Unbelievable floor nurses.

[kjblack]

A patient is brought down to SICU because of complications from a small bowel follow through. A little background info on this patient......obese..140 kg....5 ft 3 inches.....N/V x3 days.....mottle from nipple line down when she arrives.....no lower extremity pulses......sinus tach at 180..patient core temp at 94.0 degrees...no palpable blood pressure.......Anesthesia present at bedside to intubate, place aline, and right ij triple lumen, patient has a 22 gauge to right thumb...it works long enough to give 4 cc's of ROC....then blows..no other IV access before cline is placed. Meanhwhile I'm at the head of he bed trying to keep this lady from aspirating because she just vomited 800 cc's....patient finally gets intubated, cline done, aline is done. Cline completed by Site Rite...so we have immediate confirmation..Anesthesia leaves......primary Doc is out of town and OC doc is at home..but leaving for the hospital....the OC doc is a endocrinologist...freakin' great....meanwhile I decide to pump this lady with 4 liters of fluid in about 30 minutes...finallly doc shows up..doesn't know what the hell to do....what a surprise....floor nurses are standing around doing nothing...one is standing at the left side of the bed telling the patient to calm down....hello idiot...she just received a paralytic....the other nurses are now sitting down in the hallway while me and my co-workers save this lady. About 1 hour later my patients vital signs are now ABP125/87, CVP12, HR 102 SR, mottling has decreased considerably, patient now following commands, pH7.31, C02 42, P02 70, the initial gasses were 7.0, c02 41, p02 32, BE -13, long story short..three days later i am in the bosses office because I was written up by three floor nurses for my attitude when they brought the patient down......the floor nurses claimed that there was verbal abuse, and physical abuse(one nurse claimed that I shoved her), verbal abuse was cussing. Nevermind that this patient was under the care of these 3 genius floor nurses for three hours before they figured out that something was wrong. If I had to do it over again I would do the same thing because we discharged that patient home just recently after having a small bowel obstruction repaired. If I have to lose my job over a few idiot floor nurses so a family can enjoy there loved one for years to come then that's what I will do. As far as the shoving goes...nothing could be further from the truth.....cussing yea probably..but nothing a good seasoned ICU nurse hasn't said or heard before. Unbelievable floor nurses.

[AliRae]

:thankya: :bowingpur

nicely said and thanks from a lowly med-surg nurse

lowly my rear end ... the floor scares me to death.

[prmenrs, RN]

ICU nurses honestly don't know how floor nurses work and vice-versa. In the ICU, nurses must focus on minute details. Floor nurses, it's all about how well you can juggle.

Walk a mile in my shoes. If you don't want to do that, then cut me some slack. Acknowledge that it's "different" over there, and give each other respect.

[Roy Fokker, BSN, RN]

Good post TraumaRus :)

ICU nurses honestly don't know how floor nurses work and vice-versa. In the ICU, nurses must focus on minute details. Floor nurses, it's all about how well you can juggle.

Walk a mile in my shoes. If you don't want to do that, then cut me some slack. Acknowledge that it's "different" over there, and give each other respect.

I always appreciate my ICU nurses - if someone on my floor is crapping out, I am re-assured in the knowledge that I have a splendid backup team from ICU.

I wouldn't dare presume to know what to do in an ICU setting - too many machines, beeps and buttons for me! I'd probably get over stimulated and seize or something!

I am wondering how many patients the floor nurses had apiece, how many hours and days that they were fighting with the MD to get the patient taken care of? How many supervisors that they had to argue with to finally get the patient to the ICU?

Reminds me of a post-op lady I was taking care of for three nights in a row.

From night one, I was urging the MDs to look into her BPs (I didn't see one that was less than 170/100), Tachycardia and K/Mg levels. In my mind, the interventions being done were too half hearted. Not robust enough. She needed more help in controlling those than she was receiving.

