Well here I am, back from vacation.
I went in today determined to be positive and it didn't take a half an hour to have that dashed on the rocks.
At 6 am I took report on a patient that had been admitted since 3am after being in the ER since 8 pm and had been holding for a bed until after change of shift because of staffing. So here is a nice 72 year old lady with CHF who has diuresed nicely but is still in need of a little tune up. At 6 am she has been in the ER for 10 hours not because all the beds are full but because there isn't a nurse that doesn't already have 5 patients.
Before I go any further, let me present my first bitch. PATIENTS SHOULD NEVER HAVE TO STAY IN THE ER IF THERE IS A BED AVAILABLE. That is a grave disservice to the patients who are uncomfortable and can't rest. They are paying for a hospital room and that is what they should get, a hospital room with a bed, phone, TV and some privacy. There are options. Instead of trying to save every last dollar, the hospital could keep a nurse on call, they could offer a day shift nurse a little bonus to come in extra. If nothing else, the unit director should be required to come in. NO PATIENT SHOULD BE DENIED A ROOM UNTIL ALL ELSE HAS BEEN TRIED AND FAILED.
OK, I call report to the floor. I tell the receiving nurse that the patient is on oxygen and a nitro drip and will need telemetry. (Meaning, she will need oxygen,an IV pole and to have the tele box ready.)
I load up the patient, put her on the travel monitor which weighs 30 pounds and because we are short staffed and there is a code going on in the critical rooms, push the gurney up to the floor. When I get up to the floor there are 4 nurses sitting at the nurses station. They all look up as I push the gurney by. None of them get up. I maneuver the gurney into the room which means I have to move two visitor chairs, two over bed tables and push the patient in bed A's bed out of the way. I get the gurney next to the bed. There is no IV pole and no oxygen connector on the flow meter. I put on the call light and wait several minutes but no one comes in. I am getting stressed because I know I have three other patients downstairs with full workups to do and it is 6:45 and I am already close to an hour behind. I smile at the patient and tell her I will be right back. I go out to the nurses station and ask for the nurse. I have to ask several times before someone gets up and comes to help.
What kind of message does that send to the patient? I am not important enough for a nurse from the floor to come in and greet me? Do you really think that she didn't notice how rudely the other nurse treated me? Why do we persist on acting like this toward our patients and each other? Nurses piss and moan about not being treated like professionals and yet this is how we act.
Well this patient noticed. She happened to be the mayor's mom-in-law. She didn't want anyone to know who she was but I hear she raised holy hell with administration this afternoon. Good for her!
Monday, July 9, 2007
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8 comments:
I know those nurses at that nurses' station. They work everywhere. And I don't understand them. At the risk of sounding like someone who used to walk 3 miles in the snow to school and back - uphill both ways...it's still true:
I have worked where at night we had on average 10 patients apiece, charge nurse included (that would have been ME). I have worked on on a 35 bed tele floor (with 34 patients) with just me and a float nurse overnight and yes, we did admit to that 35th bed during the night.
Not that I'm in any hurry to do that again, but I don't get this whole thing about not admitting due to staffing. You don't get to turn them away from triage due to ER staffing. What do they think is going on in the Bargain Basement?
we must work at the same hospital.
Despite the pitfalls of not admitting due to staffing and holding patients the only leverage that Nurses have in correcting the situation is strict adherence to Nursing ratio's and yes, not taking that 6th patient (or 35th) that put you out of ratio. One hospital I work at has a 24 bed med surg unit that they only budget to staff 20 beds. A deliberate decision. But when the ER is holding admits the Nurses on the floor become the bad guys for not taking patient out of ratio. The anger over the situation needs to be directed at administration who could staff every bed, bring in travelers, call registry for day to day shortages but they don’t do it. Nurses should stop blaming each other and support our right to work safe. That does not excuse the dead wood you described who would not get up off their duffs to greet a patient.
You've just described almost every single patient transfer I've done off of our unit. In fact, the bright and shining exceptions are the ones where the nurses or aides are actually there in or near the room to greet the patient and/or help me get them settled in.
More often than not, I'm moving furniture, hunting down an aide or two to help me and one of my fellow aides to get the person from our bed to the new one, and/or getting the patient settled in without ever seeing anyone from the new floor.
Contrast with our floor, where as soon as the room's cleaned, it's readied for admission, with IV pole/pump, monitor patches, etc, as soon as the nurse gets report, he/she gives their aide an ETA, and when the admission/TX hits the floor we're at the ready. Doesn't change the fact that we can't move people out of the ED fast enough, but the ones we do get up to our unit, we do get in with a minimum of fuss. (I must be spoiled)
Not a nurse yet, but I'm working on it.
There's always another nurse...It's called an AGENCY NURSE if nothing else. Somewhere in the metro area, there was probably a nurse willing to work on tele tonight. We used 40% of our total bed capacity to hold inpatients tonight. Of course, at night, we're not staffed for "full", but we don't get to just say "no" to all the people coming in the lobby, so we end up just being full and running our asses off with a staff meant for 60% full.
The nurses that get me are the ones who sit on their duffs at the nurses station while a patient is telling me that they need help to go to the bathroom, and the unit clerk is telling the patient that it doesn't matter that they've been calling for the last hour and a half - they have to wait till the NA gets there at 8 a.m., and it's now 6:15.
And, let's not forget "report". Gods forbid if a patient needs something during report, which is all on tape anyway. Why do ALL the nurses have to listen to reports from patients they don't have any intention of answering call lights for anyway? Shouldn't nurses just listen to initial reports for their assigned patients and listen to the rest of the patient reports after they've settled in their own patients?
But, I'm just a "vampire". What do I know?
I had the exact same thing happen the other night. We were short on transporters, and with pts going to the telemetry unit, an RN has to go with the transporter. So half the time I bring my tele patients up myself, because if I wait for a transporter to help me, my patient just might lose the bed to someone already admitted to the hospital.
The tele nurse assigned to the room rolled her eyes and pointed to the room. I was left to get the pt in bed, point out the call bell, explain how to get the TV and phone turned on...ARGH! With 11 patients waiting for me downstairs!
Admittedly, when I used to work on the floor and we had an 8-patient ratio, when they would bring up my 12th patient at 4 AM when I was trying to chart, I would inwardly sigh and roll my eyes....but I would GET OFF MY FAT BUTT AND GET THE PATIENT INTO THE BED. It's not the patient's fault, and they should not be treated like crap, or just additional workload.
I hope so much that I am not that loafy nurse ignoring my admission... or ignoring any admission. I've been the ER nurse, the tely nurse... and I try to see both sides of the spectrum. Unfortunately, we all can't play in the sandbox together as there are just too many of us who think we work harder than everyone else.
It's a shame, really.
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