Monday, August 04, 2008

Top Dog

"Charge nurse pick on 6xxxx"
"Can I speak to the charge nurse?"
"Have the charge nurse call the nursing supervisor."
"Ask the charge nurse if she can help you."
"See if the charge nurse will go speak to the disgruntled family in room X"
"Ask the charge nurse where XYZ is located."
"Tell the charge nurse that you found a discrepancy in the pixus system."
"If you don't like your assignment, speak to the charge nurse."
"Didn't get a meal break? Tell the charge nurse"
"Not enough nurses to take care of all the patients? Tell the charge nurse."
"Resident is MIA/not returning pages/being a jack ass! Tell the charge nurse"
"Couldn't obtain the blood work for labs that the docs ordered....tell the charge nurse"
"Patient just spiked a fever/vomited/pulled out central line/fell out of bed/stopped peeing/dropped his blood pressure... Tell the charge nurse"
"Patients trash needs to be emptied...tell the charge nurse housekeeping staff

Get a sense of where I am going with this entry?

It's a rule in the ICU that you can't be the charge nurse until you have been working on the unit at least a year, have all of your additional ICU credentials (ACLS/PALS), and aren't a complete pompous asshole, arrogant bitch unapproachable.

It's always suspenseful to come on shift and see the name of who will be charge. Some are FABULOUS and some are completely awful, unhelpful, lazy, and rude less than fabulous.

I never hesitate to ask the charge nurse a question and I always keep them updated on my patients conditions. AFter all, they can be a huge help if when shit hits the fan and/or you feel overwhelmed or frustrated. I'll admit it, I've asked a series of assaine questions; however, for the most part I try not to abuse the charge nurse...they have enough to handle.

So how surprised was I when my nurse manager approached me Friday night and told me that I would be orienting to charge nurse? Very surprised, especially since this was my first week back taking care of patients since fracturing my pelvis plus Friday was night #3 of a 4 night stretch.

When orienting to charge nurse, they pair you with a senior nurse who gives guidance and explains the ins and outs of the job. However, they largely let you fumble through the night and get your feet wet. I lucked out because my senior nurse was very experienced and helped me anticipate what might happen, but I still worked myself to the bone. During report from day shift, we were told that there was a pending transfer from an OSH of a circumferential arm burn. The resident still needed to sign off on the acceptance and decide what patient we could move off the unit to accept it, but the ball was in motion. Our night began when we got a call from the transfer center that we needed to accept a pediatric patient with bilateral palm scald burns from a hot iron. (That's 2 beds we need to free up). To accept the circumferential burn we needed to move someone out of the ICU onto step down. To accept the pediatric patient, we needed to transfer out an adult step down patient. Confused yet? Try being the one to coordinate all of this.

Just when I thought I had worked all of this out with the resident and admitting bed officer, a stretcher rolls onto the floor. WTF? Who is this patient? Oh, well this is the adult transfer....who we haven't accepted yet! We don't have a bed! Neither the resident or the nurse received report on this patient! this is going to get ugly. Not sure what to do, the patient was admitted into the system and kept in holding (sort of like an ER patient) until we could open up a bed. Eventually (3 hours later), crisis averted.
Patient in room XYZ decides to plug his ET tube and is sating 88%....STAT page respiratory and the resident,disconnect ventilator, bag the patient, deep lavage suction..............where is the resident? where is respiratory...........suction........bag patient.....suction.......COUGH!! Patient breathing again. Settle patient, reconnect ventilator, monitor vigilantly, send ABG in 30 minutes.
Patient in room ABC looses A-line (this is a problem as the patent's blood pressure is dependant on dopamine ). Page resident, take cuff pressures every 2 minutes, set up for new A-line. Anticipate that resident will fail miserably at inserting this Aline into this 3rd spacing fluid overloaded patient and page the night fellow. 15 minutes and 2 attempts later, fellow manages to inert a new line.
Patient in room EFG drops blood pressure and stops urinating. Reassure the bewildered resident, suggest it's time for a fluid bolus!
Nurse for patient 123 gets into argument with the pharmacy over dispensing a new ativan drip. Get on phone with the devil pharmacy tech and explain that the patient had line changes and all new drips must be hung, so even though a new drip had been hung at 8pmfriday and didn't expire until 8pm on Saturday, we needed a new drip STAT. You can't stop sedating a patient on a ventilator. dumnbass!?!?
Staffing office calls to tell us they are sending 2 nurses for day shift. We should be overjoycing, right? WRONG. We need at least 16 nurses to "safely" staff the unti, the 2 nurses they're sending us, only puts us at 13.
The mother of the 34 year old patient in room MNO calls for the 5th time in 7 hours "to check up." OK lady, here's a little insight for you.... your kid 34 year old son burned his peni$ 2 days ago and made it clear at that time that we are not to give our any information over the phone to anyone except for his wife (who we assigned a password to for obtaining info). It's 3am and he's sound asleep. Like we explained before, we don't connect calls into the rooms after 10pm, it's disruptufl. you need to get the # from the patient and call them directly. Please don't send him flowers because flowers aren't allowed on the unit .And lastly, stop trying to bribe me with coffee and a muffin if I'll let you come in before visiting hours begin at 11am. thankyouverymuch
Receive phone call from the ER attending that there is a 40%er in the ED who needs to be admitted.
Patient in room QRS shits himself for the 8th time requiring the nurse to change his sterile dressings on his back and legs for the 7th time. Time to make sure that the 3rd CDiff specimen has been sent and then insert a rectal tube. If the devil created diarrhea, then God created the Zassi.

A whole lot more happened that night, but I won't bore you with details. I was in charge again Saturday night and didn't get out of work until 9:30am Sunday morning. I went to bed at 6pm and slept until 11 am today. I'm all recharged and it's a beautiful thing....that is until I go back to work on Wednesday.


Anonymous said...

yes that sounds familiar. I was charge of a Burn ICU and it was lovely getting a family of 4 from a house fire at 0500.All criticals,2 adults,2 peds. If we leave them in ER the staff doesn't know how to deal with them(back then) and they will get way behind in fluid resus,not to mention airway management. (this was before trauma centers). So we need to shift 4 out of ICU side to step down and set up and stabilze these pt until day shift nurses are there and in the rooms.Phew!
I break out in a sweat reading about your night and remembering how it was for me.
Thank God you can do it,we need good nurses in charge.

Ativan Side Effects said...

My name is Brian Lane and i would like to show you my personal experience with Ativan.

I am 30 years old .I started taking this drug about 10 years ago to help with some pretty bad anxiety and depression I was having at the time. I started taking a 1mg dose twice a day 1 in morning and 1 before bed. I tapered myself down to .5mg twice a day and then finally was able to get off it for about 3 months this year. I just started taking it in .5mg doses again due to the anxiety and depression resurfacing after 10 years. I dont know if its coming back because I got off the medicine or just that I am having a relapse but I have to honestly tell you that those years in between when I was taking it were the best years of my life. Just be VERY careful not to take this in larger doses.

Side Effects :
sleepiness, addiction It really helped me for what I was taking it for but it was very difficult to stop.

I hope this information will be useful to others,
Brian Lane