In any case, she needed better monitoring than simple telemetry. I had 7 other patients other than her - one with near constant n/v and another who was getting 2 units PRBCs, one under isolation and one with bad pain control. My three post-op knee replacements were actually my most stable patients - despite two of them having epidurals which needed regular assessments.

Night 4 rolls around and she is assigned to someone else. Telemetry calls up and tells us - "She's going into A-fib". Called MD, who brazenly tells us to start Cardizem drip and starts shooting orders left, right and center.

We put our foot down, called house supervisor and insisted that she be transfered to ICU....

... where she still was, two days later before being discharged back to the floors to recover.

We made sure our documentation on that case was airtight. I plan to bring this up at next staff meeting - it's absurd and downright dangerous. I don't know how many times we have to tell our Docs - we DO NOT do medicated drips on the floor. We are not exactly "equipped" to handle a crisis if it were to arise.

Sorry for ranting.

cheers,

:)

[canoehead, BSN, RN]

I can see how easily the woman could get that sick, even with an attentive floor nurse.

Perhaps the previous shift hadn't looked in on her during the last hour.

Report at shift change.

They have to assess and care for other patients.

They called whoever was on call and tried something low risk like a fluid bolus.

They had to wait for whatever they tried to work.

They called back and said "I'm not kidding, she's really sick"

Try something else, and wait.

Call back, demand ICU transfer and maybe get it the first time, or maybe not.

I see 4-5 hours the woman had to get sicker, and with a really good bowel infarct/rupture she could have gotten that sick in an hour. So the nurses were not necessarily ignoring her. Probably very concerned and attentive actually, but they don't have the resources an ICU nurse has, and they were dealing with an endocrinologist who didn't lay hands or eyes on the patient until she got to you.

When I was a supervisor we had a lady that was going bad, with chest pain and an ashen color. The doc demanded we fluid bolus her 4 times, and wait for effect. He didn't believe the blood pressures we gave him, and was asked to respond to the bedside to verify her condition for himself. After some harassment on the floor he said he figured the only way he'd get some sleep would be to transfer her to ICU (where the nurses knew what they were doing). Amazingly, on transfer her pH was 7.1, and then the stat orders started flowing. It took us 4 hours from shift change of almost constant calling, getting orders, and reassessing to get her to ICU, and they called me after two hours of getting nowhere.

I think they were very concerned and frightened when they got to you. If they weren't then you have a great opportunity to do some educating. Point out the impending signs of doom and give them something to do. Was someone scribing for you? Grabbing supplies? Spiking IV lines? Pulling meds? Answering phones? Putting orders in the computer? Delegating will cut your workload in half when you get a critical patient, and if you're really good you can convince a supervisor to leave a helper with you all night.

[nrsang97, BSN, RN]

To the OP:

I CANNOT tell you how many times I had to BEG the ICU RN, CHARGE RN (OF ICU), and NURSING SUPERVISOR, and HOUSE DOC for a patient who was going bad to be transferred to the ICU before it was TOO LATE. Sometimes they tried to refuse saying pt wasn't sick enough.

I had been a nurse less than 6 months on a busy med/surg/neuro/surg unit. I had admitted the pt at 0300 and she was alert and oriented. Only odd thing was she wouldn't open her eyes while she talked. Pt was on tele and stable. I came back at 1930 for my shift that night and the na came to me and said "I cannot wake up Mrs.Jones to eat. Should I save her tray for later?" I immediately went and assessed this pt and I couldn't get her to respond to anything ( sternal rub and what not). I also asked the aide how long she had been like this and she told me since 1530 when she started her shift. I called the house doc on call and got orders for STAT CT. I actually had to fight with the CT tech to do the CT to rule out CVA. Pt dx was r/o CVA. CT told me that they didn't need to to test CVA was ruled out the night before. I explained about the huge change in status. CT agreed to do test and told me to SEDATE the pt. I explained that pt was UNRESPONSIVE and was still told by the CT tech to SEDATE HER. I finally told the tech that I would give her something so I didn't have to waste anymore time. Pt taken to CT and came back with report taped to front of the chart. MASSIVE CEREBELLAR CVA. Called the resident on call and told her result of CT and was told to call the attending. I had tried many times that night to get ahold of him and unsuccessful. At 2330, Pt BP was 220/100 (something like that), Pulse ox was 50% and pt was turning blue and had wierd resp pattern resp rate at 40. We called resp stat and house doc intubated and ICU came up to get the pt. They were very helpful and took the pt to the unit. (In this hospital we had to wait for ICU to come up and get the pt for transfer to the ICU).

