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??

[Fribblet]

Sort of off-topic, but, frankly, all RNs should be required to have ACLS. Monitored floor, critical care, ambulatory surgery, Office RN, whatever.

Any patient can tank unexpectedly.

[grandmawrinkle]

TO CLB --

That is all well and good and likely not an isolated situation with the way things are going in healthcare. It is also a management problem. OP did not say that the staff on her ward (unless I missed it somewhere else in this thread) weren't trained in tele/ACLS so I was assuming that was not the case. In my area (heavy nurses union involvement) what you were describing would never fly. I have worked in parts of the country, though, where I could see it.

I was going to say this before, but really, although I DO feel that the floor nurses needed to get involved in this situation instead of standing around with the "deer in the headlights" thing going on, it probably would have been wise for OP to jump in and get things started as far as treating the patient as well. I would have felt really bad as an ICU nurse dropping off that patient. You bet your ass that those nurses after OP left talked the rest of the night about the "dump" they got from ICU.

[ok2bme]

It was not nice, and it seems like you realize that cracking jokes and making fun was not the ideal thing to do. All you can do is apologize to the nurses and try to react differently if something like this happens again. Life gives us opportunities to grow.

[caroladybelle, BSN, RN]

Sort of off-topic, but, frankly, all RNs should be required to have ACLS. Monitored floor, critical care, ambulatory surgery, Office RN, whatever.

Any patient can tank unexpectedly.

And people on the street, in bars and the shopping mall can tank unexpectedly.

Different nurses are differently abled. I know some excellent clinicians with amazing knowledge and skills, that would quit before doing ACLS. ACLS involves certain skills, rapid response, rote memorization that would push and perhaps go beyond their capabilities.

In places that I have worked that have required ACLS of all RNs (including skilled care, medsurg, psych, etc), it has been a failure. The facility rarely wants to pay for the classes, or maintain the upkeep of skills. The nurses on some floors may pass the class and yet never use the knowledge on the floor - exactly how secure are they going to be when they never use the skills.

If some floor nurses barely can get their hospitals to arrange for them to get a 2 hour tele class, what is the chance of getting them to do what it takes to keep everyone up on ACLS?

There are also nurses that will pass ACLS, but don't necessarily have the personality traits that go with doing ACLS. They are not bad nurses but it is just not what they do.

And for those that are good and knowledgeable at it - you will see a mass exodus from Medsurg to the ICUs. Quite bluntly, if one begin requiring the same things (skills/coding/standards of care) of medsurg nurses that are required of ICU nurses, why keep working in the Medsurg arena, where one has the legal responsibility to do so with 5-10 pts rather than 2.

(PS. Good clue as to why I work CC?)

Sure, everyone can tank at any time - so when will our facilities be forced to stop short-staffing floors, and adding more and more duties to the already overstaffed RNs, while taking none away?

[klone, MSN, RN]

Yes, I agree with Caroladybelle - unless you use it semi-regularly, it's a wasted skill (meaning, it's one that will be quickly forgotten, and when faced with a rare situation where it's needed, you probably wouldn't remember what to do anyway), and it's very expensive to maintain. It wouldn't be cost effective for all RNs to be required to be ACLS-certified.

That is the whole purpose of Rapid Response teams - to provide the certification and ongoing training for a select few that will use it regularly and maintain their skill.

[RNBSNxo]

Well they need to know what to do, patient safety is the concern. It can be an issue of competence. I know in emergecny situations some of us lose our heads and thinking skills. Maybe your hospital needs some mock situations, inservices, etc. You seem to know the drill so why not do some inservice projects about what to do in emergencies? Make some posters, something. This will get farther than the jokes and grudges to follow.

We have emergency situations, RRTs and Codes often on our floor so I have even caught myself before thinking how did the nurses on a lower acuity floor not know what they were doing. But I see these weekly, not an expert by any means, they see two a year. Educating them would be great.

[caroladybelle, BSN, RN]

Maybe your hospital needs some mock situations, inservices, etc. You seem to know the drill so why not do some inservice projects about what to do in emergencies? Make some posters, something. This will get farther than the jokes and grudges to follow.

We have emergency situations, RRTs and Codes often on our floor so I have even caught myself before thinking how did the nurses on a lower acuity floor not know what they were doing. But I see these weekly, not an expert by any means, they see two a year. Educating them would be great.

Again, the point is that most hospitals are not willing to do so or to facility the use of such things in a meaningful lasting way.

