Would you take this assignment??

  1. I arrived to work last week (7p shift) and my assignment was:

    Patient #1: 48 y/o male, s/p CABGx4, 6 hours out, still intubated, all the usual lines and tubes, CT output was averaging about 150/hour, needed FFP and PRBCs, on epi, dopamine, vasopressin, ntg, insulin, mag, and maintenance fluids, b/p super labile, was atrially paced with frequent episodes of non-capture and pvc's (despite the surgeon's meddling with the pacer).

    Patient #2: 42 y/o male, s/p crani secondary to sah, about 3 hours out of surgery, ventric, aline, foley, and when I walked down to his room, screaming his lungs out and trying to climb out of the bed.

    These patients were FIVE rooms apart, and not in a corner or curved hallway where it would be possible to see both, but five rooms apart down a straight hallway.

    I NEVER complain about my assignment when I go to work. When I questioned this one, the day charge nurse who made the assignment got SUPER ticked off and we had a major tiff that ultimately ended up in me refusing the assignment.

    SO, instead of the crani I got a brain dead patient, three doors down, waiting for our state's organ procurement agency to show up and do their thing. THAT patient came with her own nurse from the agency; all I had to do for that one was put in orders and get meds from Pyxis. I was SUPER busy with the CABG; one of my first hours he had 240 out from his ct! Once the FFP and PRBC's got in he was a little better, but I was never able to wean any of the drips that shift.

    What would you have done? Am I wrong for thinking my original assignment was unsafe? What's your ratio for CABGs and how long, if at all, do they stay 1:1??
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    About SICU Queen

    Joined: Jan '02; Posts: 571; Likes: 505
    RN/Mother/Housekeeper/Vet/Should I go on?
    Specialty: 16 year(s) of experience in SICU

    18 Comments

  3. by   fakebee
    No way. That's a totally inappropriate assignment based just on acuity.Factor in the safety risk of a confused fresh postop patient and that was two disasters waiting to happen. As far as the CABG patient we normally have them as 1:1 for the first 8 hours but of course that goes out the window
    if we're short staffed on night shift. After having 2 assignments where I took a second pt while my Cabg pt was less than 4 hours postop I refused to work in our CVICU anymore because I felt so strongly it was unsafe. Of course my mgr and charge nurse now think I'm lazy but I still have my license and I haven't killed anyone. I think the saddest part about nursing is that if you advocate strongly(as in saying Hell no I won't take that assignment) for pt safety and quality care you develop the reputation as a troublemaker and malcontent, instead of being recognized as one who stands up for and embodies the ideals of nursing. You have to watch out for your pts and yourself- nobody else has the stomach for it besides the bedside nurse. How sad...
  4. by   meandragonbrett
    No, I would have refused it. We keep our hearts at !:1 for 8 hours. Why was the pt. not extubated already? The CABG should have been paired up with somebody that's not on a vent and is either waiting on a step down bed or close to being dc'd to step down.
  5. by   NurseyPoo
    I think I would have walked up to the person who assigned this and laughed stating..."Okay joke is over...what is my real assignment!" That is completely unsafe and inappropriate for anyone to take. WOW! Either one of them could go bad at any second...Especially the Crani...He could have hurt himself and then where would you be?
  6. by   SICU Queen
    Quote from meandragonbrett
    No, I would have refused it. We keep our hearts at !:1 for 8 hours. Why was the pt. not extubated already? The CABG should have been paired up with somebody that's not on a vent and is either waiting on a step down bed or close to being dc'd to step down.
    He wasn't extubated because he was so unstable.

    Thanks for the reinforcement. I didn't think it was unreasonable of me to want a change, but I was made to feel like a troublemaker because of it. It's one of many problems that plague this facility, and nursing in general. I'm just about burnt out and I'm ready for something different.
  7. by   AliRae
    Maybe we're all spoiled, but in our PICU, we rarely pair vented kids. End of story. (Well, unless they're trached, but those are easy!) Doesn't matter how stable the kiddo is- they can be sedated and paralyzed, and they'll be 1:1 99% of the time.

    I would have refused the assignment, too, and I'm not a habitual refuser either.
  8. by   nrsang97
    I would have refused too. That is one heck of a unsafe assignment. The CABG and Brain death with the organ procurement are both 1:1 patients. And if 1:1 can't be arrainged then paired with someone completely stable who is ready and waiting for transfer.

    I had a assingnment one night that I had a pt whose condition went unstable at 3pm. He was on max dopamine and was changed to dobutamine and was even more unstable after that since tachy 150-170. was put on milrinone and pressure dived. pt put back on dopamine and this time added neo at max dose. Both neo and dopa at max doses.

    Other pt was SAH/ICH with ventric, vented and turn q2h. I asked if I could be singled but was told "Sorry no singles tonight." I asked if I could have a second less acute pt and was told that that was the best they could do. I did talk to the charge nurse in private and told him that I would keep the assignment but I thought it was way too acute. It was my last night of 3 in a row. Deffinately will speak up next time.
  9. by   Gixer268
    Absolutely not. Maybe if you want to loose your license. This has been preached before. Until nurses begin to refuse these crazy assignments charge, management, and administrators will continue to do this. If hospitals can afford to pay MD's those "generous" salaries, they can afford to pay for an extra nurse or two. Understaffing is the hospitals problem not yours.
  10. by   HHW2006
    Our post CABG pts are 1:1 for at least the first twelve to twenty-four depending on how they are doing! I guess I am spoiled at my facility, because I have never been given an assignment that I felt was unsafe.
  11. by   meandragonbrett
    How many CABG/Open hearts do you do a day? How many beds do you have? Sounds like a dream!
  12. by   msjangir
    This assignment is not fair. CABG pts having a lot of work and with this much of inotropic suport, heavy ct drainage, blood transfusion, fluids with another post craniotomy pts. I work in a ctvs icu where our assignments are for the ventilated pts are 1:1, there are no chance to have a second patient with atleast a post 24 hrs cabg pts.
    In your case refusal of assignment is the only solution, and it has been seen when a shift incharge is bais to a particular staff they assign like this without thinking impact of this on patients life who need a single staff.

    Mahirn :trout:
  13. by   clarkheart
    I would have refused that assignment too. That CABG would have stayed a 1:1 in our CVICU until they were hemodynamically stable, which your patient was not. As a charge nurse I would never have assigned such a load to someone. You should have asked your charge if they would have felt safe taking that assignment.
  14. by   traumalover
    open hearts are never a one to one in our unit....unless they are on crrt. Have never had problem with double assignment anymore than wih a severe septic shock pt who kept coding all day long or unstable tbi with chest and abd injuries.
    Sometimes when we have confused pts who are agitated PCT or CNA sit one to one to prevent them from self inflicted harm

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