I did everything I could to get this pt the care she needed. So when ICU received a unresponsive intubated pt they wern't upset with me. I was wondering how long she had had the changes before I came in.

So if the change had been picked up earlier and I didn't have to spend time arguing with the CT tech we may have got the pt to the ICU sooner.

Sometimes things are out of the floor nurses hands. They may have begged and pleaded with the MD or whoever they needed to to get the pt off the floor to the unit before things went so bad.

I cannot tell you how many times we have gotten patients from the ER that should have gone to the ICU. Or the times we have gotten a pt from the ICU only to turn around and send them right back.

I am sorry this thread hit a bit of a nerve since I worked at a med surg nurse for 5 years before I went to ICU. I now work in the neuro ICU and love it. I also know how fast a patient can change. I had my own pt go from NSR at 1900 to wide complex sinus tach at 1910. So I understand what it is like on both sides of the fence. If I had the choice to go back to med surg or stay in the ICU, I would stay in the ICU.

We all need to show a little respect for each other. There are different stresses in med surg and ICU and many are the same. Many of the best nurses are med surg nurses. You have no idea what we have had to learn to juggle and keep up with. So maybe put yourself in their shoes, they don't have the resourses we do in the ICU.

[oldiebutgoodie, RN]

Well, I was an ICU nurse right out of school for about a year and a half, and just switched to a med-surg floor, (for many, many reasons!) so I am aware of the differences between the 2 styles. So, without getting into an ICU vs med-surg debate, I have a few observations:

1) Maybe the hospital needs a rapid response team, if they don't have one. I have now been in situations on Med-Surg where the doc did not want to transfer the pt to the ICU (despite the patient being gray with sats in the 70's), and once we called rapid response, they took it seriously.

2) The OP should have delegated tasks to the Med-Surg nurses. THey probably figured if they tried to help, they would get in the way, get yelled at, etc.

3) It does seem that on the floor, time management is stressed over assessment of patients.

I will say that since being on the floor, I have noticed that sometimes floor nurses miss a few things, like having suction set up for "drooling" patients, or doing vigorous mouth care on the total care patients. But I can also tell you stories about the ICU nurses from hell I worked with, and frankly, I would rather be with my floor nurse collegues.

Oldiebutgoodie

[UM Review RN, ASN, RN]

I've had to work with nurses who acted this way toward their colleagues, so I'm inclined to believe he/she is for real.

One nurse we worked with just couldn't be happy until she had the next shift nurse in tears. We actually used to beg our Charge nurse to give our patients to someone else so we wouldn't have to give Report to her.

She'd come in and assume that we were all morons and without her, the patients would all be dead. She jumped to conclusions all the time, and the conclusions always focused on how stupid we were. She appeared to have no concept of time when we described what was going on with a patient, and somehow couldn't visualize emergent s/s happening over a period of hours.

She second-guessed our decisions and our assessments--and we were always wrong, wrong, wrong. If she didn't find something to criticize--oh wait, that never happened, so I can't really say what her response would be.

I'm not exaggerating, either. I can't tell you how many complaints her behavior towards us generated, but I do know that a couple of our newer nurses couldn't take it and transferred out.

When this nurse finally decided that the entire unit was not good enough for her and moved to ICU, we were all group-hugging in the break room with relief.

No one deserves to be called names and disrespected to that degree.

Please remember that.

[sirI, MSN, APRN, NP]

Thread time out for staff review.