Hi, I have been employed at a local hospital for 4 months now. I work a general med surg floor and I am hitting the point where I feel unsafe and like I am screaming at a brick wall.
We often get ER patients who meet sepsis criteria (we have a protocol) and within 3 hours fluids need given, with a lactic drawn, and an antibiotic. During ER report I tell the nurse these things need done before pt can come to the floor. Her reponse is that they can't get an IV. We had to page the supervisor and complain and suddenly she has an IV in. Then we had to call the dr after she arrived and get the orders (after the 3 hour mark). He was told he didn't know her labs were that critical. This happens, often. We actually have a frequently filled sheet to add admissions that shouldn't have came to our floor... is this normal? To have to take unsafe pts at least once a shift?
No one between days and nights knows policies for AM procedures. I've tried to be proactive and ask for a sheet, but no one has done anything. So during AM report, I am always yelled at for doing something that no one knows to do.
Advice is absolutely terrible. I will ask how to approach a situation and be told "I dont know" (from nurses for 30+ years) or "don't worry about it." Example: distended abdomen with fecal management system and decreased output from it. I asked how to know if its clogged or not in right or how to irrigate it and was told to not worry about it.
These are just a handful of things I've witnessed.
There is just no continuity between what I'm scolded for during days and what I'm told at night. We often get patients meant for ICU or a telemetry floor, neither of which we are prepared to handle. Our DON actually stayed late one night to lecture me and tell me I should have RRTd a stable patient when she came to the floor, as they shouldn't have came there originally. (Not any blame on the supervisor or ER for sending her like that)
Unfortunately my knowledge of when to impliment it and when not to isn't great. But we have been told to impliment it on any and all patients meeting it. And many times my charge nurse of the night is also telling me the same-to follow up with the needed orders and fill out the papers ER should have started.
Do you have any advice for resources, as I am struggling to find good ones on the floor? Maybe any good online sites or references I can brush up on, any clinical books to keep on me at work?
It's helpful to understand the new Sepsis core measures, which are easiest to meet by being less selective of what patients get included, but that's also more dangerous.
If you have any sort of practice council or other ways of having input I would recommend that as a way of improving patient care. Many nurse new to a facility or unit often feel like they don't have enough experience there yet to be involved in this sort of process, when really those are the most important nurses to have on these committees since they haven't just settled in to acceptance of how things are.
I'm certainly not encouraging you to lower your standards or expectations, just be careful of the 'grass is always greener' impulses since you may find a worse situation somewhere else or more likely something no different. It's better to actively improve the environment you're in.
This happens at my hospital too despite the sepsis protocol. They bolus the patient and send em up with a dry bag of fluids, forget to send blood cultures before starting the abx and boom, next thing you know you're calling a rapid response and sending them to ICU for levo (I'm in a med-surge unit with a pulmonary lean so they give us all the 100 year old septic full code patients that have had pneumonia for a month. It sucks that I am inclined to blame the ED nurses for being careless but I'm sure it has more to do with their assignments or something...
MunoRN, RN
8,058 Posts
For sepsis in particular the Sepsis 3 guidelines are the most up to date Consensus Definitions for Sepsis and Septic Shock | Critical Care Medicine | JAMA | The JAMA Network
It's helpful to understand the new Sepsis core measures, which are easiest to meet by being less selective of what patients get included, but that's also more dangerous.
If you have any sort of practice council or other ways of having input I would recommend that as a way of improving patient care. Many nurse new to a facility or unit often feel like they don't have enough experience there yet to be involved in this sort of process, when really those are the most important nurses to have on these committees since they haven't just settled in to acceptance of how things are.
I'm certainly not encouraging you to lower your standards or expectations, just be careful of the 'grass is always greener' impulses since you may find a worse situation somewhere else or more likely something no different. It's better to actively improve the environment you're in.