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??

[regularRN]

Sounds like they had it under control - Rapid Response is the med/surg RN's first call. So maybe you should criticize him/her, as they were there and "standing around".

[LouisVRN, RN]

As a Med-Surg nurse I have to agree with a lot of things said by the other posters in response to your initial post. While I recently took a telemetry class that helped to familiarize myself with the cardiac medications to treat various conditions prior to this I was pretty limited in knowing interventions to recommend. Even with the knowledge know our policies prohibit the administration of these meds without a monitor. Our Med-Surg patients are not monitored, you said that you were watching the monitor so are you sure the med-surg nurses knew the pt was in SVT and not a-fib or something? Having nurses who are not trained in ACLS start administering medications and treating cardiac problems would be disasterous. Like someone else said if this pt converted within 2 hours they should probably not have been on the floor to begin with. Because of the lack of beds we have been getting more and more patients who previously would have been considered Tele/SICU status and yet we are not receiving additional training.

A perfect example we had a patient admitted to the floor (not monitored) with newly diagnosed a-fib. The nurse called and received orders from the doctor. The nurse then writes the order and comes over to ask me "What's Jackson?" Me: "I don't know, what's it for" "A-fib, but the pharmacy doesn't know what it is either" "Do you mean Digoxin?" "Oh, yeah, that must be it." Sometimes having people watch and learn and make sure the patient is stable is better than having them do without having the knowledge base.

[RNKPCE]

I can't imagine admitting a new onset atrial fib patient to a non monitored floor??? Was there not a patient on a monitored floor that could be triaged out to a regular floor? Would insurance even pay for admiitting a new onset AF and then not monitoring them. Other than vitals and a some PO cardiac meds what interventions would you be able to do. How would you assess the few interventions you could do since they wouldn't be monitored?

[runsmiles]

Boy! did you miss a teachable moment. Floor nurses do not have the same skills that an ICU nurse would have, even though they have an ACLS certification. This could be classify as "lateral violence". I guess nurses do still eat their young.

[klone, MSN, RN]

I guess nurses do still eat their young.

Please stop with the tired cliche. The OP has been a nurse for less than a year, I don't think that qualifies as "eating one's young."

[hearthelper]

I am glad I posted, and it is good to see everyones take on the situation. I apologize if I offended anyone and I would never call a M/S nurse stupid nor would I consider any of my co-workers stupid. I just like to see proactive people at work not reactive people I am always learning at work and I like for others to be trying to improve or show interest. Also, FYI I spent my first year as an RN on a cardiopulmonary stepdown unit where on a good day I had 6 pts and hopefully 2 pts on critical drips and 1 pt with a sheath that needed to be pulled. Thanks for the replies!!

[mappers]

"Doesn't rapid response include a doctor of some kind? even a resident?" Not at our hospital. We are not a teaching hospital and do not have residents. ER docs do not respond to RRs and it would be a crap shoot as to what doc's might be around at any given time.

An ER doc does respond to a code, however.

[caroladybelle, BSN, RN]

I don't think so. If you take monitors on your floor, you need to know ACLS and what to do in an emergency or ACLS situation.

Respectfully, I have some news for you.

The nurses on the floor do not make the decision about monitors on the floor - management does. And frequently management installs them, without ANY regard to the training required, or the extra time and care needed when you place monitors on a medsurg floor, nor the liability that this places on the staff. And if staff questions the wisdom of this, they get told "Well, there are monitor techs/The only pts that you get will be (snort) stable pts". If the medsurg nurse gets training - it will be a 2 hr course with maybe a open book test. No ACLS, nada in most cases. No "what to do with SVT".

In my previous incarnation, I got all of the aformentioned 2 hour class on rhythm strips and zero training on what to do with SVT. One afternoon, RT comes to report that one of my "stable" pts (there were 6) had a heart rate of 170. I go in and it was 150. Then dropped back to normal. I requested telemetry and paged the MD...and paged ...and paged...and fought and fought with tele who requires an electronic order. Temporarily I put the pt on the EKG until we could get argue tele into giving us an "unauthorized" tele monitor. Pts pressure was stable but would go into sudden episodes of sinus tach for a few minutes and then convert back - no symptoms.

Between me, my charge, my ADON, the rapid response critical care nurse, it took 2 hours to get a tele order and over 5 to get an MD to see the pt - they didn't care as long as the pressure held.

Pt finally went int SVT and pressure dropped - then the MD would come. We attempted myocard, but had to shock the pt to convert. Why, on a medsurg floor where no one does this, you may ask? There were NO ICU beds and the cardiac tele floor will not take a pt in SVT.

At that point I have had other pts crawling over the side rails, family members angry that I did not have time to hand feed their loved ne and they had to assist their loved one to eat, techs ticked that I asked them to do postop vitals and didn't "help" them enough (the tech actually had the temerity to stop the ADON as she was running for sedation for the cardioversion to tell her to tell me that I needed to stop and help her pass trays). We were also going into shift change and someone assigned a "float" nurse with NO tele 2hr class/experience to take my pts at the shift.

Somehow I managed to give report after successful cardioversion to Cardiac, pack the pt, and rushed report to my relief. I offered to transfer the pt to cardiac. After all, I was there and knew what went on and could give a accurate report. I then stayed for 15 minutes to catch up some meds.

I then get called in to HR a week later. The wanted clarification as to why I clocked out 45 minutes late that day. I explained the situation to them. They then dismissed the need for me to give direct report, because "the float should have been able to take the pt and answer questions" - the one that never even saw the pt and had NO cardiac training.

I mean afterall, the budget rules and that 45 minutes costs the hospital and will put a mark against my "Stewardship" points for eval.

Bluntly, if the medsurg floor actually managed to get 4 overworked nurses together in the room, they were concerned beyond belief. But if the pt was asymptomatic, and pressure was holding, chances of getting the MD to care abut the MS opinion often is useless - many will not listen until the RR Team clarifies that there is something to worry about, sad but true.

MDs want to care for their pts on their specialty floors. And they are the money makers. This means management will continue putting monitors in places that do not have the knowledge, or time or ability to properly care for those pts. And it is a shame.

PS. I now work CC and have had a lot more tele training.

[caroladybelle, BSN, RN]

Boy! did you miss a teachable moment. Floor nurses do not have the same skills that an ICU nurse would have. I guess nurses do still eat their young.

If you note the OP is a relatively new nurse and therefore is "young" in career.

[AOx1]

I can guarantee there are nurses and physicians who are more knowledgeable than you. How would you feel if they made jokes at your expense? This was unprofessional, and did not in any way contribute to helping the patients. If you were interested in furthering the profession you could teach others instead of make fun of them.

[Pepper The Cat, BSN, RN]

I worked in a very very small hospital for a while - 60 beds.

One day, I come in and there was a heart monitor at the desk. I had no training, was the only RN.

The doctor calls, wants to know how the pt is doing, what's on the monitor. I tell him "little hill, big hill, big valley - little hill, big hill, big valley". Lucky for me, he laughs, tells me to look out for "little hills by themselves" and what to do if I see one or a lot of them. I was so glad when that pt got shipped out to a bigger hospital!

[heron, ASN, RN]

All of the above and remember also: "First, do no harm". The last thing you want in a crisis situation, or a crisis trying to happen, is people doing for the sake of doing, with no idea of what they're supposed to be doing. Without knowing anything about the training of or hospital policy for those med-surg nurses, it seems that they did exactly what they should have done: called the rapid response, which presumably includes an MD.