Critical Pt and More stable Pt

Specialties MICU

Published

I was going to put this in the general forum, but it kinda has to do with ICU too.

Earlier this week I had two patients for two days. One was really sick on a vent, septic shock. Wound vac, plenty of gtts. Multiple consults of course so many doctors coming in and out. Bedside procedure with the surgeon both days, with the pt ending up going back to surgery on the second day.

Other pt is resolved sepsis, with only NS and abxs. Lethargic on bipap receiving PO contrast for a CT. Not easy and quite time consuming, but had to be done. Contrast with thickener (ew! anyway). Husband very needy, always at bedside and turning on call light. Asking for ice water for himself all the time. He'd put on the call light for silly stuff and saying "When you get a break I'd like some ice water." Taking me away from my other pt. Still, I did so politely and juggled them both. Its my job.

Pt #1 was sicker, but I felt like the other pt got a lot more attention. I was in that room way more. And pt 2 had a transfer to med bed but never got it

I've heard other nurses explain to pts before that the other pt assigned to them is "really sick" and they are busy with them. I always thought that was pretty taboo and never said it before. I don't want a pt to think that they are lower priority. But these were ridiculous requests. Finally I told the pt and husband that I was outside with a doctor right now and would be back in a few minutes.

My question is, Would you ever politely say somehow that you're busy with someone else?

I could only say "I'll be in to help in just a few minutes so many times. I was worn out by the end, and apparently it showed on my face to just about anyone. The husband finally said that I looked very "stern". I told him I was just multitasking in my head. But he said I was a good nurse. Very decisive/well managed. ((UGH!))

That was a question and a vent. :p How would you have handled it?

Specializes in CVICU.

Wow that would be annoying. I guess I would say something like "I wish I could do that for you but it really isn't a good idea for me to be leaving the floor today d/t some other obligations. The waiting room is right down the hall and it has everything you need." I would say this very politely and then leave the room cursing in my head.

Yep. We've not problems telling family that we are busy attending to other things that are of a higher priority. We don't have open visitation, and we're not here to wait on the family. They can fend for themselves.

Specializes in CVICU.
Yep. We've not problems telling family that we are busy attending to other things that are of a higher priority. We don't have open visitation, and we're not here to wait on the family. They can fend for themselves.

Oh my! How do you ever keep your Press Ganey scores up??? :D

Specializes in multispecialty ICU, SICU including CV.

I'm surprised your ICU lets family members eat in the room. Mine doesn't. No cell phones, either. We have one chair for family members. They are welcome to visit by all means, but they aren't really encouraged to camp out. I think it's about limit setting and what your ICU culture dictates. It doesn't really matter so much what you say as one person, even if it's appropriate -- if everybody else caters to this patient's husband, it makes you look like the bad guy. Probably your manager needs to get involved and discuss with your whole unit what is and is not required of you and is expected of visitors as far as behavior and back you guys up. No where I have worked have I been required to pass water to family members, and I don't think that should be an expectation (your manager might say different, however.)

I usually just handle it very matter of fact. I floated out to our stepdown last week and I was in the middle of passing meds and charting on the patient in the room that I was assigned to -- another nurse had the other guy. The family member of the other guy in the room asked me for a chair. I just told her "I'm with a patient right now" and she backed off. She went out to the hallway, assumably to run down somebody else that could cater to her needs immediately....LOL. If this guy asked for water and I was too busy, I'd just say "I have a critical patient in the next room that needs 3 things right now. The drinking fountain is in XXX location, and the cafeteria is XXX."

We actually went through a point where there were no limits on how many people in the room, anytime they wanted. They changed that back to only 2 visitors at a time because it was just ridiculous. We still have unlimited visiting hours.

I didn't mind getting water at first, but then it got out of hand. I felt too bad to say no after I had already been getting it. I'm guessing maybe he heard the doc say something because I heard him quote that "She has a really sick one next door." It made me uncomfortable for him to know that though. It didn't stop his ridic requests.

I just didn't know if that was stepping on the bounds of pt confidentiality. I was ok saying I was with a surgeon, doing a procedure, etc when I was doing it.

I wish we had limited hours again. I would have never dreamed of being like that when my father was in the ICU!

my question is, would you ever politely say somehow that you're busy with someone else?

here is where you balance the "customer service" aspect of what we do with the "clinical requirements."' when you strip it down to abc's, medications, treatment, and analysis, our job becomes deceptively easy.

you are in ultimate control of your cns to motor synapse.

for example, you walk briskly past the pesky visitor standing in the doorway trying to flag you down, casting him a "one moment please sir," as you continue on regardless of his adamant insistence that you stop. why?, because you are responding to an abc situation in another room. otherwise, in the absence of a clinical justification to the contrary, you must appropriately address the customer's needs, or potentially face the wrath of management. in the example above, you would return and explain that you were called away to an "emergency."

always be appropriate and professional even in the face of the vilest human being imaginable, "kill them with kindness," cut it short, and call in the next level (supervisor), as appropriate. never make it "personal."

the husband finally said that i looked very "stern". i told him i was just multitasking in my head. but he said i was a good nurse. very decisive/well managed. ((ugh!))

assuming then that you do not allow the other patient's interventions to suffer as a result, this comment would indicate a tough but successful shift.

Specializes in Trauma acute surgery, surgical ICU, PACU.

I always try to remind myself that being extremely self-absorbed can be a huge aspect of the sick role - for a pt and their family.

I remember one guy I had while I worked on a surgery ward, took it so personally that I wasn't cheerful and waitressy. "You could at least smile!" He snarled.

When I told him I just wasn't smiling because I was concentrating on not making an error with his IV pum programming and that I was also worried about another pt of mine who was "very sick", he knew not to take it personally, and we got along much better.

I don't think "There is someone else who is very sick" violates privacy, it just gently lets them know that they aren't the centre of your world, without hitting them over the head with it.

My father in law still, several years later, takes issue with a nurse he had who was not cheeful and didn't offer him a basin or a warm blanket.... I remember visiting him the next morning after this, and he asked "what does code blue mean?" - It means your nurse was too busy to worry about a warm blanket and you should just have asked and not begrudge her the fact that you had to ask! Geez!!!

:twocents:

Specializes in floor to ICU.

I haven't been in ICU very long but have noticed that when they get well enough to hit the call light all day long for non-essentials, they are usually not ICU status anymore and it's time to move 'em out!

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