Flamed during report. - page 3
I just need to vent a little because I'm feeling pretty beat down right now. I love my job in PACU, but some days I feel like every nurse in the hospital absolutely hates me. I try to always be... Read More
Mar 25, '07Occupation: ICU/ER RN Specialty: 10 year(s) of experience in ICU/ER/TRANSPORT ; From: US ; Joined: Mar '07; Posts: 231; Likes: 90This is how it is at my little hospital. If we get an admit from paccu/or/er or where ever and we (in the icu) are busy (with another admit or pt crashing) you can eathier sit on the pt down there or bring them up, but you are responsible for that pt until a icu nurse signes off on the chart. Now that means you stay with the pt, hook them up on the monitors,o2 and continue care for the pt. No difference if your a rn or crna you care for the pt until relieved. Now there has been times it has taken 5min or 30min. And yes people get pissed off and complaints are wriiten and voiced. Now these issues rarely occur cause we are pretty swift about moving the lower end accuities out of the unit when we need a bed, but there has been times in the past just like everyone when you have to take care of a situation before getting a admit.
Mar 25, '07Occupation: RN Specialty: 6 year(s) of experience in general surgery/ER/PACU ; Joined: Mar '06; Posts: 120; Likes: 22I don't mind staying with the patient and hooking them up, I will be more than glad to do that. The position I get in, is that when we run out of space in the PACU, we have to put the OR on hold. That means patients who are finished with surgery are being held under sedation. That rarely happens, but those are the times when we have got to move some patients out (esp. when my nurse manager is practically pushing us out the door). So when that happens, I try to call a report, but if the receiving RN is busy (which is understandable, we've all got work to do) then the only choice I have is to bring the patient straight over with or without calling report. I only ask that we be considerate of one another and not tear each other's head off, but realize that we have to make the best of the situation and do what's best for the patient.
Apr 1, '07Occupation: RN PACU, Private Practice in Massage Therapy & Healing Touch Specialty: Cardiac/Vascular & Healing Touch ; Joined: Apr '03; Posts: 590; Likes: 29just remember, in the ER the nurses often get NO report on a GSW that has been dumped on the loading dock or a scant report from a medic that is incomplete. I have worked in ER, CCU, now PACU & know about that patient rolls in from the cath lab (they forgot to call report & have another AMI needing an intervention). Jump in & take the patient!! Don't let the patient see an unprofession display (as I have many time witnessed as two nurses duke it out over report). They are ill, & should not have to feel like no one wants to care for them. Take a deep breath & talk to your manager, team leader, charge person so that this is become a working relationship not a battle. We are all experiencing different levels of stress. None like what was known to Flo. Nightingale when she got to Crimea & found the soldiers dying all around her. We do not have it that bad when one thinks of what she & her 40 or so nurses had to do! Re-read this if you want to remember why we do what we do.
Apr 5, '07Occupation: RN Specialty: 16 year(s) of experience in NICU, PACU, Pediatrics ; Joined: Mar '07; Posts: 159; Likes: 32We fax our report to the floor so we don't have that problem and then the cna's transport the patients and place them in the beds
Apr 7, '07Occupation: RN Specialty: 17 year(s) of experience ; From: US ; Joined: May '04; Posts: 1,427; Likes: 376Quote from Laurel RNWe've had to refuse patients and it's not because we don't want to work in the PACU as Ali earlier stated.It is absolutely amazing to me that PACU would refuse to take a patient! That is unheard of where I work. They call, we take the patient... no matter what we are dealing with. Even if we have patients backed up from the floor, if we are short staffed, have a patient going bad, and we are dying. Wow. It never occurred to me to even attempt to refuse a patient.
But we are all accountable for on-time starts so we would not want to delay the next case ... plus, then we'll just be there later when that next patient comes out. Sorry to hear that that happens. I don't think it's a common occurrence at most hospitals, at least not the 3 hospitals I've worked at.
Since you never refuse patients no matter what, I have to ask: What happens when every nurse in your PACU already has two patients each and the OR calls to come out? Who takes that patient?
No one likes to see that happen, and when I charge I try to communicate with the OR "chief" and OR charge nurse right away in the morning and let them know that there could be potential problems if they insist on running such a big schedule that day because either we have ICU overflow patients with no place to go taking up our slots or have call-in's with no replacements.
