Venting.

[newnursemoon, ADN, RN]

Alright. My pt decannulated themselves today. She just pulled the trach out and was found sitting up O2 100% without it in. I called my charge/RT/pulm/attending immediately. Ended up they agreed to leave it out and see how she did. She continued to sat 97-99% on 2L NC without issue. I have 5 pt on a heavy floor (PCU) and then this happens. No one made a big deal bc “oh I mean at least she didn’t need it” but I still feel so guilty?

im trying to transfer but my applications always get reviewed for 1-2 days then rejected. 
 

I don’t know anymore- advice?

[Caroline Keith]

5 PCU patients is just plain unsafe, dude. Depending on how heavy/sick, it should be at max 4 or even 3 (that's a stretch, probably only California could swing it). It's a safety issue, but it sounds like you did everything right. What was your load like? Is there a central monitor person, or do you have beepers or just auditory alarms around the unit? *** happens, don't take it personally--look at the system and what procedures/policies are in place that led to it happening. It could have been way worse. Did you find them, or did an aid? Or did an alarm go off? Were you busy with another very sick patient, so that you may not have been able to check on the trach patient for a bit? What if the patient didn't do well, and they didn't have a monitor/notification system/aid to tell you? The more they stretch your staffing the more dangerous it gets. 

What kind of unit do you want to transfer to? I ended up going ICU because I hated feeling stretched and like I couldn't give thorough care. At least in ICU you normally have one to two patients, and yes they're way sicker and have a lot of *** going on, but you HAVE the time to do right by them. 

[MunoRN, RN]

I don't know why you would feel guilty, if out-of-the-blue a patient is going to grab their trach and pull it out than I'm not sure what you feel you should have done differently.  

[newnursemoon, ADN, RN]

20 hours ago, Caroline Keith said:

5 PCU patients is just plain unsafe, dude. Depending on how heavy/sick, it should be at max 4 or even 3 (that's a stretch, probably only California could swing it). It's a safety issue, but it sounds like you did everything right. What was your load like? Is there a central monitor person, or do you have beepers or just auditory alarms around the unit? *** happens, don't take it personally--look at the system and what procedures/policies are in place that led to it happening. It could have been way worse. Did you find them, or did an aid? Or did an alarm go off? Were you busy with another very sick patient, so that you may not have been able to check on the trach patient for a bit? What if the patient didn't do well, and they didn't have a monitor/notification system/aid to tell you? The more they stretch your staffing the more dangerous it gets. 

What kind of unit do you want to transfer to? I ended up going ICU because I hated feeling stretched and like I couldn't give thorough care. At least in ICU you normally have one to two patients, and yes they're way sicker and have a lot of *** going on, but you HAVE the time to do right by them. 

I found them with our CNA- the bed alarm went off and we both went in, that’s when I noticed there wasn’t a trach. I had 5 heavy pt that day, the other 4 included a respiratory distress pt who didn’t like the feeling of an o2 cannula or mask, a cancer pt with a swollen arm who would rip out her IVs, a GI bleed, and my one self pt who was in a lot of pain (hi Q2 morphine). 
 

I did kinda want to try ICU, I’m still new (<1y experience) and was wondering how to shadow there? I’ve never stepped foot in an ICU, minus the times I’ve sent a pt there. 

[JBMmom, MSN, NP]

As has already been said, 5 PCU patients is crazy. And I know it's easier said than done, but don't beat yourself up about the patient pulling a trach. I've had patients extubate themselves and I used to get really upset as if I had failed. However, I know I've checked all my restraints and equipment positioning at the start of every shift and with all care, so sometimes things just happen. 

And if you're thinking of ICU, now is probably the best time to apply. They're looking for applicants everywhere. Although if this next wave rips through as bad as previous, it's not a great time to start in ICU. Good luck!

[nursel56]

On 8/15/2021 at 6:22 PM, newnursemoon said:

Alright. My pt decannulated themselves today. She just pulled the trach out and was found sitting up O2 100% without it in. I called my charge/RT/pulm/attending immediately. Ended up they agreed to leave it out and see how she did. She continued to sat 97-99% on 2L NC without issue. I have 5 pt on a heavy floor (PCU) and then this happens. No one made a big deal bc “oh I mean at least she didn’t need it” but I still feel so guilty?

im trying to transfer but my applications always get reviewed for 1-2 days then rejected. 
 

I don’t know anymore- advice?

Guilt for things that aren't your fault is the worst. Unfortunately it is rampant in nursing, even after years on the job.  I usually dislike those "letters to myself when I was young" things, but I would, in this case, tell myself to actively banish this type of guilt because it lets the real source of the problem off the hook.

Sounds to me like you're doing really well as a new nurse with a heavy workload.  Maybe I'm too cynical, but I think that's also probably the reason your transfer requests are rejected.

[Snatchedwig, BSN, CNA, LPN, RN]

Your not Superwoman so don't let anyone try and make you out to be nor should you put all that pressure on yourself. If they wanted closer observation they should of gave you less patients. 

[2BS Nurse, BSN]

You've been working less than a year and they're giving you 5 PCU patients?

[newnursemoon, ADN, RN]

3 hours ago, 2BS Nurse said:

You've been working less than a year and they're giving you 5 PCU patients?

Yeah. Funnily enough now we’re up to 7 guys. 4 nurses scheduled on a packed floor, but the charge can’t take a team bc they have too much to do

[SmilingBluEyes]

7?

Buh bye.