Know your limitations!!!!!

[ladside, BSN, MSN, LPN, RN]

i did a couple of agency assignment shifts two times per week for a month up until a month ago. (i maintain my current prn position as rn staff nurse elsewhere...been there for 4 years). my day on the job at this ltac facility, i was asked to state my specialty. i am a med/surg nurse....nothing more, nothing less!!!! ( actually, there is a little bit more to me than that but that's another thread.) i went to the required orientation and was again asked to state my specialty. med/surg!!!!! some of you already know where this is headed. i arrived at my shift, received my assignment, and reported to the unit for report. low and behold!!!! three of my five patients were on the ventilator!!!!! i got on the elevator, went back down to the supervisor's office and i wanted to say those three little words that pack a real punch. you know, the ones where the first letter of the first word starts with w; second word starts with t, and the final word starts with f. but i was very professional about the entire thing even though i was threatened with abandonment in a round-a-bout sort of way if i left. so, being the excelsior grad that i am, i looked ever upward, back up to the second floor. i have a couple of years of vent experience under my belt but that was back in the days when that belt was a size small....do they even make those anymore?????

anyway, i said to myself that it's only one shift and they will correct their mistake tomorrow. well, as we know, tomorrow never comes. i'm here to tell you, ltac vent patients are nothing like the homecare vent patients. ltac vents are some sick people and everybody in the building was on isolation for this and that. after 3 weeks of that crap, i said hell no!!!! we were getting our own vitals, doing our own accuchecks, collecting our own labs, writing our own novel on the 8-page-front-and-back nurses notes, documenting each set of vitals on the graphic sheet, nurses notes and a critical care flowsheet. then we were scolded for not getting off on time! didn't take me long to realize this place had/has some serious management issues; not to mention the fact that the staff was mainly composed of 95% agency. when my shift ended, that was the end of that........until, a nameless person talked me into going back and giving them another chance yesterday. i went in, got my assignment. wow....only 3 patients. i showed them!!!!! proceeded to my unit.....again, up to the critical care unit! what's up with this? no biggy...only 3 patients. how bad could it be? took report as we walked. patient #1: sweet fella, w/c due to post-op surgical infection. ivfs. only at 33cc/hr? no, wait, 33.33cc/hr. i looked at the nurse and asked, 'what's in the d*** bag? amiodorone!!!! yes, a blasted drip!!! patient #2: peg feeding, waffle boots, fentanyl, neo-synephrine, and propofol drips!!!! 3 drips on one patient for this one nurse who's specialty is med/surg!! patient #3: ng tube, cva-like symptoms, hx chf, dm, copd, htn, cabg on 09/01/11. finally, a healthy patient. i proceeded to just go do my job because i already knew this night was my last night in this facility....ever!!!! as usual, had to hunt down the meds, and the literature to go along with those drips. i have never in my 256 years of nursing, hung a drip or had a patient with one. lpns were not allowed. lpn one day, stay away from the drips. pass boards that day; go to work the next as rn, nab a patient with a drip. at what point was i to gain the education about drips...over night in my sleep? (that's literally what they did to me when i passed boards last year at my own job...until i threw a hissy). so, trying to make the best of a terrible situation, i prioritize my care last night, tended to my drip patients first, and then proceeded to my healthy patient. i got so far as to hang the ivpg on the pole...not even so much as connecting it to the pump, when 'mgmt' called a team huddle. lasted 20 minutes. i returned to my patient, whom i had dressed with a new gown at his request at the beginning of the shift, and saw that he was sound asleep. only his respirations were very labored. i immediately thought hypoglycemic episode but blood sugar when i checked it at this point was 108. so, i practically knocked myself out with my dual bell steth by trying to get it off my neck so fast. it got caught underneath the isolation gown. could not get a bp. pressed the emergency light for assistance, no one came, not even a "may i help you'. i ran to the door, caught respiratory passing by as well as another nurse and called for an rrt. her response? "what's that?" i ran to grab the crash cart while yelling "code blue room 25!" twenty four minutes later, we transferred the patient out to the hospital across the street. the paramedics returned to bring back an oxygen tank and asked for the nurse that was taking care of the patient. i was in the hall talking to several other nurses. no one would say anything. at that point, i was already mad as hell, ****** off, and was ready to know the crap out of somebody anyway. so, i said, "i'm the nurse, what now?" to my surprise, the paramedics started clapping:yeah::yeah: and congratulating me on a great call in 'coding' the patient before he went completely down. they said that he was waking up and fighting the tube before they made it across the street. i'm not the greatest nurse in the world but my patients don't die while i'm on the clock. call it blessed or what have you, but it's the truth. seriously, though, it was great teamwork when the team finally dragged their a$$e$ into the room. i said my final good-byes for the last time this time because, as i have said so many times, i'm med/surg!!!

ps. forgot to mention that the doctor made rounds on the multi-drip patient and gave me the 3rd degree about the patient being on propofol. to shut her up, i finally her that the only thing that i knkow about propofol is that the rich tend to get more than their fair share of it and never-never land is no more.

also, as you can imagine, it took me a while to write out this chain of events and as i was doing so, this long term care facility called and offered my the wocn-mgr job. great opportunity....no more 12-hr shifts, no more weekends, no more holidays and they are offering to pay for my certification. 8:30am - 5pm and/or 10a - 7:30pm. do the math....1 1/2 hours for lunch and it is a 5 minute drive from my house as opposed to the 12+ hours, no lunch, and a 57-mile drive one way!!!! so now, i'm wound mgmt!!! woooooooo-------hooooooo!!!!!! i need a break from med/surg!!!!!

[Certifiable, BSN, RN]

Ok, I'm going into my 3rd year out of 4 of my BSN and I think I understood MOST of what you were talking about.

What I don't understand is how being a Med-surg RN means that you don't deal with "drips"?

[ladside, BSN, MSN, LPN, RN]

Ok, I'm going into my 3rd year out of 4 of my BSN and I think I understood MOST of what you were talking about.

What I don't understand is how being a Med-surg RN means that you don't deal with "drips"?

Under no circumstances do we do drips on the floor. Those patients are transferred to the units. I do IV fluids and piggybacks, etc. But specialized drips that require critical monitoring means that the patient is not deemed stable enough for the floors. After they are stabilized and the drips d/c'd, then they are transferred out of the units on the med/surg floors.

[nurseprnRN, BSN, RN]

mechanically speaking, all ivs are "drips." but in this context, the word generally means hemodynamically active or sedative drugs given iv, requiring titration (regulation, changes in rate) for effect, meaning constant monitoring. these are generally icu or stepdown territory, but occasionally are found in extremely stable med/surg patients (like a dopamine drip for renal perfusion, not bp regulation, at a constant rate).

:yeah:

op, enjoy wocn! you have earned it!

:yeah:

[ladside, BSN, MSN, LPN, RN]

mechanically speaking, all ivs are "drips." but in this context, the word generally means hemodynamically active or sedative drugs given iv, requiring titration (regulation, changes in rate) for effect, meaning constant monitoring. these are generally icu or stepdown territory, but occasionally are found in extremely stable med/surg patients (like a dopamine drip for renal perfusion, not bp regulation, at a constant rate).

:yeah:

op, enjoy wocn! you have earned it!

:yeah:

of course, this varies by facility. i haven't had the pleasure of working at one that allows such on the floors. i agree, wocn will be a welcomed change for me. i really could use a minute to gather a second wind.