Neuro Floor Nightmare!

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Specializes in Telemetry/Cardiac Floor.

background: i worked on a neuro floor that should have a 4:1 pt to nurse ratio, because it is considered a critical care floor. our shifts are 0600-18:30. i received my 6th patient at about 15:30. problem: for some reason we didn't have a decent pct/secretary. a variety of people were putting in orders. some orders got missed including mine. this was a serious problem since my pt. was admitted with a k+ level of 7.2! the doctor came in an hour later and the orders still weren't put in. he was ****** and looked at me like it was my fault. i dont know how to put in orders and wasn't trained to do so. besides that, the orders were missing. when i finally found them they were tucked behind the front desk computer. by the time they were put in and results were received, night shift was there and got the results. the pt. k+ level was 8.0.:eek: the pt. could have coded. so obviously the night shift nurse looked at me like it was my fault, and potrayed it to the physician that way. i'm so upset and depressed i don't know what to do. in the midst of all this i had other patients and physicians pulling me in different directions. i never want to go back. what should i do??:crying2:

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Specializes in Pediatric/Adolescent, Med-Surg.

If you are considered "critical care" there is no way you should have 6pts!! Even if this is step-down, no way in hell!! I would be looking for a new job!!

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Specializes in Telemetry/Cardiac Floor.

Yeah but, who wants to hire a 5 month pregnant nurse?

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Specializes in Med Surge, Tele, Oncology, Wound Care.

Is there a way you could have filed for what we call a "assignment by objection." Or claim "safe harbor," We fill those out when the staffing is unsafe. That way if anything happens it might be able to protect you.

That sounds just awful!

I would tell your manager that you wont work (or demand) that you get training on putting in your own orders- at least. Just in case next time a stat order needs to be put in the system you can at least do it yourself if your HUC is busy, or at lunch.

I wouldnt want to go back either when your licence is at risk and so are the lives of patients! I hope that dosent happen very often.

I just had my little one and being pregnant and a nurse is not easy!

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Specializes in Telemetry/Cardiac Floor.

Thank you, I will see if that is available!

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Sorry that your feeeling that way. Just learn from it. There are good and bad days at work. This is just one of the bad days! I know that it's the secretary's job.....but next time you have the oppportunity to learn how to encode stuff, learn it. Afterall, if there's a delay in treatment and the patient coded, it will be you and your license on the line.

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Specializes in Telemetry/Cardiac Floor.

And... the other patients and their problems and their orders? I guess they'll get ignored since I'm putting in my own orders for other patients. "Learn from it" learn from what???:confused:

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Altho I doubt anyone will admit to it, try to find out why/how the orders were misplaced. Sit down ASAP with your boss and talk to her/him about what your shift was like and how to prevent further problems. Was this an ER admit? Were you told in report that your pt K was elevated? Where was your charge nurse or manager when this was all going on? Is this a common staffing problem? I hope for your sake you can get some resolution with this before you go on maternity leave. Best of luck in your career and with your new little one!

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Specializes in Telemetry/Cardiac Floor.

Good points. The charge nurse was no where to be found. It was a direct admit, so no report. The assistant charge nurse was standing there with nothing to offer. I discussed the entire problem with the charge nurse when I found her. She repled.."I'm sorry, but that's how it is. What can we do?" I wasn't satisfied with that answer. I will mention it to my manager. I left that day at 20:00, the charge nurse was still there when I left. Everybody was swamped. :crying2:

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Specializes in Neurosurgical, Orthopedic, Wound Care.

Wow!

This sounds so much like my floor! For a moment I almost thought we worked together!

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Specializes in Med/Surg.

I agree with learning how to put in orders. No, that doesn't mean you'll be putting in all of them (as you mentioned, neglecting other patients because of this), but you CAN then put in the ones that you HAVE to have without exception. Even if this admit had two pages of orders, if the one you needed dealt with treating the potassium, then that's the one you could have put in, rather than all of them.

I have had to do this. We have one HUC that is SO slow, the chart rack gets backed up for hours. Unfortunately, she KNOWS that we'll put our orders in if we have to, so it lets her get away with slacking (and without going in to detail, yes, she does slack), but if it's something I need ASAP, what can I do?? She'll put charts with a lot of orders, or orders more difficult to enter, at the bottom of the pile to "deal with later." (My managers are aware of this, and of the rest of the problems with her. Why anything hasn't been done is beyond me, but I know for sure that they are aware :mad:).

At my facility, though, all of the RN's are trained in order entry. On night shift, there is either no HUC, or one HUC that floats hospital wide, so when we get admissions, we have to put our own in usually.

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I would fill out an incident report. They are usually used as "learning/teaching" tools and identify system problems. After all a pt was almost harmed by this system breakdown.

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