Our OR doesn't seem to understand that. They will continue to run more rooms than what our PACU can handle and wait until they start getting put on hold before they worry about it. They want to work completely independently of us and love to say that it's "not their problem" but it indeed becomes their problem when they continue to ignore what's going on in the PACU. Eventually there will be no more room for the cases they want to run and yes, that becomes the OR's problem.
Prime example is during our weekend and night shifts when there are only two PACU nurses staffing the unit. We might have two or three ICU overflow patients leaving only one slot to actually recover OR patients.
We tell the OR what the PACU situation is, yet they continue to run two or three rooms at a time knowing that there is only one slot to recover patients and each room gets upset because they assumed that the remaining slot would be theirs and that wherever the other OR rooms are supposed to go once they finish is "not their problem".
Emergent cases are one thing, but I've seen way too many "emergency" cases at 3am or on saturdays (carpal tunnel releases for example) when we have a slim staff and/or ICU overflow patients and they continue to run their cases anyway knowing that there will be no place for them to go once they finish.
Mar 27, '09Joined: Mar '09; Posts: 2; Likes: 1We have an awesome new report system called "voice care" where we call an automated system and give detailed uninterrupted report. Now that we are accustomed to it the report only takes about 5 min. and then we call the floor to have the nurse listen to report and we will arrive in 15 min. Win Win for everybody including the shameful disgruntled exchange between nurses that the patient can't help but hear.
Mar 28, '09Joined: Jan '09; Posts: 9; Likes: 5One way to help deal with this is to set up a work group with team members from both areas. You can get together and talk about the problems and solutions. This helps you both understand the others side. We all know that it is difficult in most areas of the hospital now but all the team members need to work together. I think this works better than having the managers talk only.
Jul 10, '09Joined: Apr '05; Posts: 82; Likes: 9DONs & CEOs don't give a flying flip about the need to assign pt's by acuity so floor nurses duties are evenly dispersed.
They have their own, bottom line criteria & hospital/corporate policies to follow.
Even when it is CLEAR assignment by acuity means better, quality care for ALL pts.
We're in an aged population center- we go "WHOOPEE", when we have a pt under the age of 65!
Lots of Alzheimer, dementia, incontinent, & isolation pts who think they're 8 years old, & can walk.
Try having 5 like that, & then getting 2 admits in a row from PACU or ICU with tubes, drains, & mortal pain.
If one or two from the first group falls, rips out an IV, or pulls the pins out of their fingers...
Sometimes, I will have a charge nurse or clinical mgr who actually helps.
None of us are SUPERNURSE, we can only handle so much at a time & not compromise the health, well-being, & safety of our pts.
Bless all nurses who care!
jansailseaLast edit by jansailsea on Jul 10, '09 : Reason: additonal text
Jul 17, '09Occupation: Ubermom Specialty: 19 year(s) of experience in M/S, MICU, CVICU, SICU, ER, Trauma, NICU ; From: US ; Joined: May '09; Posts: 2,289; Likes: 4,050Welcome to the world of PACU.
It is unfortunate, but I do have some tips:
1. Make sure your patient is as comfortable as possible before you send them up. I know we want to get rid of some of those who are a pain in the butt, but not only is it unfair to the patient, but also unfair to the staff on the floor. Medicate well, and make sure criteria is truly met.
2. We know we cannot avoid the nausea sometimes even after fluid infusions for replacement and all the drugs we can give. It is the way it is. Just make sure all interventions are done so that the nurse isn't calling the doctor the minute the patient gets there. I think that is the fairest way to go.
3. Tell them o the floor that you will help settle in the patient and to please just peek in to make sure that he/she the RN on the floor is okay with the patient (especially at change of shift). I tell them they just need to peek in their head, but I can take the first set of vitals and take care of the most immediate needs upon the transfer. Of course, this applies to change of shift when I have to accompany. For those I don't accompany, I make sure that the transporter takes care of the patient as much as possible before they are signed over.
It usually works.
4. For those who are just plain miserable and want to take their frustrations out on you, just smile. What can you do? I just repeat the same mantra over and over again, "I'm sorry I had to bring the patient up, but unfortunately I cannot hold the OR. Call me if you have any questions." Then I walk away. Nursing is 24/7. Deal with it.
5. I remind them that I worked the floor and there is no malicious intent to make their life miserable. I do not do it on purpose so they can give me a hard time. They don't know what is going on with the OR and if there is an emergency on the floor, I stay with the patient until someone is free--even if it is the nursing administrator that has to do it. I understand about patient safety and will work so that everyone is safe.
