Tele Nurse

6 Oct

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So what are we? We crazed tele nurses with the glazed look in our eyes running from: The med room →to the patients→to the monitor station (patient is alarming)→to the chart→Now orders (rate control)→vitals signs q 4 hours (more for those prudent nurses with patients on gtts or that unstable feeling or post procedures) →Alarm reviews→the phone is ringing→your patient is taching out on the monitor→ more IV now orders→accuchecks(where are the techs?)→ ok you can be capped at 5 patients since one is on gtt:amio(but only for the first 24 hours) How generous of the admin→See the board–ER room # 1313→you take report via phone from ER nurse immediately(why beat around the bush? they are busy too! )→Check charts and found “transfer patient to regular medical floor”→You call to give report but they sound mad and want to call you back→They never call back→More medications→ IV Cardiac Meds→ Cardiac Heparin protocol gtts on all the A fibrillators→TEEs and cardioversions.→Heart Rate of 35–the order reads: put an external pacer on and set to shock at  Heart Rate 25 (I am afraid can the patient please go to ICU? Charge nurse please call)→ OK that one is out to the unit→ER calls→you took report –on the way out of the ER the patient coded and died of massive PE→You see the board a transfer for you from the ICU→You swap reports I give you one of mine and I will take one of yours(maybe tomorow we can switch back).→Check PTT for this one, check Vanco trough for that one and Dig level for the other one→Dig level 11.7! What that is so high→More Now orders Digibind and the pharmacy wants a weight because the MD based the order on 150pound and the patient is 100 pounds wet→fix the order→Finally the newly consulted cardiologist looks at the patient, the chart, and asks what drugs were given at night? I look– 11pm 0.125mg of Dig given– At 1130 the Dig level was drawn! DUH! It is not rocket science, it just takes someone to stop with plain common sense! →No digibind. → All morning medications are given.→your 4 hours since you last vitals are over it is now time to start over again. →reveiw alarms→Your only real stable patient wants to go home–you call the attending he says “If it is ok with neuro” You call neuro, this one says “if ok with cardio” Cardio says sure follow up in a week!–Discharge nurse is available she is called and comes for the patient→Hurry up and chart on this patient! →You see the board it is a transfer from med/surg for a SBP of 89! She needs fluids! What (I just do not understand) But they want to monitor. → Vitals done with highs and lows→your 91 year patient who is nonverbal (or one word) answers is contracted on one side and was sent for a bronchoscopy to maybe suck out the secretions she is drowning in from aspiration pneumonia post CVA who is also uncontrolled A fib, and leaning towards infection maybe sepsis. Go in to reposition as you do q 2 hours and the daughter with the red lipstick on her teeth says: “she sounds so much better since the bronch.” New nurse Jane surprised by her calm answer stated: “She does sound less gurgly, but I have to tell you that your mother is very sick right now and I am not sure if she is going to be the same person as she was before the stroke.” The daughter says: I want everything done for my mother. I nurse Jane understand completely what she means as 3 physicians have spoken with her about her status →full Code it is but hopefully it will not happen here, hopefully she will go peacefully at home because I can not imaging breaking the contracted arms to get the chest for compressions. → Have to leave the floor to transfer my external pacer to the unit with the clinical→My low blood pressure transfer arrives and is stable only needed some fluids.→ Go medicate my 25 year old with severe pneumonia that almost caused the kidneys to shut down from sepsis→Sputum sample→blood cultures→lactate→urine samples→pedal pulses→stool samples→Consents signed→ Tele strips→Heparin up and down (when will it always be therapeutic once) →New IVs→Check charts for orders–charts are gone because there are a billion people in  here→Patients pooping→ No helpers→Need a boost→Vital again→try to chart→finally give report to the nurse for the med surg transfering out→look up labs/results and make those calls→ Vitals again→more meds→pull tele strips review alarms→Antibiotics not renewed–make call. And everyone thinks we are “short, abrubt and mean.”

The next shift is here. Give report. You can not imagine what you did for the last 12 hours, but you know you worked, and all are mostly stable. Good bye. Go home like nurse Taylor up there.

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2 Responses to “Tele Nurse”

  1. Karen January 16, 2009 at 15:30 #

    This is exactly how I feel each day after work. So exhausted I can’t even begin to tell you what I have done that day, It would take me all day!!! Have been on tele unit for 5 yrs and I keep wondering, “There has got to be an easier way to do this and actually enjoy it.” So good to read your article and know I am not the only one who feels this way. Let’s keep our heads up. We are doing great things, even if no one acknowledges it!!!

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    […] bronze blue to dry dead blue and just left the room and went back to check on my own patients in a continuous assessment that lasts for twelve hours. I am supposed to go home and be […]

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