Thursday, June 26, 2008

Nurses don't eat their young...

But some definitely don't make it easy.

I have had some great preceptors and helpful mentors so far in my Emerg experience (only about 2 months worth so far) so I can't say that nurses typically eat their young. I think that people are starting to realize that they NEED new grads, and if they don't help newbies succeed, there will be no help in the future. I did, however have an experience with a nurse on another floor that bothered me. Perhaps this can start the Emerg/Floor debate, and the animosity between them (at least, in my hospital there is some animosity).

The other day, during one of my precepted shifts in Emerg, I had a patient who had a fairly active GI bleed, whose hemoglobin was about 68g/L (normal is 120-140g/L). We start transfusing patients below 80 typically. She was elderly, was cared for by friends at home for the most part, but was basically immobile and the caregivers knew something more was wrong then what they could deal with. She also had melanous, loose stools (eww).

Anyway, General Surg came to see her, and admitted her so that she could have surgery the next morning (they didn't feel she needed surgery ASAP, but definitely soon). They had a long list of admission orders, and not knowing when she would get to the floor, we got started.

She needed two packed RBC's (which require multiple vitals and constant monitoring), a 2nd IV line, more bloodwork, a foley, 2 fleet enemas, not to mention the pre-op meds and other medications. I spent 2 hours at the bedside getting almost everything done for her. The only thing I didn't get to was the 2nd packed RBCs and the 2nd enema.

The foley took longer than expected because the woman was fairly tall and large ( requiring a bunch of hands to help roll), and she had wet her bed and her gown. So I got the foley in, changed the attend, changed the sheets, and the gown. THEN she needed the fleet (I was not going to let her stew in her wet attend for the fleet to start working. She already had a level 1 pressure ulcer and I didn't want it to break the skin by sitting in wetness). Twenty minutes later I had to change her attend AGAIN. To save time, I was also infusing the medications as well as monitoring her vital signs for the packed RBC's. In addition, I was slower then a regular nurse because I'm new at this stuff. It all adds up.

So as mentioned, 2 hours later we find out that a bed is available for the patient. My preceptor (who was helping roll my patient when needed and working with 2 other patients) helped fill out the fax sheet, faxed it to the floor, and then called the nurse using the handy dandy phones they have. I guess you dial into the computer the phone you want, and the nurse who carries the phone acknowledges the call, and that comes up in the computer. Then we called a porter, and packaged the patient up to go to the floor.

The porter came and stated that because the blood was infusing, she couldn't take the patient up herself. So I went up with her. I was extra staff anyway so it was fine. There would still be someone to help with the other patients.

So we get to the floor, and the nurses look at us as if we are from another planet. "Who's this?" they ask. "This is Mrs. X, we sent the fax sheet up about 10 minutes ago. She's going to bed 205a" I said.

"We didn't get a fax", they reply, annoyance in their voice.

I clearly remember my preceptor sending the fax. Trying to be political (and in a bit of a shock), I state, "Well I'm pretty sure we sent it, perhaps it's at the machine."

She sighs and goes to the fax machine. No fax. So that happens once in a while, the fax machines break down. So I ask "We called the nurse phone as well, and it acknowledged the call. But its ok, I'll give verbal report once we take the patient to the room". So they call the primary nurse for the patient and we get her settled in the room.

I give a verbal report (which in hindsight was silly because everything was already written on the faxed sheet which was in my hand because we send it with the chart), and the first thing she asked me was "We need to do Packed RBC's TONIGHT?? and the fleet HAS to be done tonight?" as if to say that she was annoyed with me that I didn't get it done downstairs, and that it would be too much work for her to do this.

Look lady, I thought, I just spent 2 hours with her to get almost all of her admission orders done BEFORE she even got to the floor. Doing a few set of vitals and changing her once more won't be that hard.

Of course I didn't say that, and I was kind of shocked with the way she seemed to blame me for giving her some work to do. I kinda just stammered and said "that's what's in the orders for tonight, so yeah. Sorry."

She then did the angry sigh and said thanks in a sarcastic tone, and then left the nurses station in a huff. The others at the nurses station looked at me as if I was scum. I left the nurses station in a hurry, shocked at the reception I received from the floor.

I didn't get mad until I was in the elevator, I think I was too shocked to be angry before. Plus, I was new. I hadn't worked in the hospital for 10 shifts yet. And I"m a new nurse. What if I had done something wrong? What if there was this policy that I haven't heard of? So I just kept my mouth shut.

There was NO reason for them to talk to me in that tone, or that way. I'm a person, and I worked hard to limit the amount of work that they would have to do. What if the bed had been available right away, and they would have had to do ALL of the work? They should be THANKING me that I was able to spend that time with the patient and get those things done.

I know that the floors are busy. I used to come home exhausted as a student during 12 hour shifts on the floor. I had even worked ON THAT FLOOR as a student nurse, and I don't remember it being that hostile. I know the patient load is tough, and there are post-op patients that are heavy. But that does not mean that they get to be rude to the emerg nurse that is bringing them a patient. We're swamped downstairs too.

My mentor later stated that if I get run through the coals again, just think of yourself as a PERSON first and a NURSE second. No one should be treating me like that, despite my limited nursing and hospital knowledge. If I had done a nursing task wrong, it would have been my preceptor's task to mention it. I had done nothing wrong.

The only thing I did wrong was being at the right place at the right time for her to bitch. And the sad part is, she was a new(er) nurse herself. Probably younger than me.

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