In the facility that I cited, they had a lovely poster exposition during nurses week, along with a pasta meal served. There were a good 20 displays shown, with lots of interactive things involved. I saw plenty of CC nurses and management there. And also few to no medsurg, psych, ER staff.

On that day for Nurses week, only 3 of us made it off of my floor to "celebrate nurses". In our strictly enforced 30 minute lunch, we barely had time to run down, get through the food line, and run back. On day shift, I had 12 patients shared with an LPN, 14 units of blood products, and several moderate risk chemo infusions, plus Atgam to give to a pt that had a reaction with the previous dose.

Do you think that we had time to actually see any of those posters or absorb the data?

As a former traveler, that is the situation in way too many facilities, even some of the good or Magnet ones. More and more pts and duties getting dumped on the medsurg nurse and none being taken away.

At some point, you cannot get blood from a stone. At some point, you have to say that you cannot give any more, because there is nothing left to give.

And I left Medsurg.

[Flying ICU RN]

Whenever a patient has something adverse happen to them, I could care less if the people standing around are playing Parcheesi.

What matters most, is what I do next.

[Fribblet]

And people on the street, in bars and the shopping mall can tank unexpectedly.

Different nurses are differently abled. I know some excellent clinicians with amazing knowledge and skills, that would quit before doing ACLS. ACLS involves certain skills, rapid response, rote memorization that would push and perhaps go beyond their capabilities.

In places that I have worked that have required ACLS of all RNs (including skilled care, medsurg, psych, etc), it has been a failure. The facility rarely wants to pay for the classes, or maintain the upkeep of skills. The nurses on some floors may pass the class and yet never use the knowledge on the floor - exactly how secure are they going to be when they never use the skills.

If some floor nurses barely can get their hospitals to arrange for them to get a 2 hour tele class, what is the chance of getting them to do what it takes to keep everyone up on ACLS?

There are also nurses that will pass ACLS, but don't necessarily have the personality traits that go with doing ACLS. They are not bad nurses but it is just not what they do.

And for those that are good and knowledgeable at it - you will see a mass exodus from Medsurg to the ICUs. Quite bluntly, if one begin requiring the same things (skills/coding/standards of care) of medsurg nurses that are required of ICU nurses, why keep working in the Medsurg arena, where one has the legal responsibility to do so with 5-10 pts rather than 2.

(PS. Good clue as to why I work CC?)

Sure, everyone can tank at any time - so when will our facilities be forced to stop short-staffing floors, and adding more and more duties to the already overstaffed RNs, while taking none away?

If there's a code cart where you work, you should probably know what's in it, what it's for and how to use it. Period.

As to the hospital not providing the class: boo-hoo. I took ACLS and PALS on my own time. I needed it and the hospital courses did not jive with my schedule.

Again, it's pretty simple: If there's a code cart where you work, know what's in it and how to use it.

(And by the way, it's not just ICU that uses code carts. We use them in the ER and sometime we have 6-8 patients. Also, you need to know a bit more than ACLS to work in the ICU. Seriously, if learning ACLS is too much for a nurse, then, well, I don't even know what to say. ACLS isn't difficult.)

[HamsterRN, ADN, RN]

Being ACLS trained and being allowed to use ACLS by your facility are not one in the same. I wouldn't expect a med-surg nurse to push adenosine on an otherwise stable patient without the assistance of a nurse experienced with that intervention if RR staff are readily available.

[hearthelper]

The point I was trying to make in my original post was the first thing that any Nurse (med/surg, lpn, rn, icu) should do if there is a change in the status of your pt the MD should be notified. I can't, even as an icu RN, push any drug without an order. All I expected the nurses to do would be to get the ball moving so we could help the pt sooner instead of waiting for the MD to call back and give his orders. I don't expect the Med/Surg RNs to run a code just know to send somebody to call the doc. This wasn't a dump as stated in a previous post. The pt had never been in SVT before and was pretty stable from a cardiac standpoint. She had a hx of afib. There are some interesting post in response to my original post and have enjoyed interacting with allnurses.

[regularRN]

A.fib is very common... all med/surg RNs can recognize a.fib (without a monitor). SVT... not so common, but difficult to diagnose without a cardiac monitor but obvious enough - pt is gray, diaphoretic, cold and clammy... feelings of impending doom, losing consciousness.

Med/surg RNs have five (or more pts), ICU one, maybe two.

The rapid response RN is an ICU RN, called to the med/surg floor in an emergency... specifically to deal with the emergency, including communicating with the MD.