Let me say right here before I even get started with this post…so that no one can misunderstand...I LOVE MY JOB!!!! However if there was one thing I would change it would be the acuity of the patients. Now for those of you who don’t know, I work on an acute care medicine floor. In simple lay man’s terms it is the floor where the liver, kidney confused, dementia, drug abusers, cystic fibrosis and psychiatric patients end up…that is as long as they are stable. Acute care means that I do not have the same training as a progressive and critical care nurse…normally this would be fine…but we have a huge problem.
We are CONSTANTLY getting patients admitted to the floor that need a higher level of care who should be at least progressive and sometimes critical care. It is aggravating because not only do they not belong on the floor in the first place, it becomes a patient safety issue when patients begin to decline and we are not trained to handle it as well as critical care nurses…and of course I have a nice fun example of this ;)
I can pretty much tell what kind of night it is going to be within the first few minutes of being on the floor. This particular night I knew it was going to be a long busy night and it was going to be a rough one. We only had three patients admitted to the floor which left seven empty rooms and admits for during the night. I began to get ready for report from the day nurses when the phones begin to ring off the hook. Of course it was the ER trying to call report on two new patients. Now it is really annoying when other floors try to call report during our report because there is just way too much going on and it leads to important information being missed. But we can’t refuse report so, the nurse I was working with and I sucked it up and took report. We then got report on our patients on the floor.
This left us with three patients already on the floor and the two coming from the ER…plus two other patients coming up from the ER the day nurses had taken report on…this meant four new patients coming to the floor all at once…with us trying to see our three patients before the new ones arrived. Within five minutes the ER had sent up all four patients and chaos erupted.
As I was trying to get my new patients settled and assessed, another floor called to give report on a patient. This one was coming from a progressive floor. I asked the nurse working with me to ask the nurse calling report to give me five minutes and I would call her back since I was in the middle of helping a patient ambulate to the bathroom and couldn’t just leave to go to the phone.
Within five to ten minutes I called the nurse back and received report. Before I even hung up the phone, the patient had arrived on the floor. This was my third new admit in twenty minutes and I was drowning a little. As I headed into the new patient’s room I noticed right away he had a unit of blood hanging. A patient is usually not transferred while receiving blood due to the monitoring and everything that has the potential to go wrong (and of course I was not told about the blood transfusion in report). I was a little upset about this. As I walked closer to the bed, I saw the patient had a trach (this would have been fine except this was left out of report also).
The next thing I noticed was that the patient had a massive amount of blood pouring out of his trach. There was blood everywhere!!! If I didn’t know better I would have thought there was a serial killing in the room. I quickly called for help and went to the patient. There’s not really much you can do when a patient is bleeding from the trach…there’s not really anywhere to hold pressure. I quickly turned off the blood infusing and waited for rapid and the doctors to arrive. The patient was still breathing, had a heart beat and was semi-conscious.
As I was dealing with this mess, my co-worker came in to tell me the ER was on the phone trying to give report. As she saw what was going on, she quickly jumped into help and the phone call was forgotten (apparently this was not appreciated by the nurse on the phone). I left the room to grab some towels and ran into the HOA. She started to yell at me about refusing report and how that was not acceptable. I quickly ran past her into the patient’s room. When she saw what was going on she quickly forgot about yelling and began to call the doctors and rapid since they had still not shown up. Within ten minutes the room was packed and the doctors updated. I left the room and let rapid response take over the care of the patient.
It was crazy to say the least. But thank goodness the patient was ok, because I felt like I was out of my expertise and really had no idea of what to do…so I just did the basics and prayed that would be enough till rapid response showed up. Thankfully it was…and needless to say I sent that patient right back to the floor where they came from. The nurse was not too happy about getting him back, but he was better prepared for that mess then I was. And the crazy night continued because as I hung up the phone, the ER called back to give me my two new patients.
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