Ready to leave med surg

Lev, MSN, RN, NP · Jun 22, 2015

Besides for the blood transfusion patients, the others should have been transferred out of med surg. The chest pain should have been evaluated and transferred to telemetry. The high BP should have been sent to a unit where he can get IV BP meds. In some hospitals telemetry units won't take out of control BPs like that. Was the patient in pain? The last patient...with those BPs and dropping sats...ICU material maybe stepdown...a code waiting to happen. Your charge nurse should have stepped in to help with 2nd patient getting blood and facilitated transfer out for other patients. You made it through! If unstable patients like that are routinely kept on your med surg floor, then your problem isn't med surg, it's your hospital.

sourapril · Jun 22, 2015

You worked hard to earn your license. Don't risk it if you don't feel like you can provide safe care to your patients. When you interview for another job, you can tell them that you really want to stay in your position because you love your patients and there are so much to learn, but you also feel compromised when you work on your unit because the unit is constantly short staffed and you don't have the support you need from your unit.

HouTx, BSN, MSN, EdD · Jun 23, 2015

Step one should be a (one-on-one) frank discussion with your manager. Make an appointment with her/him to ensure that there is adequate time to talk about everything you need to discuss. Next - carefully read all of the applicable clinical policies related to physician response time and management of critical events. Do you have a Rapid Response Team? If so, don't be afraid to trigger them. I'm sure (because it is required by JC & CMS) that there is 'chain of command' processes for escalation if you don't get a timely physician response. Don't be afraid to use these mechanisms to advocate for your patients.

OTOH, from the information you provided, you're actually doing very well -- coping with that sort of shift would bring anyone to their knees. Nobody died. No doubt about it - You did great.

lbnsu20 · Jun 23, 2015

Thanks for the advice everyone. I needed some encouragement. I just hate feeling so stressed out.. we do have a rapid response team. I brought in the charge nurse w my pt whose sats kept dropping. We finally got them up by increasing her o2 and finally got a decent bp on her. out of my 3 weekends on my own 2 have been this horrible. I am trying to not bring that stress home w me.. but i worry am i doing everything right.. double thinking it once im home. I double check w other nurses get their opinions when im worried about my pts. Its just extremely stressful and for some reason my orientation was not like this at all.. it was extremely easy id say.. and now that im out all of a sudden its hell. hoping ill have a better weekend next weekend. Just felt sick about my weekend.

Snafu13 · Jun 27, 2015

Besides for the blood transfusion patients the others should have been transferred out of med surg. The chest pain should have been evaluated and transferred to telemetry. The high BP should have been sent to a unit where he can get IV BP meds. In some hospitals telemetry units won't take out of control BPs like that. Was the patient in pain? The last patient...with those BPs and dropping sats...ICU material maybe stepdown...a code waiting to happen. Your charge nurse should have stepped in to help with 2nd patient getting blood and facilitated transfer out for other patients. You made it through! If unstable patients like that are routinely kept on your med surg floor, then your problem isn't med surg, it's your hospital.[/quote']
I 100000% agree with this.

rnchacha · Jul 7, 2015

I am 3.5 weeks out of my 5 week training period and I feel the same. And I only have 5 patients. We often only have 1 CNA for 30+ patients and sometimes there is a resource nurse to help with breaks. I am still forced to go to break, which is usually in the last hour of my shift, but I wish I didn't have to take it because I feel like it makes me more behind. The staff usually tries to keep transfusions and CAPD patients for other, more experienced nurses...but I still feel overwhelmed. I work in the evening so I usually have an admit and/or discharge and have to chart on 6 patients. I am still always charting for 1-2 hours after I'm supposed to be off and sometimes I worry so much that I forgot to chart something when I get home that I can't sleep. I cry all of the time (just not at work), am constantly anxious and can hardly eat.

I guess I'm telling you this because maybe it helps to have someone understand how you feel. It sounds though like you have too high acuity patients. Do all of the nurses get the same kind of patient profile? If other nurses' loads seem lighter I would speak up. Go to someone who was a mentor to you and express your concerns. I have realized that I need to speak up for myself more when it comes to that. Luckily I have mentors of sorts who have stood up for me and gotten my patient assignment changed a few times because it was just too much. If you're unable to get support, I wouldn't feel ashamed to leave if you feel unsafe.

Jm0136 · Jul 9, 2015

That's the way I feel! We get six in med surg as

Well. Some really sick. Once

The docs are

Called several times on an unstable patient, they will usually transfer them to icu or PCU. If u feel they are unstable and it is unsafe for them to be in a group with five other patients, inform the md or charge nurse asap.