elfinM

Here is an update. I could not have called the RRT as they were already packing up and getting ready to leave the floor when I saw the pt turning several shades of blue. If I had been there earlier I would have called the RRT as I do NOT care about popularity. I have since talked with a trusted co-worker and have spoken with my boss. He says that what happened was done correctly and that he would stand by what they chose to do. I explained what I would have done and he said "that was another way to handle it". It is my understanding that this is going to be reviewed by the ICU due to the way it all happened. I will always do what is in the best interest of the patient, as my job is to protect the patient, not make friends. I do thank all of you for your thoughts and I wish I could have changed the outcome, but I don't think that was possible. I will keep you updated as to what happens. Thank you all again for all your viewpoints, it helps to see it in a different ways.

That was my questions also CrunchRN. I would think you would want a charge RN to have the ability to see a bigger picture. Just a bit of fyi- Nurse manager asked the RN, who has a ASN-(as do I) to be the new charge RN. He took the position away from our Previous charge RN who has 30+ years, BSN and PCCN and gets multiple request from previous patients for her to stop by and see them. I am not sure if this is a place I want to stay at.

Thank you. I would never be one to say that I know it all, or that I am perfect, but I would like to think that some things do click. Your comment makes me feel like maybe I do know a little more than I give myself credit for. Thanks!

This recently took place in front of me, (not in my care) and involved a charge RN. It has really bothered me and I wanted to see what you all thought. Male, 57, suspected MI day before. Had vomited some dark emesis previous day. You walk in and his sats are 77% on room air. You place 2L o2 by nc and pt doesn't tolerate, so you change him to a non rebreather at 15L o2. Ok so far, pt states "I just want to stop breathing". Blood pressure is 58/0, Abgs are obtained and the tube is very dark, almost black. ABG comes back ph 7.2, lactic acid 8 (granted not a good number to start with). The Rn of this pt has called md and order for IMCU bed obtained. I walked in and the pt is turning blue in the face, and I inquire about called a CAT call (our rapid response team, I am thinking intubation as blue is not a good sign.) Charge RN says "We already have an Imcu bed and we have everyone we would need here. Lets get going". The charge Rn, new grad Rn and Precepting Rn and respiratory tech are at the bedside. They grap the respiratory box off of crash cart and go to imcu. (I am thinking I want a better airway than this and how about some drips to address the BP). The end of story is patient was placed in imcu and after 20 minutes transferred to icu and intubated. By this time he has a bp of 48/0 and ph 6.8 lacitic acid of 12. (this was over 1 1/2 hours. From floor to icu) Pt ended up not making it. I am disgusted that the Charge RN was told by the Manager that nothing else could be done, she did a good job. I am thinking she should have got more help, so that drips could have been started earlier and maybe have given him a chance. I feel for this patient and family. Do you think I am being too critical here or is there room for improvement. I have been doing this for over 6 years, would like to think I can see trouble. Turns out pt never had an MI, miscommunication between shift RN's!

No issue that pt needed blood. No issue it needed to be done right then. Issue is nurse manager talking to rn who voiced what they would do, and no blame on the RN that ACTUALLY made the choice to not listen to manager and follow protocol! Should the two rn's be held accountable for the choice of the RN taking care of the pt. Do we no longer ask our co workers what they would do?

More info. Pt was on floor, manager and charge rn took pt off floor BEFORE said unit arrived.

Mananger and charge took pt to gi lab. passing blood bank on the way, however floor nurse told them to tube it to floor. NO time was lost to this disagreement as an RN walked the blood to the gi lab! Patient safety was the important point, as with the blood being able to be removed by anyone, sent to wrong floor, or getting lost in tube system, there was more harm possible to the pt. RN caring for pt remained on the floor.

Yes, the NM wanted the blood tubed down to the gi lab. Blood bank stated that unless it can be secured, meaning someone has to present a badge to receive, then it does not go back in the tube system. This tube system is new (operating for 4 weeks), so previous policy would have been to walk to blood bank receive blood and walk it to the gi lab, which is near the blood bank. The nm wanted the rn to receive the blood on the floor, by swiping her badge, then place it in another tube, and send it to the gi lab. No one would have had to swipe a badge to receive. Pt had another unit hanging when left floor. Should have called bb and had them hold blood there or take to gi lab directly instead of tubing to floor.

