Archive | February, 2010

I work in an Animal House

8 Feb

Do not worry. That is not a picture of me after working three shifts in a row. This is a piece of art work found on deviantArt by Sabi-Krabi found here http://fav.me/d1ty67k   The sheets look comfortable though and maybe I would not mind being swaddled like that for a while.

Everyone knows that working on telemetry floors can be a little chaotic sometimes. Part of my personality is drawn to the bedlam like the moons pull on the ocean. [or something like that] .

On the third day of my work week, a few weeks ago, the associate of  my Fave Pulmonary MD summed it up best when responding to a question: Where are you? via the telephone, he answers: I am here, down here in this hell hole.

I started my work with a 6:1 ratio where 1 of the 6 was to transfer to medical. On the next door medical floor it was heard: a patient screaming with post operative psychosis that was to transfer to telemetry for…the administration of intravenous haldol. Now we all have learned that intravenous haldol has the potential to prolong the q-t interval that could lead to torsades. It must be expressed about that medical floor, sometimes while dripping full of sweat and stress: I look over and see those nurses lounging around reading fashion magazines and wonder about what the hell really is going on around here.

I have the inclination that since I am the only nurse with a transfer to medical patient, that I will be the nurse to receive the psychotic patient. So I run out of report and try to assess my patients as quickly as possible: not starting off with a good face to my patients as I seem hurried. We all learn with speed: patients often do not care, what their blood pressure is, what pills you are encouraging them to swallow or what drugs you are pushing into their veins: if they do not feel that you have time for them, the rest is meaningless.  Quick assessing like: blood pressure cuff on, listen to lung bases only, ascultate the anterior chest speedy like and check legs for edema, light touch on the belly; forget about 0800 coreg administration, they will not get it till 1000.  That is it folks, no turning, no ordering their breakfasts, no chatting, no untangling messy IV tubing. The OCD in me gets  highly annoyed as my inner self panics about that unlabeled, tangled IV tubing.  I get the phone call: It is the clinical coordinator with the news I had guessed: Give report on your transfer [wait I have not even seen that patient yet as she is the most stable] and I have assessed only one patient! The clinical says: Give report and get report on your transfer.

I walk back to the nurses station. The nursing supervisor is there! Great! I take her to the side and tell her: There is a grave unsafe situation going on here and feel terribly worried. The staffing on this floor is at an all time low, every nurse is at maxed ratio and there are only 2 nurse aides for allll of these patients. That means, in my humble opinion: no patient will be turned properly, no patient will be bathed, no patient will be fed, and some patients will fall out of the bed today.

When the monitor is alarming on the confused patient: sinus tachycardia, that was in normal sinus rhythm, that patient might be on the floor.

During this conversation with the supervisor, the chief of medicals partner was eavesdropping. He erupted in a rage and threatened action and demanded to know why from the vice president of nursing: Why do you tell me in the meetings that hospital staffing is adequate when clearly it is not?

Who shows up to the floor within one hour? The director of my floor and the vice president of nursing and they want to know why I went to the cheif medical to complain about “nursing” issues. <curstey> Excuse me but I did not do that, is it my fault that he was listening in to my concerns?

Needless to say his rage was worth naught [he is well-known for a good rage, always directed towards nursing], it did not miraculously bring more staff to the floor STAT. It did however, put me on a list I am sure: the list of whiney nurses for administration.

All of this stress worsens my confidence in the clinical coordinator, the one I need to trust to control this place.

The worst vision came true! The supervisor moved my medical off and moved in the psychotic post operative patient. The nursing supervisor gives the IV Haldol, IV Valium, takes a blood pressure for me and walks away. Yes she left me and so did the clinical. I find the patient: in four point restraints in a room farthest away from the nurses station. The patient is thrashing around even in restraints. The NGT so pertinent to healing a perforated ulcer has been dislogded and I am maxed out on sedation drugs. The patient then rips out of the restraints. Someone did not do a good job with those posies.

I am weakened: at 1000. I start assessing and taking blood pressures and passing medications all together now. The psychotic patient goes to ICU, apparently for deep sedation with intubation for: safety? I had no idea that psychotic patients could be intubated and sedated for the pure reason of psychotic-ness? Someone fill me in because I am still very new at this and I never heard of that before. I thought patients were sedated /intubated for: ventilation needs.

And what happens a week later?

I get called into my directors office to “chat” about concerns that she was probing for. After wasting 45 minutes of my time that I needed for end of shift wrap up she pulls out a paper. It says on the top: Corrective Action. Apparently my contract states that I can only call out sick twice in a six month period and if I defy that contract rule: grounds for termination are clear. I have been out four times in the last six months. Basically it felt like: You tell me about these nurses; since I did not stab anyone in the back, or feed into this probing: I get reprimanded? Now? After excellent work ethics for three years?

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