6. I remind them that we are professional colleagues. Basic respect is expected. If they don't have anything nice to say, then they need to "zippa the lippa."
Jul 18, '09Occupation: Ubermom Specialty: 19 year(s) of experience in M/S, MICU, CVICU, SICU, ER, Trauma, NICU ; From: US ; Joined: May '09; Posts: 2,289; Likes: 4,050Quote from ali anesthesiaPACU doesn't like holding the OR. But if the PACU RN is not able to take on another patient (i.e /his/her patient is going down the tubes), it is UNSAFE to expect him/her to take another. If there is a spot, we ask that the anesthesia provider stay with the patient. Most are accommodating, there are a few providers who feel it is not their job--regardless it is their responsibility until proper turnover has occurred. We emphasize patient safety and that if the PACU RN doesn't take the patient, the anesthesia provider would be considered culpable for abandoning the patient. It works well in our unit.Another perspective--I have problems with PACU nurses not wanting to take the patients from the OR. They are always understaffed and busy or want the patient street ready when they get them. If you don't like to work in the PACU, find another place to work.
Anesthesia a stressful enough in a busy hospital where short turnovers are expected. Then having to deal with delays because of PACU issues just does not make sense. Our chief CRNA solved this problem with PACU supervisor, when she said the PACU budget would be charged for the extra OR time.
I understand your issues, I used to work in PACU, but having been in anesthesia gives me a whole new perspective. The patients deserve the best care--I give it to them in the OR, so it is not unreasonable to expect it in PACU.
Jul 18, '09Occupation: Charge Nurse Specialty: 15 year(s) of experience in Ortho/Joint/Trauma ; Joined: Jul '09; Posts: 7; Likes: 1i am a charge nurse on a very busy ortho unit. we have 8 to 18 surgeries a day. our average length of stay is 2-3 days. we never have more than 6 nurses on our unit.
the only time i will ever ask a pacu nurse to hold a patient is if all the nurses have taken a report and are either checking a patient in or waiting for one to arrive.
that is the safest thing to do. the nurses may have 3-4 other patients and the new one. once the new one is in and settled we take the next one.
we have worked really hard with the pacu nurses to make sure the patient is stable before sending them up. there was a period of time when there was lack of trust.
the patient might still have propofol in their line or have unstable vital signs.
the last vital sign was decent but by the time we got them we were bolusing them.
then there was the pain and nausea issue. most of our patients get duramorph spinal injections. so we cant medicate them for 12 hrs. its nice to have the pain controlled before we get them!
so we all worked very hard. we have pretty much stopped drilling them during report, they know if i ask them to slow down its because its for the safety of the patients...all is happy now.
we still have one pacu nurse who thinks sending patients out with temps below 95 is ok. that one we are still working on!!:d the key word is communication!! perhaps the charge in the pacu could meet with some of the problem floors!! just a thought
Feb 1, '10Specialty: 10 year(s) of experience in L&D,Wound Care, SNC ; From: US ; Joined: Aug '06; Posts: 330; Likes: 74Quote from PANurseRN1Not a PACU nurse, but I am an L&D nurse who spent 1 yr doing OB-recovery we did 2-4 c-sections a day with a post partum tubal or two as well. My job was to do nothing but pre-op and recover those patients. At my old job and now started recovering c-sections where I currently work so I totally understand where you are coming from! There was an LPN at my old job that used to always ask me to pre medicate patients with pain score 0/10. My thoughts on that subject are pretty much the same as yours. She would also give me the same song and dance about not being able to give "the good" drugs on the floor.
2. You had better care about what meds were given in PACU, since they could directly affect your pt's recovery. This boggles my mind that someone would not care what meds were given. What would you say if the pt coded and the doc asked you what the pt had in PACU? "I don't know" isn't exactly a response that's going to make you look that great, let alone help your pt.
3. If the pt is pain free/not nauseated, it's pretty difficult to justify giving strong IV meds. How do you explain that: "The pt had a 0/10 pain rating, but I gave him 25mcg of fentanyl because the floor nurse wanted me to"? I've gotten plenty of post-op pts who didn't require meds in PACU. It never even crossed my mind to demand the pt be medicated prior to transfer. I trust the judgement of my PACU colleagues; if in their best assessment they feel the pt doesn't require medication, then I trust their decision. If worst comes to worst and the pt is in pain or nauseated, it doesn't take me that long to get the med out of the Accu-Dose.