Recipe for disaster

I should totally be looking for nursing jobs, but I just can't get my act together, and here it is April already and most of the GN's have probably already interviewed for ICU positions, so I'll probably be stuck on some telemetry floor again. I can hardly wait.

I'm so burnt out from working telemetry understaffed that the thought of being a brand new ICU nurse (who's had a year's nursing experience and will be expected to pretty much pick up and go with it, detailed orientation or not) makes me almost want to cry. And not in a happy way either. 3:1 ratios are common now (that's three patients to one nurse) in an ICU (yes Virginia, there is such a thing as ugly staffing numbers).

Sadly, most ICU nurses look back rather fondly at the days when ICU = 1:1 care was the norm. I mean, it does sound right, doesn't it? I mean, if you're so sick that you can't breathe spontaneously or your heart can't beat on its own, wouldn't you like someone watching all your drips and vent settings pretty much continuously, especially if you're say, fresh post-op? I would.

Six years ago on our sub-acute cardiac floor, we took 3:1 on days and everyone got all bent out of shape if they had to take 4. Now we routinely work 4:1 on days, and it's always 4:1 on evenings (that's when most of the new admissions come up) and 5:1 isn't as uncommon as it was even 8 months ago when I came off of orientation. Ratios at night? 6:1. And that's on a sub-acute floor. You don't want to hear what the numbers are in plain old med-surg units.

Then I started thinking about something that happened when I was two months off of orientation, and discovered another layer of wrong about the situation. They send a patient down to an emergency non-invasive procedure with transport and the primary RN, right? So okay, the patient goes down on a monitor/defibrillator and a med box. The RN stays with the patient.

But then I started to think about something a former ICU nurse told me about their vented patients going down to a procedure manual bag only, and how it was basically between the RN and RT (bagging the patient) to code the patient until help comes.

Uh. So I'm not sure where you hit the code button in the middle of the hallway; I guess you just scream really loudly like a maniac so at least security comes?

Any way.

So then I started thinking back to my patient, and how they sent me, a new grad, fresh off of orientation, down with the patient and transport (who quickly left, leaving her alone with her patient in the hallway. I didn't think about it at the time (or tried not to, any way) but now I'm wondering about a few things. Like how a BLS certified, non-ACLS certified nurse is supposed to perform BLS in a hospital without an ambu bag, and what in the world good a med box does for a nurse who isn't certified to push the emergency meds any way. I'm not even sure we can push them ourselves without a PA or doc in the room/hallway, ACLS certified or not.

And how long would it take the code team to get to the code? (I remember once having heard a code called twice because apparently no one came the first time, and another nurse and myself watching the ICU interns down the hallway from us stumble out of their respective units looking completely clueless and like, "Uh, so where's the SICU?" or wherever they were supposed to go.) Not only was it not particularly reassuring to me that half of the code team didn't even bother to respond to a code call the first time, I started wondering how you'd designate which hallway you were stuck in, all alone, doing BLS, until they came. Code-calls aren't optional, "if you have the time, come up and check this GI bleeding patient, pretty please." kind of thing, people.

Not only that, transport was nowhere to be found, and I wanted to get my patient back up to the floor without waiting around, so I transported the guy back. Alright, so leaving alone for the moment the whole "nurse does everything" thing, how safe is that? I'm supposed to be watching the patient and the monitor and yet I'm acting as transport?!

HUH?!

Sounds like a recipe for disaster to me, dear.