming all at once. I was down to 3 pts so was expecting admits but this was ridiculous. 8 pts in total. I had been helping another RN out by getting her patient, a direct admit situated; while at it did the assessment. meanwhile I get calls from the unit secretary re 3 more pts arriving. All mad as hell, with irate families, no IV sites, etc etc. At 6-6.30pm. I was tied up with one trying to get a line, calm down a furious daughter, tired, stressed and mad at the world. At 6.45 had yet to even see the other 2. Today, I start out with 4....a very rare occasion. all new to the floor from the day before. By 8am, one had new onset chest pain; abnormal EKG extensive cardiac hx. When I finally got her settled and still waiting for a tele bed I am getting OR calling for another. FX wrist. 88yrs old. Find her doped out of her mind after 5mg ms04 iv several hours before. No contact for the family on the chart. Hold OR start paging Doc. Now its 11, she gets chest pain is increasingly drowsy. O2 sat...;75. Chest pain. Still waiting on a bed for the first. 1pm stat troponin/ tele order recieved. Chest pain gone, o2 on, sats better, ekg better. 1 st chest pain lady gets a bed on tele. Transport myself (no-one else to do it!) At 5pm took this pt to PCU myself....still waiting for the troponin level. drew 2 hrs later. Now I call the lab, call the charge nurse, and it takes this long to do anything. As I left I looked up results. Troponin high, BNP sky high. Echo abnormal. So I ask myself, why on earth are these frail pts with extensive cardiac probs on my floor in the first place and why does getting anything done involve so much hassle. Is it the same everywhere???? I am afraid some days for my liscense in these situations. I mean, there is only so much I can do. Be interested in other nurses experiences. I have hated this facility ( a Top 100 hospital!) from day one. But is it any or much better elsewhere?

[suzanne4, RN]

Where was your unit manager during all of this? How about the nursing supervisor? Who triaged these patients to your floor from the ER?

[plumrn, BSN, RN]

That sounds like a typical day on our med/surg, sad to say. It is incredibly stressful, and I and all the other nurses do worry for our pts, and our licenses'. I take short cuts today, that I wouldn't have dreamed taking a few years ago. It is survival. We have few RN's, mostly LPNs. If an LPNs pt has chest pain, a few years ago, I would have been the one in there assessing them, and calling the doc. Nowadays, I have so many irons in the fire, with several high priorities going all the time, that I just direct them what assessment and interventions to be sure are done, and call the doc themselves.

It is even worse at the surrounding hospitals. I don't know if it is routine elsewhere, but the night nurse (who has a whole wing to herself at night) is responsible for drawing all of the am labs herself! I hear that some units in surrounding hospitals have no CNAs on days, and the nurses do their best to get all the baths/linens done, but they say that most days only a few get done. Between discharge paperwork, and getting new ones back in, there is no time for baths/linens.