somedays are diamonds...somedays are stone

[CRNI-ICU20]

Hi everyone!

I want to share my day...both to get feedback...and to maybe ask ourselves some heartfelt questions.

On Fri. I rec'd a pt. from the ER....

50-ish male..

GI Bleed-ETOH

Coags off...liver disease

INR 3.54

Nurse in ER did not follow orders..

"give FFP, then draw repeat INR"

Instead...hung blood...the slow way...

Pt...too anticoag. to send to endop for scope/injection/cautery of esoph. varices...

Pt. sent to ICU to correct coagulapathy and stabilization for endop.

Spent the day draining the blood bank

Hung 5 units blood....4units FFP...

Pt. was scoped under gen. anesthesia....with intubation to protect airway..

Pt. was previously actively bleeding with emesis approx 2000cc at a time....

clots, etc...

BP low 90's with rapid infusion of both blood and fluids bilateral arms...

Pt. was stabilized enough to scope....massive varices spurting actively...major major bleeding....very grave situation...

.......

Now comes the hard part...

I had another patient...who had been on transfer to the floor for four days...

I finally got a room assignment...called report to the RN on the receiving floor....signed off orders....gave what drugs were supposed to be given...

missed one drug time...

(this just happened to be at the time my patient was projectile vomiting blood everywhere)

The floor nurse called me....asked why I didn't give the Heparin SQ (not exactly a critical event...could be re-timed)...

I explained the current crisis, which at the time she was calling, was continuing and ongoing...

She began to scold me....complain....telling me how I was not doing my job...etc.

so I just put the receiver to the phone down on the counter...and let her continue her rant...( I know...this may have been really really rude....but at that point....after one pee break and no food for twelve hours....I had no energy left to listen to her...and I didn't and don't believe it is in my job description to listen to yelling from a co-worker, doctor, or patient family member....)

because at that same moment, my bleeding patient was launching again!

She called up again...

Continuing her rant....wanted my name....my supervisor's name....because by golly in her eyes, missing a Heparin injection was tantamount to causing irreperable harm....(can we be any more myopic than this???)

I told her I didn't have time to give her my supervisor's name and number....she began to SCREAM at me??? (not kidding!!)

My question is:

Is this what we have come to as nurses? Where we bite one another?

Threaten to 'tattle' on one another, as if we are little snots in a schoolyard?

Are we sooooo ANAL retentive, that we fail to see the bigger picture??

Can we cut one another any slack anymore???

I was told that this particular floor has a policy that is from management down that if a patient's call light goes on, ONLY the nurse who is assigned that patient can or will answer that light....is this about as lame as it gets??? (six nurses just standing there while the light continues to beep...because the nurse who is supposed to answer is too busy???)

What the heck is the focus here?

What is the thinking here....

Feedback is welcome....

Thanks

[PANurseRN1]

What a nightmare! I like the idea of putting the phone down on the counter and walking away.

That sounds like one dysfunctional hospital.

[cardiac.cure03]

All I can say is... Man, she needs an attitude adjustment! Maybe she was having a bad day as well, but there is no reason for any one of us nurses to act in that behavior.

I don't believe you did anything wrong. I wouldn't have listened to it either.

Hope you don't have anymore days like that in awhile!

[clee1]

I'd have called HER supervisor to discuss the unprofessional behavior of one of his/her nurses.

[TigerGalLE, BSN, RN]

I could understand if she called because she saw that the heparin wasn't signed off.. Only because maybe you gave it and forgot to sign it. I see no problem calling to clarify that.. But if you didn't give it, the time can definately be changed.. So she needs to get off her power trip and chill out.