maybe I wasn't being nice.....

[hearthelper]

So, maybe I wasn't being nice to my fellow coworkers, but common on we need to be a little more intelligent about our decisions. I work in ICU and had transferred my pt out of the unit to the Med/Surg floor when about 2 hours of her leaving she went into SVT with a HR around 200 (which I could see the second she went into it b/c we watch the telemetry for the hospital in ICU.) So, I watched the monitor for about 3-5 minutes (the telemetry tech notified them as soon as the pt went into SVT) hoping that they were going to turn her around but instead they called a rapid response. So, I went straight to the room to find 4 nurses standing around the pt, who was asymptomatic and stable. They did have the crash cart in the room, the BP machine on pt but the most important thing that no one had done was to notify the DOCTOR so you can get some orders for some meds, or I guess we could all just stand around her until crapped out on us!! At this point the pt had a HR of 200 for 10-15 minutes. I called the MD got orders and we converted the pt. Afterwards, one of the nurses overheard me being critical of their response to the pt and I know I should not have done that and I do feel bad for cracking jokes about them. This is a typical expected reaction on the med/surg floor and it happens too often. We are all nurses and all been taught the same principal things for ACLS response to a pt in SVT and they did act appropriately with a majority of the event but why wouldn't you call the MD as soon as you know your pt is in SVT??

[PatricksRNMommy]

Instead of criticizing and joking about the med/surg nurses, maybe you could have given them some helpful tips on how to best handle a situation like this in the future. Not all med/surg nurses are ACLS prepared... I know that at my hospital, there are med/surg patients that are on tele (usually due to pre-existing conditions that might make them more inclined to have a tele issue) but their nurses often call us to ask questions about their tele strips. Yes, they should have called the doctor, but they did do some good things. They went to the bedside with the patient, they were checking vitals, and they knew enough to call a rapid response (which in essence is them saying they aren't sure what to do and they need more help). Your attitude towards them does nothing to foster good relationships between the unit and the floor, which I know can be a problem in many hospitals. I respect the knowledge and experience of my ICU's nurses, but at my hospital you can't transfer a patient to the unit without hearing snarky comments (her: "I can't believe you didn't put in a Foley" me: "Sorry, wasn't thinking about that when I was starting two new IV's, getting a stat EKG, drawing labs, and starting the nitro drip... my bad").... I could vent about this all day. Next time, instead of talking bad about the nurses, given them (or their charge nurse) some constructive criticism :)

[Sun0408, ASN, RN]

What is policy on the med/surg floor? On our floor, it is policy to call RR, have them assess the pt and then THEY call the MD to get orders.. The floor nurses could have been doing what they are trained, monitor the pt until backup comes.. Just because the pt was on tele does not mean the staff is ACLS certified and can cardiovert the pt.. Just a thought....

[RaziRN]

I don't understand. At my hospital when rapid response is called RT, the house supervisor, an ICU nurse and the hospitalist arrives. During this time the primary nurse is usually assessing the pt. along with obtaining vitals if not already done and generally staying at the bedside until help arrives. While the primary nurse is directly caring for the pt. the charge nurse or a fellow co-worker pushes the code cart down the hall to the room and brings the pts. chart and the if the hospitalist doesn't arrive it's usually the charge nurse who calls the MD as the primary nurse is usually tied up in direct pt. care. There are usually fellow nurses around to help run and get certain meds if needed. So where were all these people? Or does your hospital run their RRT differently?

Also, as a previous poster mentioned, not all nurses are ACLS prepared. I am a med-surg nurse that is not ACLS prepared and I admit I've made stupid mistakes but I'm only nine months in and I call for help when needed. I do plan to get my ACLS as I seem to be finding myself in a lot of critical situations lately. :/

[nursynurseRN]

It sounds like the M/S nurses did OK.. if they were at the bedside and called a rapid response team what esle could they have done? I know I can't convert a patient on a MS floor. It is not our protocol. MS is NOT ICU, we cannot just push anything even with a doctors order. They have to go to ICU to get something as simple as labetatol IVP. )I work in a 500 bed trauma hospital in Orange county CA)I am glad you went up there and did that becasue they probably wouldn't have done anything till rapid response would have come up. Also in my opinion if they pt went to SVT only after 2 hours after transfer they probably were not stable enough to transfer to a MS unit and probably waranted a DOU unit. I know you have a year plus experience, but you need to realize you don't know everything, and you never will. I don't know how many ICU new grads have come to MS or oncology units because they couldn't cut it in ICU after a 2-3 years. What you did was right in handling the patient but you need to familiarize yourself with protocols of different units too. Next time ask the MS charge nurse about the situation, I think they may be able to give some more insight on what happened. Also, maybe you were right and these nurses were incompetent, it is unprofessional to make comments about the situation just for gossip, if you have a real problem with it write it up or bring it up in a meeting.

[klone, MSN, RN]

With a stable, asymptomatic pt, it sounds like they did exactly what they should have done - called a rapid response and allow the RR team to assess the pt and go from there.

