I was relieving one of my coworkers for lunch the other day. He and I were doing walking rounds down the aisle of curtains where his eight patients were, talking softly about what needed to be done for each person. In a bed two curtains down from where we were, one of our "intractable back pain" frequent flyers was holding court in her usual spot. Her family was seated all around her, taking up all the available chairs, and they were all dining on Chinese fried chicken wings and pork fried rice. We paused so we could listen to what they were talking about.
"I's thirsty," one relative said. "I'm getting some water." The pantry, where water and an ice machine are available to everyone, was no more than three yards from where they were.
Replied the Queen of Back Pain: "Never mind that. Where's that damn nurse? He's spozed to be waitin' on me. Go get him to get you some water."
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9 comments:
Baaa! That makes me angry.
Me too. And you should have seen my fellow nurse. He's a very mild-mannered guy, and he got all red-faced and pissed off.
eight patients? Good lord, where do you all work anyway?
ER Nursey: We work in a busy ER in a big urban area. Eight patients is NOTHING. When it's busy, they start to DOUBLE US UP by putting two stretchers in a room! Yep. I've had 12 or more patients--and I'm talking about ICU patients, tele patients--really sick people in addition to the people who are in because they have a cold and can't understand why I can't stop what I'm doing (titrating a Levophed drip) to get them a blanket.
Fortunately we have a new director of emergency nursing who wants to cut our "high acuity" area of eight beds in half and staff it with two nurses so that each one will have four really sick patients instead of one nurse with eight or more. We'll see if she gets the approval for that....ha ha ha.
Whenever we have what we consider an unsafe patient load, we protest. All of us fill out a form that goes to management and to our union representatives. It's supposed to "protect us" in case of something horrible going wrong. Hah.
Unfortunately, I don't think it's any different that any other ER in this city.
I would've thinned their herd, probably before they started in on the insulting demands.
We used to have a hight pt/staff ratio, and the worst part was that we'd line the hallways with our overflow to make room for the new ones. I've had as many fifteen under my name, but we built a new wing and my manager is really good at justifying new staff positions so now eight is kind of at the upper end. Five or six is more typical in our moderate acuity area. Where the real crunch now is in the critical area: we're supposed to have three of four patients each but it can easily get up to five or six people headed for an ICU with one RN responsible for them all.
In some ways though, getting the people out of the halls has really taken the edge off of the place.
Incredible...
Where I work, we won't let more than one relative in at a time. ("infection control, folks, you understand..?")
I did have a similar patient once, tho, and we had some harsh words over the differences between 'waiting on' and 'nursing'
Our "rule" is two visitors at bedside per patient. However, it's rarely enforced because the CEO of the hospital (or whatever his correct title is) prefers our hospital to run (and look) like a hotel, and in hotels, apparently, people are allowed to behave as badly as they want.
However, there are times that I'll have the clerk call security to clear the ER of ALL VISITORS--like the time we had two codes in progress, two more on the way via ambulance, and the ER was packed. Boy did things really go smoothly once all the looky-loos were sent packing.
Wow. Your ER is just about the most unsafe I've ever heard of. On just one chest pain patient, I'll be stuck in the room forever pushing all that metoprolol and re-dosing nitros, etc. Eight of those would be impossible. These tubed septic patients on pressors 'n stuff are nearly 1:1 nursing. We have this lengthy sepsis protocol that we follow that is very detailed, for instance.
We are well-staffed by national standards, I think. Most of the time, we have six patients or fewer on the non-critical care side (5 seems to be the safe number where you can still turn and burn the beds) and 3 patients or fewer on the critical care side, and many times we only are assigned 2.
If you're looking to move, we're hiring!
Wow. Yeah, if I was looking to move, I know almost anywhere but this city I'd find a better ratio.
Admittedly, when we have float nurses around, things are much better (I'm one). For example, if we get a chest pain with EKG changes, if the patient gets put into a busy area, the float (me) will stay with the patient, getting him stabilized
(nitro drip, lopressor, aspirin, morphine, yada yada) in the thirty minutes before he goes to the cath lab. I'll do the same thing with any notifications that come in, like an APE or arrests in progress. We have a big sepsis protocol which is why it's such a pain when we get little old ladies from the nursing home with fever and hypotension.
Hopefully one of the good charge nurses will be on, and will be aware when you're getting swamped, and will divert the tough patients away from you, and will send not-so-busy nurses over to help you if you need it...but sometimes there just is no one to help. And that's when I protest to the union. Oh--and the residents really help out when they can. If I'm busy managing a bad case, they'll start lines and draw bloods and take care of the less-sick patients when they see them. But yes, it can be a total nightmare.
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