I apologize in advance if this is long, but I want everyone to get the full picture before giving any input. Here goes:
I work on a med-surg floor and the only time we get vented patients is if they are DNR/comfort care. One night I had gotten report from the ED nurse about a vented patient I would be getting. She gave me an excellent report and I knew exactly what to expect when this patient arrived. We don't normally keep vents on our floor but the ICU is right next door so it's not hard to get a vent. Here is the beginning of the tricky part-the patient was on a sedative drip (don't want to give away too many details) in the ED that we can't have on the floor, but was to be switched to a new drip upon arrival which we can have but the ED can't (I don't get it either). So I told the nurse before sending the patient up, give him and IV push of something to hold him over till we got his drip set up on the floor. She did just that and then called to say she was sending up the patient and had called respiratory to set up the vent on our floor.
Well, the patient arrives and I'm finishing up with another patient but got to this guys room within minutes of his arrival. I know I had told the charge nurse and another RN about this patient but apparently everyone was shocked when he arrived. Now things get really sticky. I should have told the ED nurse to not send the patient up till the vent was ready here, but there was miscommunication. When she gave me report, I thought she said she was calling a resp. therapist to come up with the patient on the vent. Apparently she had said she was calling the resp. therapist to set up the vent by us and would be here when the patient arrived. Miscommunication happens and not always at the best times. The vent had not even arrived yet and the IV push that the ED nurse gave wasn't doing much. The patient was starting to wake up and fight the ET tube. Luckily his HHA was by his side to hold his hand and the MD was in control of the ambu bag. Still a bad situation since I still needed a few minutes to get his new drip set up. As soon as I finished up with this other patient and arrived to this guys room, all the other nurses vanished. They got the patient settled in bed and that was it, they were done helping. One nurse (a traveler, not even a regular staff nurse!!) who I get along with very well helped set up suction and get stat meds to sedate the patient. It's not like they were called to other rooms, they left to go sit by the nurses station. This whole time he was awake, fighting the tube, reaching to pull it out, and overall anxious. I still needed to set up the drip, the maintenence fluids, check his vitals, and keep him calm. If the HHA wasn't there he would have yanked out the ET tube. Now, given that the other nurses were in the room when he arrived and had seen the situation you would think they would offer to help and I wouldn't have to ask. Apparently, thats not true. The charge nurse was standing by the entrance to the room with her arms crossed, just watching what was happening while the travel nurse helped out. Another nurse was calling the pharmacy to yell at them to put the stat order through to Pyxis, something the travel nurse had already done and we didn't need 2 people yelling at the pharmacist.
Eventually I got the patient settled and after 3 hours he was finally sedated and comfortable enough where he was not awake, breathing over the vent or trying to pull out the tube. I had also been told in report that the patient had 2 sacral ulcers (not big ones, maybe stage 2) as reported by the HHA and the dressings were done daily at 10am. The ED nurse had not looked at the ulcers. I normally do a full skin assessment with every admission, but it took so long to get this patient sedated so the ulcers were not my main concern. I rarely have patients with vents and usually don't have to turn them much (just enough to get a pillow under one side, haven't had any with pressure ulcers) and was scared to turn this patient too much. I didn't want to dislodge the ET tube or disturb him or wake him after finally getting him comfortable. We learn in nursing school, A-B-C:airway, breathing, circulation. I got those covered, it was a frantic 3 hours, I was not about to possibly wake him up.
I spoke to my manager in the morning, told her the above situation and explained that I felt no one was really helping me except the travel nurse. She told me I should have asked for help and I can't completely blame everyone else. She knows me as a nurse and I do ask for help. But in obvious situations like what I just described where it is emergent and I'm already frantic, I didn't think I would have to ask all these experienced nurses for help, they would see what's going on and ask if I needed anything. True, no one is a mind reader, but would you really just sit back and watch this when you could at least offer your assistance? Any other floor I've worked on the staff has offered help or asked if I needed anything, and in much less critical situations too. I'm just baffled that I got the blame for this. Should I really have to ask for help when I'm trying to set up a drip and prevent this guy from yanking out his ET tube? Was I really wrong here? She also said I still should have assessed his skin, which I don't totally disagree with but as I explained it took so long to get him calm and sedated and I'm not used to turning patients who are vented. Please give me any feedback you have, this has been bothering me. Thanks!!
Thank you all for your feedback so far. I just reread my own OP and realized I forgot to clarify one thing-this patient was/is DNR and we accepted him for comfort care. My floor can accept vented patients if they are DNR/comfort care and vented because we really don't have to do anything to maintain the vent. The respiratory therapist is right next door and can be there in 10 seconds if need be. The patient was appropriate for the floor, that was not an issue. The drip he was on in the ED was propofol, which we cannot have on our floor. But he was to be on a moprhine drip on our floor which apparently the ED can't have (still baffled about this one). And this charge nurse has a major attitude problem with me and several other nurses. I have no idea why, but it's very obvious when she doesn't like someone. She will be talking to another nurse literally right next to me and be laughing and smilling, get to me, and become a stone faced and cold. Others have noticed this too and have no idea why this nurse treats us this way. The day nurse and I both agreed that the pressure ulcers were the last thing on our mind, especially since the patient was just waiting for the family to arrive and would be extubated within 2 days. Thank you all for your feedback, keep it up!!
ChocoholicRN
213 Posts
Thank you all for your feedback so far. I just reread my own OP and realized I forgot to clarify one thing-this patient was/is DNR and we accepted him for comfort care. My floor can accept vented patients if they are DNR/comfort care and vented because we really don't have to do anything to maintain the vent. The respiratory therapist is right next door and can be there in 10 seconds if need be. The patient was appropriate for the floor, that was not an issue. The drip he was on in the ED was propofol, which we cannot have on our floor. But he was to be on a moprhine drip on our floor which apparently the ED can't have (still baffled about this one). And this charge nurse has a major attitude problem with me and several other nurses. I have no idea why, but it's very obvious when she doesn't like someone. She will be talking to another nurse literally right next to me and be laughing and smilling, get to me, and become a stone faced and cold. Others have noticed this too and have no idea why this nurse treats us this way. The day nurse and I both agreed that the pressure ulcers were the last thing on our mind, especially since the patient was just waiting for the family to arrive and would be extubated within 2 days. Thank you all for your feedback, keep it up!!