There is a manager who wanted an RN to overlook policy and procedure, and got mad when other RN's voiced their opposition to this request. Who is wrong here, the manager or staff RN's. Situation was pt on floor gi bleed in need of multi unit of blood. pt had unit hanging and was taken to gi lab, blood sent in hospital is done by secured tube system. manager wanted RN to send the blood to gi lab after receiving it on the floor. Problem is it can not be securely sent from floor to another unit, so blood would be in tube system "unattended". Two staff RN's voiced their opposition to this request. "Newer" RN, said "he told me to send it and he would take the heat for it". "New" RN decided that her co-workers were correct and then had the blood hand delivered to the gi lab to be hung. Mananger had charge RN "council the two RN's that voiced their opinon. Who is in the wrong here? Isn't pt safety the number one goal. Manager stated "pt needed blood right then and it was best to not have followed the policy and procedure". Just asking.

Cograts to you for calling it like it is! Your comments are supported by some of the replys that followed it. I have read that your comments are to be blamed on everything but the real problem that you covered in your statements. Nurses do take it and worse we rationalize the behavior as tolerable and acceptable. This is supported by the replys on this thread. If Nurses of all experience would remember the patients and how we can not meet their needs based on the current conditions we all find ourselves in then maybe something would change. This is not about personal issues, this is about the core essence of nursing and what we are here to do. That can NOT be accomplished with such dishevel in our profession. Thank you for pointing out some truths. You can see that for some that the truth hurts!

Great thoughts and thank you for the other viewpoint that is the only way to truly solve a problem, as nurses know! I think that it will take time to get nurses at the bedside, it is not an overnight solution, but a step in the right direction. If nurses ban together, not as a union, but as a professional group and make the situation better, than it will draw others into the profession. One problem with getting others into the profession is, in my opinon, is the lack of unity. I do dream big of having a profession that stands tall and gets demands met for not only pts but for ourselves. Yes, it will take time, as you have already seen, but we need to make the most of every moment given to us to make a difference. We don't have to wait for change, but be the cause of change. Thank you again for opposing viewpoint. It helps me claify what I am wanting to let people know about.

I had posted a previous thread regarding "Why does nursing allow itself to be short staffed". I heard alot of wonderful ideas on the root cause of the problem. Someone posted online the new bill introduced into the Senate regarding staffing levels. It is S. 73 and you can find the whole bill under http://www.senate.gov go to The Library fo Congress THOMAS home and type in the bill number there. The main theme from previous replys was to become more unified as a whole. Now is the time to act, if you really mean it. This bill requires any facility that received medicare payments to have enough RN on staff and takes into account the pt care level. Hospitals must keep 3 years of records recording the decline in pt mortality related to increased nursing care. www.ANA.ORG is another location to get information. Please contact your Senators and Reps, this bill has already been sent to a committee and that could mean death to it. Take action and let's put out complaints where they count. Thanks!!!

The other day at work the charge nurse said she was giving me my 6th pt. I am a new grad, on the floor for 3 months and it is a tele floor. I was not happy, but said ok. She did not give me that pt. Later in the day I was talking with a pt who was crying and upset over outside stressors and I have been working with her to develop plans for her care with her. The charge nurse told me I was spending too much time with that pt and that I needed to walk away from her. She also stated that she had to manage my whole team while I was in there and the aides were "going crazy" being busy. I had checked on my whole team prior to going in to see this pt and the other pts were all asleep, the aides denied being busy when I asked them, and that the charge nurse was at the desk the time I was in the room. I was sitting within ear shot of all my patients and had a phone on me (we carry them so anyone can get a hold of us.). She informed me she hadn't got lunch or breakfast, (many days when I haven't being new). I offered to take her pt from her and she refused. Now not my problem I offered. I am so angry at this. I want to come to work and do my job and not harm anyone. I didn't find this exchange professional in the least, if I had done something unprofessional please let me know to correct it. This charge nurse has made it clear I am not her favorite person, mind you I was not hired to make friends, but to take care of pts. Any words of wisdom?

Thank you everyone for your input. It seems everyone knows the problem, but what do we have to do as a whole to make the change. Granted an individual nurse trying to take on management is a sitting duck. Doctors have managed to united themselves, without unions, as a profession to gain respect from the hospitals. How can we take that model and apply it to our own profession, and are more nurses ready to do that than not?

I agree with your statement! I am wanting to find out the root problem as to why this exist at all. I want to make a positive change for nursing, but until I can uncover the reasons that create the problem it can't be fixed. I have co-workers who blame it on just being women. I find that personally offending. Whether man or woman, as Nurses we face this together. I am just trying to understand why this problem exist at all. Where did it go from being about the patient and doing what is right for them, to the bottom dollar? When did the essence of Nursing get lost in healthcare? Just wondering. Thank you for giving me insight into what I am trying to understand.