NotANewRN

It sounds like you may have a chaotic orientation with different preceptors which leads me to believe you are in an understaffed unit. Every nurse is not great at precepting. Also every nurse is not great at being precepted. The ICU is not the best place for a new grad and certainly not one who is focused on being more "right" than all the nurses that actually know how to do the job. Maybe this job is not the right fit for you.

How do you know it's blood?

I did re-read. I read the whole case and all her responses. To answer your questions: Transport would transfer the patient because he had floor orders therefore he is a floor patient being held in the ICU. The Heart on a diuretic was a fall risk, ok. What patient in a cardiac area is not on a diuretic? Probably the only cardiac patient that isn't a fall risk is a sedated, intubated person on a paralytic with restraints. If the other nurse only had 1 patient and was not getting the admit on a cardiac unit, it would seem as if that patient was a high acuity patient on ECMO, a ton of drips, receiving CVVHD, a fresh Heart, coding or something else that deemed her a 1 to 1. Yes, hospitals can be awful with staffing and units can have terrible managers. We all know that. But we also know that not every nurse is not meant for every unit.

It wasn't triple ICU patients. A floor patient with transfer orders. He doesn't get continuous monitoring.

So I went back and read the case and all her statements. The Heart was ambulatory and her concern was that she was a fall risk. That is a legit concern but that is not an ICU patient. After fully reading everything, I am very convinced she was not caring for even 1 ICU patient and refused the patient that may have been a real ICU patient. However, the intimidation and inappropriate behavior by her manager is not acceptable. It also seems like this hospital skirts the rules quite frequently. I think she could have found a stronger misdeed to pursue action against them if she had worked there longer. HCA also has a terrible reputation where I live so I believe they do a lot of questionable management actions with employees and patient care. I wish her the best.

Maybe I have only worked in high acuity ICUs over the last 20 years because it has been so few times that I have had a patient be able to call to go to a bathroom. She made it seem like the Heart was on an oral diuretic, was coherent & continent enough to call for the bathroom. That sounds a whole lot like a step-down patient in my world. A "new" open heart ICU patient would not be able to do those things.

So 1 patient was a floor patient and the other was a post-op patient that was continent and could request to go the bathroom. Neither of those patients are ICU patients. She refused a 3rd? Why? Her assignment is a floor patient with transfer orders, a step-down patient and a potentially true ICU patient.