Saturday, October 29, 2005

Critical Mass....of Nurses

I'm sure we all remember our Wheatena lecture! Why, it was the highlight of my nursing education! Today we have drug reps, back then they must have had Wheatena reps...

I'm a Cream of Wheat fanatic, myself. Freakin' nectar of the gods, it is! Trust me, when you've been NPO for 36 hours and you are status-post intubation, that first swallow is absolute heaven. A little sugar, a little milk.....ahhhh.....the epitome down-home comfort food! I never will figure out how it qualifies as a full liquid, though.

I realize that it has been a long time since I've worked anywhere in a hospital but the emergency department. I realize that life on the telemetry and med/surg units has changed in the last 16 years.

Why on earth does an entire floor have to shut down because one patient goes critical?

Let me give a hypothetical example. Say there is a telemetry floor that holds 50 patients, but the census is at 45. There are nine nurses (5:1 at night), a unit clerk and a charge nurse. A patient at one end of the unit goes critical. At this point:

  • The ER cannot obtain a room number for the new admission because
    • the charge nurse is busy assisting the nurse whose patient is crashing
    • only the charge nurse can assign a room number
  • If a room number has already been assigned, no nurse on the unit will take report
    • because a "patient is crashing" on the unit.
    • they are busy
  • The new admission happens to be assigned to the nurse whose patient is now critical.
Now it doesn't take the logic of Mr. Spock to figure out that:
  • The charge nurse
    • knows which rooms are available for an admit
    • knows which nurses are open for the admit
      • doesn't need an hour to figure this out
      • can delegate the assigning of the room
      • can make a decision and revise prn
  • The nurse taking the new admit with room assignment
    • has an open room ready and assigned
    • is not involved with the critical patient
    • has no reason not to take report or accept the patient after report has been given
      • hectic activity in one room does not preclude giving care in any other room
      • is able to assess his/her patients without the charge nurse
      • can hold paperwork if necessary until unit clerk is available to process orders
  • The nurse of the critical patient, if assigned the new admit, should have the admit given to another nurse and be open for the next admit after they have transferred their patient to ICU.
Am I missing something here?

In the ED we have critical patients on a continuous basis along with a rotating census in every other bed, but the unit does not come to a halt because there is a code going on. Patients keep getting triaged, orders keep getting written and carried out, nurses multitask and take over for each other where necessary.

Two nurses, a doctor and a respiratory therapist (or two) can run a critical patient and get them transferred to ICU. It does not take an army....or an entire unit of nurses.

Can someone shed some light on this?

I just don't get it.


At 10/30/2005 05:52:00 AM, Blogger Nurse Adam said...

I am so in agreement with you. I don't understand it either. They don't get the fact that if we have a code in the ED, ambulances still bring patients to us that may also be critical.... we can't turn them away.. we have to keep on working...

It wasn't long ago that I was working on the telemetry floor and complaining about the ED, now I understand that the ED nurse is trying to keep the flow of patients going to facilitate the never ending flow of patients coming through the door. The ED doesn't have the option of saying... well no more admissions for us.. we are full....

At 10/30/2005 10:53:00 AM, Blogger ICU 101 said...

the last 2 shifts i worked, i was the charge nurse... we had 10 admissions each shift and during the last shift, we had 3 extremely sick patients (one ended up coding)... even when it's that busy, it's unheard of on our floor that we try and obstruct an admission from any unit... hell, even if we did, it wouldn't fly...

running a code is a hectic and crazy thing on my current unit, but we also have the benefit of a Code Team in our hospital... once they arrive (and the million other doctors who just want a piece of the action), they really don't draw on our resources except for the primary nurse and maybe 1 other floor nurse (to be a runner for supplies)...

At 10/30/2005 02:23:00 PM, Blogger kenju said...

I shed no light on anything today - but I do love Wheatena!

At 10/30/2005 04:36:00 PM, Blogger I am a Milliner's Dream, a woman of many "hats"... said...

I _love_ Cream of Wheat...grandma used to make it with butter, sugar and a bit of milk (or cream if she had it still out from grandpa's coffee.)

After studying NG tubes (ick) this week, I was thinking how nice some CofW would be for someone who has been NPO.


At 11/03/2005 05:29:00 PM, Anonymous Anonymous said...

You so hit the nail on the head with this post!


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