To tell or not to tell?

[freckles23]

Hi there, so I have a question regarding patient load since this will happen every so often. What do you do when you have a heavy patient load at a hospital and one or a few patients take up the most of your time? (Confused patients, unstable, pain seekers, dnr dni comfort care pts). im asking this because certain patients are a heavier load than others and if you have an unfair load in your assignment it is bound for trouble. The other night I was stuck with a patient for almost 2 hours trying to get her started on a drip and then she was confused and i had to deal with the family and it was just a mess and I was unable to attend to my dnr dni patient who was on comfort measures and felt so heartless because the dughter kept coming out and I had to keep telling her Ill be there when I can to give pain meds for her mother meanwhile Im dealing with a mess in the other room.

So my question is, is it okay to tell your other patients that you were caught up in another room due to an emergency in order for them to understand why you werent able to attend to their needs in a timely manner. I feel if you let them know that then maybe they will have some sympathy and understand that if it was them that needed the emergency I would be there right alongside with them. How do you approach this kind of situation? Especially if you are running a code or rapid and itll be awhile til you see your other patients. I am asking because its kind of like would you ever tell a patient you are short staffed nurses? no because then it looks bad and unsafe for them. So do you really tell them about other emergencies or just leave it alone that you were late and apologize.?

[AceOfHearts<3]

We say exactly that- we are sorry we were unavailable but another patient had emergent issues. I've had another nurse on my unit get b***hed out by a family she was on the phone with when she said "I'm sorry, there's an emergency on the unit and I need to hang up" and proceeded to do just that. I had had to call a rapid response for a patient of mine that had a chest tube that suddenly started coughing up large amounts of blood- that took priority over updating a family on their loved one.

The nurses on my unit are really great with helping each other out, so if somebody needed pain medication and I was really tied up with another patient I would probably ask somebody else to give the pain med for me- I would be happy to do the same if the roles were reversed.

[Sour Lemon]

I try to establish reasonable expectations as soon as I come on for the night. I make rounds, invite patients/families to call me for anything, and let them know that if I'm with another patient, I'll come to them as soon as I'm able to. Most people are reasonable if you've made it clear that you want to help. Explaining how things work ahead of time also keeps their imaginations from running wild. Explanations given after the fact are often seen as excuses.

If I have two high priority things to do at once, or someone is left waiting for an unreasonable amount of time, I call on my co-workers for help. They're great at jumping in, because of course, I do the same for them.

[MunoRN, RN]

I guess I'm a bit confused as to how you got stuck in a room for 2 hours trying to start a drip?

If it becomes an issue with patients or families, I explain that we have to prioritize our workloads, and you don't necessarily always want to be first on my priority list. But if the only task you had on your list ahead of medicating the comfort care patient was to start a drip then that should have been doable.

[freckles23]

I guess I'm a bit confused as to how you got stuck in a room for 2 hours trying to start a drip?

If it becomes an issue with patients or families, I explain that we have to prioritize our workloads, and you don't necessarily always want to be first on my priority list. But if the only task you had on your list ahead of medicating the comfort care patient was to start a drip then that should have been doable.

I had to start a heparin drip then pt was confused and brady in the 30s as she had been and i kept having to go back and forth to the room because the pt kept trying to get out of bed and the whole family was there making it difficult to get anything done so i had to move pt to front of nurses station to keep an eye on her then she pulled her iv out so i had to apply pressure because a pressure dressing wasnt helping.

[OrganizedChaos, LVN]

I had to start a heparin drip then pt was confused and brady in the 30s as she had been and i kept having to go back and forth to the room because the pt kept trying to get out of bed and the whole family was there making it difficult to get anything done so i had to move pt to front of nurses station to keep an eye on her then she pulled her iv out so i had to apply pressure because a pressure dressing wasnt helping.

Was anything done about the confusion? I know you can only redirect so many times but wouldn't it have been best for her & everyone if she was put on some meds to calm her down? Obviously if it wasn't contraindicated for whatever reason.

[freckles23]

Was anything done about the confusion? I know you can only redirect so many times but wouldn't it have been best for her & everyone if she was put on some meds to calm her down? Obviously if it wasn't contraindicated for whatever reason.

she had a one time dose of 2mg ativan but with her heart rate so low i wasnt going to give it.

[OrganizedChaos, LVN]

she had a one time dose of 2mg ativan but with her heart rate so low i wasnt going to give it.

Good point. Just wondering if at any point it was feasible to give it to her. I have also learned that, sometimes, no matter what you tell families they just want their loved one to come first regardless.

[Kooky Korky, BSN, RN]

You should have asked a co-worker to medicate the patient who was in pain for two hours. If I were the woman's daughter, I'd have been calling the supervisor to get pain relief for my Mom.

[RNperdiem, RN]

This is where your charge nurse or coworkers cover for you. Sometimes they are observant enough and don't need to be told, and sometimes you need to let them know your other patient needs help. Someday, be prepared to return the favor when your coworkers are behind.

There is nothing like hearing " We have your patient in rm# 1 turned, meds given, intakes and output recorded and everything caught up".

[djh123]

I somewhat often have problems in my LTC/rehab facility with residents who want and/or need too much of my time, and whether I should or not, sometimes I do apologize to others for not getting to them sooner or forgetting something they'd asked me for (due to the overall load).

[Double-Helix, BSN, RN]

Whether or not it was "necessary" for you to be caught up with another patient for that length of time in this case, the fact remains that there will be emergent situations that pull a nurse into 1:1 care for a period of time.

To answer your question, yes, it is okay to tell your other patients that you cannot assist them for X period of time because you are involved in an emergency. However, it is not okay to leave them without assistance for that time. You must find another nurse to monitor your patients and attend to their immediate needs. At the very least, a nurse tech needs to be able to round on the patients and respond to call bells (if pts are A&O) and notify you or the charge nurse of any needs (such as pain medication) that he or she cannot meet alone. While a patient needing pain medication may not sound as pressing as a confused and bradycardic patient, one of your patients could have experienced an acute decompensation, or event like a fall, while they were unattended. Without family present to advocate for those patients, their change in acuity might go unnoticed if there is not a plan in place to cover your (or any RN's) patients while you're unable to leave the bedside of another.

If your current staffing or culture does not support this, you need to go to your manager and escalate as needed.