Dear Nurse Beth,
I currently work for a privately owned community hospital at a combined ICU of 26 beds.
JCO came by on December 2017 and we were told that we failed their audit due to charting.
JCO returned on May, and we failed again due to the same exact reason. Now, the unit is struggling to keep an intensivist MD and they keep sending us out of towners who sometimes call a "mayday" and leave b/c they're afraid to lose their MD license. Basically the unit is a total chaos, we are charting on three different areas. We have the computer system that doesn't communicate with the monitors (hr, rr, bp, spo2, Cvc/art line, balloon pump machine, ccrt machine, etc), so we have to manually validate q15 min or more often depending on MD orders.
We also have a hourly flow-sheet where we have to write down every single monitoring vital from the monitor (which has already been validated on the computer chart), plus drip rates on prescribed metric system and ml/hr conversions hourly, plus we also have to document our assessment findings on this flow sheet (even though we've already documented on the computer system). Then, each drip has a perspective paper log that we're supposed to do as well. That's because our computer system doesn't communicate with the pumps, or the medication profiles system.
Then, we have a separate area in the computer system for intake and output where we manually total out the intake and the output because nothing crosses over unless it's entered by the RN.
The charge nurse's duties include auditing Foley's, central lines, medication compliance, ventilator management, plus all the mentioned charting, hourly per shift.
The temp-director informed us that we are now responsible for auditing each-other in a written two page document that may take up to 2 hours to complete. This is in addition to all the paper and computer charting we're already doing. Staff is calling in sick on a daily basis, RNs are also leaving at least one per month. Everyone is constantly coming in late and staying up to two hours after their shift to meet the charting requirements.
Staff is at each other's necks, I've been threatened by another RN of getting punched in the mouth over a computer while I was trying to catch up with my charting after my shift.
I'm worried about my license, and most importantly I'm worried about my patients safety! We're up to our necks with triple charting, it's killing us. Everyone is on edge, we don't even have a secretary, no nursing techs, we don't even have the basic supplies most of the time like flushes, IV tubing, printers don't work, only a few computers can print. And, AOS gives us <30 min to transfer out a patient who has an assigned room, regardless of my other patient's condition. We have a two patient assignment, but lately with all these staff call ins we've been tripled.
It's a nightmare because I'm under contract and it doesn't expire until Jan of 2019! What should I do?
I feel like calling out safe harbor every single shift!
Most of my medications are not at the unit, the narcotics are in a locked box inside a locked box for which we have to get a key for, the key is sometimes at the pixies at the total opposite side of the unit. Then we have 15min to return the key, and scan the medication at the bedside that's if the scanner and computer at the bedside even works!
It's a nightmare! I'm losing sleep, I've been having patients that have critical symptoms that the previous nurses have missed. I'm starting to feel chest pains, my anxiety it's at an all time high, I can't hardly sleep the night before my shift, I've developed anorexia nervousa and I've lost about 15lbs in the past 2 months. Every morning before my shift I feel nauseous and throw up everything, even water! I'm a single mom, new nurse barely 22 months in practice. Any advice from you would be greatly appreciated. I'm beyond tears, I feel like I'm in a panic state all the time. On my days off I review content regarding critical care. It's the only thing that helps to lessen my anxiety.
Thanks for your time!
Some of the things you list are serious and some are common aggravations. In many units not all computers link to a printer, the narc keys are in the Pyxis, meds have not been delivered by Pharmacy, and not all devices interface. If you worked previously in a unit where infusion pumps interfaced to the computer, it's hard to go backwards.
Some of this is "reality shock", but it sounds like most of the pressure you are experiencing is due to the failed JC surveys combined with lack of nursing leadership. They are frantically operating out of fear and and that never works well. With revolving intensivists, temporary nursing leaders, high turnover, no help and lack of supplies, you are operating in chaos.
The biggest concern is your health. Your body is talking to you. If it's impossible for you to cope in this unit, you have to get out. See a doctor as soon as you can and use the Employee Assistance program for counseling if they have one. Short-term counseling helps with reality-checking and finding some short-term coping mechanisms.
Breaking a contract can have ramifications, but this is costing you your health and putting your practice at risk. Whatever decision you make, your health has to come first.
Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!