[Lola77]

Med-surg is different from ICU. My guess is if you worked a shift on the med-surg floor you may have a different opinion of those "stupid" MS nurses. They work their asses off with 5-6 acute patients. They don't have the autonomy ICU nurses. They called the RR and they were monitoring the patient. They did what they were supposed to do. Different environment, different skills set. Try a day on the floor - my guess is you will feel pretty "stupid" yourself.

[VICEDRN, BSN, RN]

I agree with the poster above: You will not be HEARD if you speak so harshly.

Further, I suggest that you focus on your own actions instead of the actions of others. If you decide to report to the supervisor that these nurses didn't call the doctor, they will likely have a ready answer for why they didn't do so. Conversely, you will likely find that the supervisor will discover your nasty comments and you have no ready answer.

I work in the ER and frankly, I agree with the med/surg nurses here who tell you that ICU seems to have superiority issues. If you want a foley, get one. If you want to call the doc, you should do so. Insisting that someone else do it for you is nothing more than lateral violence! A code is a cooperative effort. The other nurses were perhaps busy. A team player calls the doc without blaming others.

RR comes from ER in our tiny hospital even though we have an ICU. We have seen nurses with their backs against the wall who's entire report is "I don't know. I found her this way." We are accustomed to codes in ER and ICU. They are not. Teaching is the answer here.

[mappers]

At out hospital, once R/R is called, they take over. We get vitals, monitor the pt, etc and wait for RR. We have protocols some protocols in place, but mostly get vitals and draw labs. Notifying the doctor is not part of the picture until the R/R team is there. That floor might not have any protocols. None of us are ACLS. Maybe you don't realize this?

Now it this was me and I had seen the SVT on the monitor, I would assess the pt. If she was asymptomatic, like you said, I would have gotten vitals, drawn stat labs and called the doc. I would not have called an RR unless the situation started to deteriorate or if the doctor did not respond timely.

This happened to me once and the pt actually was "feeling dizzy". I did not call an r/r but was able to get her transferred to ICU within 20 minutes or so, since the Dr. called me back. I did the right thing. Have you looked into what the protocols are for the floor you're criticising? Doesn't sound like you have.

"Seek first to undersand, then to be understood." Stephen Covey.

[mappers]

"need to take the next step and notify the MD so you can get some med orders. "

Ummm....You do realize that they most likely could not have done anything with those orders since Med Surg nurses generally are not allowed to administer those types of drugs, right? And they most likely wouldn't even have those meds on the floor.

The only order they could have gotten was to transfer the patient to a higher level of care (which is what the R/R team does.)

[himilayaneyes]

You have to try to remember that as an ICU nurse you are the code team. You transferred your pt to a med/surg floor not even a tele floor. A good question is does your hospital require med-surg nurses to have ACLS b/c some hospitals don't. Some only require it for monitored areas. I do agree that the 1st thing they should have done is call the doc. But if those med-surg nurses called a rapid response team..then they did what they were supposed to do except for calling the doc. Med-surg nurses aren't allowed to give certain drugs. However, all of the ICU nurses who respond to the rapid response are allowed to give them...so the doc should have been called. However, cracking jokes about them was uncalled for. I'm sure they were nervous and doing the best they could at that time...good thing you were there. Hopefully, both you and your those med-surg nurses can use it as a learning experience. You could have used it as an opportunity to educate your fellow nurses rather than laugh at them. If anything it's a good reason that even med-surg nurses should know ACLS. What's done is done, move on, learn from it.

[nurse grace RN, BSN]

Doesn't rapid response include a doctor of some kind? even a resident? in my facility it does and also just because you accept tele patients doesn't always mean you have ACLS, not required on some floors where I work. You were wrong to criticize and wrong to call the other nurses "stupid" , they were probably overwhelmed, unsure of themselves and needed direction. Have you always done the right thing in every situation? Are you so perfect that you can judge them? What they need is education concerning what and where they went wrong in this situation so that it doesn't happen again. Break the entire situation down from start to finish and educate about it point by point: where was the charge nurse? was there one? did anyone call the house supervisor? and so on. The key to correcting this kind of problem is education and a little consideration of staff members that are not "critical care" staff. Nurses that work in non critical care areas aren't "stupid", they may not handle your crisis patients but come handle there case load of six or seven patients and see how arrogant you are after that.

[RNKPCE]

Does your hospital have a tele floor?

This situation demonstrates the problem of having patients on tele remotely monitored. According to your post the floor is called med-surg and in my hospital our med-surg nurses may have reacted in a similar manner. However on my tele floor(monitor's watched by a tele tech) they would have known to first put the patient on oxygen(we have standing orders for this) and we might have had orders left for other meds etc. Even a tele floor nurse might call a rapid response depending how symptomatic the patient was.

Bottom line if your hospital doesn't have a tele floor maybe they should. If the med-surg floor rarely has events like this and if they aren't all ACLS then this is the outcome.