grnvillechick

here is the update---- the resisent found me at the beginning of my shift ..and told me he needed to talk with me. He later found me that day..and apologized profusely about his actions. He told me he had just lost a pt he worked very hard on before coming to the unit..and wasn't really emot stable. I listened to him...and told him I understood he was having a bad day, but it still did not make things right. He promised to never touch another drip..and we both went and made a request to the ethics committee to review Chemical code orders...to see if it could be eliminated as it apparently causes much confusion house wide. I am still going to watch him like a hawk as will the others...and feel at least in some small way things are being addressed...and yes, I did write up all up !!! thanks so much for the input..I appreciate it !!!

whew !! you mean I isn't crazy??? Your southern cousin!!!

Hi everyone !!! I have come across a most frustrating issue at work..and I was wanting your input so I can properly deal with this --- I had 74 yr old pt...dx was brain stem CVA with very poor prognosis...on a T piece, not vent at this point...family of 9 children and one very sweet and very passive spouse. The family could not come to grips with the reality of this pt's state and could only agree to a Chemical Code...No CPR--no Defibrillation...attempts by our hospitals' chaplain to get a DNR were futile. The day I had this pt, the family yet again declined DNR offers. 8 hours into my 12 hour shift--with a very critical pt trying to crash on me all day..my brain stem CVA pt becomes bradycardic --30's and junctional..and agonal resps. In the unit at the time was a first level resident of the medical teaching program ...who rushed into the room and immediately started to yell out typical code rhetoric--get the cart---place the backboard,etc---I told him this pt was a chemical code only--he yelled at me and said " I do full codes only..." and despite 2 other nurses trying to verbally stop him ( one was the nurse manager) --he began CPR. I called his upper classman resident(who was in charge of him) and when he arrived, he followed suite and now we had 2 docs doing CPR..the very thing this fammily did not want..the very last thing this poor pt needed. Finally the pt's Pulmonologist came and stopped the code and told them off in a hurry. He then got mad at the nurses for " not getting the DNR like I told you !" he never approached the family for it himself of course. No record of CPR was put in the code sheet. No mention of the CPR was told to the family. With my nurse manager there agreeing to all of it, I had no choice but to go along with it. Yet it still bothers me. The family was lead by the chaplain and I had very little chance to console them because--- In the meantime..I am still dealing with my crashing pt...who happened to be the pt of the resdient who initiated the CPR and wasn't listening to us. While I was taking off orders and preparing for my pt to go to the cath lab, this guy walked into my room at some point and shut off the Dopamine ...he never told me, couldn't remember exactly how long the pt was off..and pooh poohed the idea of titration--it was at 15 mcgs at the time he shut it off. My question is , considering how dangerous this guy was on 2 occassions on 2 different pts....shouldn't I write him up???? my nurse manager witnessed it all...but she is burned out and leaving in a few weeks, so what does she care. How should I handle this idiot in the future...as it stands right now, I think I would like to refuse care of pts assigned to him...but that isn't the solution . Funny thing is that I LIKED this one before that day. he seemed to listen and work with the nurses...but apparently he is in the GOD mode now..they all get there at some point. so HELP ME!!!!!!!

definitely this is a common thing when you are charge..I was asst unit mgr on a 45 bed floor...all pts were " VIP"'s..the govenor,a famous singers' grnadmother...these pts got fine china and steak for thier dinners...and wine too...so it was enough to deal with...and yes, on top of all that I had the " whiners"..those select few who seem to count every single thing as a "job"...the Whiners were a headache for my first six months..and they were usually the ones who had been there the longest...you know the kind..." I know everything..and could have been the charge...but I don't want the responsibility"..they are the unofficial charge nurses...that seem to be able to create much angst among the staff in a blink of an eye....here is my advice....... * approach each one individually---make them part of your "management team"..ask for thier input...and use some of it..make them feel valued...and this will encourage OWNERSHIP..once you have that , the unit will runn smooth as silk. * find the "Shiny Pennies" in your staff...these are the people who smile and do whatever they need to do...they take the extra pt..or always seem to be right there when there is a crisis...if only to run and get a supply item...they are usually the ones who are quietest..not necessarily the strongest skilled..but do a good job none the less... the Shiny Pennies are the ones to place the new grad with...they can teach the new ones ROUNTINE and STRUCTURE..they can learn all the fancy footwork later..right now the new grad needs LOTS of TLC and organizational skills...I stumbled onto this one night when I had no choice but to pair up a grad with a nurse who I thought at the time was not too quick..and a little under motivated...the next nite, the grad requested to pair up with the same nurse...and the nurse who I thought was un motivated was really shy ...it gave her confidence and she turned out to be a really good ally... * FEED YOUR NURSES...I would have " snack nite"...Pot Luck Muck nites...I would place a Hershey bar on the clipboard of the nurse who seemed stressed or who did a great job that nite... this truly breaks the US vs THEM mode...because it shows you too are in the group just as stressed and overworked as they are * take team buliding workshops...these really helped me understand the group dynamics...types of personalities , etc... * Break up the twosomes that feed off of each other...put them in geographical opposite areas...one down one hall, the other around the corner or whatever...this prevents them from conitnung the saga of martyrdom the Whiners like best..because they are separated ...yes, some can be like children indeed. * by planning a strategy, you will have more control..re evaluate prn... it doesn't matter how many-it is the acuity...and that should be your mantra response to those who count heads..or else give them fewer pts ...and a heavier load for a few days and that should cure them......if it doesn't...hey! you have someone to take the heavies for you... good luck and please let us know how things turn out...you sound sincere and like you are trying to do a effective enough job!!!!

that makes at least 2 of us.....update !!!