What would you do?

Daytonite, BSN, RN · Sep 20, 2005

Your situation with the patients in distress at your unit has been more common since Medicare went to it's prospective payment system (DRGs). People are discharged from the hospital much sicker than they used to be. Those rehab patients are probably Medicare (or skilled) patients and should really have extra nurses including an RN managing their care. You are stressed after 4 months of working because you are in a working situation where you are having to pull rabbits out of your hat all the time and you don't have enough experience.

I would recommend that the very first thing you do when you take over on your shift is to make a quick walking round on all your patients to see what kind of condition they are in. You should be able to see if anyone is in any immediate distress and start to take action. Actually, if you do this round before you get report you can confront the off-going nurse or, at the least, get her help to take care of any patients in immediate distress. Next, I would also make it a point to try to do some sort of physical assessment of the skilled patients as soon as feasible. Listen to heart and lung sounds, and check for problems with wounds. Get the vital signs on these patients from the CNAs as soon as possible. Actually, if the CNAs start at 11pm they should be taking those vital signs first thing, or with their first rounds and reporting them to you. Even though these rehab patients are in a nursing home it is safest for you to treat them as if they were still in the acute hospital.

You aren't responsible for what another nurse has failed to do, but you can protect yourself by doing the things I've listed above. My experience has been that the patient's who are most likely to go into distress are the ones who have just come from the general hospital in the past few days and those who have ongoing breathing or blood pressure problems to begin with. So, make new admissions and patients who have only been in the facility for a few days a top priority in assessing for distress.

Good luck, kiddo. It's a matter of trying to keep one step ahead.

ex1140 · Sep 20, 2005

Thanks for the reply...I have decided to use the advice you have

given me for the time being. However, I am going to give my two

week notice on Wednesday. I can't take it anymore, and I'm

supposed to supervise the CNAs and I feel like it's the other way

around. The 3-11 shift doesn't have an RN on there shift, the

nurses are trying to do tons of paperwork and monitor patients

at the same time. And like I stated previously an RN doesn't stay

on the floor until 2 or 3 am sometimes later when I come on at

11pm.

I think it's just a matter of seeking for something better because

I am tired of this facility... thanks again and God bless.