Oh, this Pt should be on a stepdown unit, but....

While I agree that that was too heavy a pt for charge, I don't agree that she was sick enough for step down. (at least not where I come from).

And let me ask you this: You were charge, could you not have changed assignments around?

I work on a med/surg floor and one of the residents said this to me today. The whole "but" about it, is that we do not have a stepdown unit and this pt was not unstable enough to go to the icu. But i was playing chase the resident around for getting dropping a dobhoff in the pt so she can get nutrition, addressing code status- peg placement-picc placement with the family, getting a wound nurse consult giving about 4-5 different iv meds or drips, changing 5 different decubitus dressings,checking the pt pressures, and then on top of it all I was charge nurse ( still new so I was a sucky charge nurse today)- What am i suppose to do when it is obvious that the pt is not appropriate for the floor but not sick enough for icu?

If it were me I would ask for written orders to transfer, hound your bed placement people, take less patients if you can, and complain up the chain of command until something gets done. That sounds like a potentially dangerous situation, advocate for your patient and don't be afraid to **** some people off.

What do you mean by drips? Was this dopamine,neo,levo,dobutamine, or anyother vasoactive drip?

I always hate to make someone give up a pt to take a sicker pt , but to be effective at charge we have to.

As a wise supervisor told me : You cannot please everyone, you need to do what is best for the unit. So if that means changing assignments the so be it. I guess I would have taken someone elses less sick pt and they could have this sicker pt and you to assist if needed then.

Remember charge is to have the lightest assignment.

We now have a high dependency unit, which I guess must be a 'stepdown unit' as it is between ICU and the general wards. But at times we still need to have a 1 - 1 'nurse special'. I suppose the hospital would not have been willing to pay for that...

We now have a high dependency unit, which I guess must be a 'stepdown unit' as it is between ICU and the general wards. But at times we still need to have a 1 - 1 'nurse special'. I suppose the hospital would not have been willing to pay for that...

They'd be willing to charge the pt for it, though. :nono:

:confused:

I got in report that this pt was having pressure issues, diminished breath sounds, foley, had some stage 4 wounds, albumin low, A&o x1, not able to turn self, dx reccurrent brain tumor. To me, that was no big deal. I thought, they would not give me a bad trainwreck being in charge and 6 mo pregnant, right?

But when I got in there to asses that I got a full picture of the pt - at least 250 lbs and q2 turns, gen edema with ooozing, labile ability to follow commands, full code, IV keppra and 3 different iv antibiotics (all not compatible), lab was unable to draw blood on her r/t bad veins, not able to get blood bc of religious affiliation, respirations 12, and the oncoming resident had no idea about her history.

I would look for your unit's policies and procedures for such drips, on our tele unit we can initiate cardiac drips (cardizem, dopamine, nitro,) during emergency and code situations, but they must be transferered to PCU or ICU. Some of our doc's try to get out of transferring a patient on these drips, but since it's against our hospital's policy they don't have a choice. They're never happy when we inform them of the policy :)

That pt sounds like a train wreck, should have been sent to ICU since BP issuse and full code. Bad charge assignment.

I work ICU and have had the sickest pt on the floor and was put in charge. I quickly swapped charge with one of my co workers. I was so glad I did.

I guess it depends on your hospital policy. In the last place I worked that was a typical patient. Nothing extraordinary about that one. On my neuro m/s floor my patients would routinely have a trach with cont pulse ox, peg/g-tube, etc, demented, on a bed alarm, venti or lumbar drain, with multiple abx. No kidding. I had six of those one night. At Hopkins if a patient needed continuous O2 monitoring then they were not appropriate for a floor. So that shows you how different hospitals can be.

Why not call the doctor for transfer orders?

Why not call the doctor for transfer orders?

I suspect the ICU needed a bed "now" and somebody had to be moved out to make room for a new patient.

It is too bad the hospital does not have a stepdown unit; that patient does seem too complex for the floors.

Perhaps you could have called the House Supervisor and asked for extra staff. She certainly knows about the transfer. The worst she could say is no.

Luckily, you both survived the night, hopefully this will not be a regular occurence.

That would have been a not so unusual pt for us, would have been nice of someone to assign it to someone who wasn't it charge. You really have to be a ROMI or needing tlt to be on stepdown where I work