Dec 9, 2006

Total Care

My unit Christmas party is tonight. We always have great Christmas parties. Everybody, including the boss, gets a little tipsy. I don't drink, but it sure will be fun watching the others get that way.

Frankly, After the week we had...we all deserve to do a few shots. Yesterday I had gotten to work to find that 3 out of my 5 patients were total care. When I whined about it, I found out the whole floor was practically total care.

How can that happen? What are the odds?
What happened to all our ambulatory homeless guys coming in from the cold?

You'd think they would increase the staffing with accuities being so high.
It just makes sense. I was running around without lunch breaks or potty breaks all week.

It really bothers me when I simply don't have time to give the best care to all of my patients. If it's just one patient taking up my time, I can usually manage to break away to get to my other patients. But when I'm in 3 rooms all day, changing briefs, giving bed baths, removing or starting Foleys.....I have no time for the not-so-heavy patients who still need my care.

Not even the best Delegation and Prioritization skills in the world will help if there is simply no one to help.

One patient looked pretty bad, admitted with pneumonia and UTI from a certain government run mental facility. Their temp was elevated, BP started crashing, HR increasing ( know what this sounds like) going from unresponsive to screaming incoherently (I was told that was their baseline). I asked the Resident to consider moving the patient to a critical care floor. She said they'd discuss it in rounds. It didn't happen.
So with my heavy load, I did frequent assessments, charted everything in detail (Including the "Dr X notified of this, no orders received")
That patient had no business being on my unit.

Another patient with whom I had developed a rapport called me a "Dirty Rat". He had Necrotizing Fascitis in his arm muscles, a result of several failed attempts to shoot up some sort of illegal drug. (He didn't elaborate)
He was upset with me because the wound care nurse had taken off his bandages from a Post-op incision and drainage and I hadn't warned him about what his arm looked like. It was a big filet. Sliced open from wrist to underarm in several places.
You could get a pretty good anatomy lesson by checking out his ligaments, muscles and bone.
I told him I had no idea his arm looked like that...the MD had ordered the bandages to stay on for 24 hours. He forgave me.
He'll probably lose that arm though.

I still love my job, but days like that make it very hard to continue loving my job.


At 14:31, Anonymous Anonymous said...

This is one reason why good nurses burn out so quickly. I went to the company Christmas party for a little while but had to leave early because my husband is sick. I felt like leaving after I heard how great the company did moneywise during the year and wondered why we still don't get enough help on the floor. Things get missed and patient care suffers. Good old corporate.

At 17:36, Anonymous Anonymous said...

Excellent post. I know a nurse at the the government-run mental health facility you speak of and there are several patients on her unit who are all reading high BPs - she spent her day doing vitals Friday. What is going on in this town?

Hang in there. It's got to get better again soon, right?

Oh, and make sure to get those walkie-talkies back on the floor in January before my clinical starts, please. ;-) Kidding, kind of.

At 19:42, Blogger Mother Jones RN said...

Take care of yourself. We need good nurses like you in the profession.


At 20:02, Anonymous Anonymous said...

I hope you have the weekend off so you can put up your fett and get some rest. Take care of yourself.

At 11:36, Anonymous Anonymous said...

there is a song from de la soul called "tread water" and it contains some of the most inspirational words i have ever read. i will share them here with you and let you know that i think you care too much to let go of what you do :)

"mr. squirrel" i said, "i'm sorry
but the problem can't be solved.
if there's no one here to help
and no one to get involved.
always look to the positive
and never drop your head.
for the water will engulf us
if we do not dare to tread.
so let's tread water"

At 15:30, Anonymous Anonymous said...

Yeah, once again I am working during the scheduled Christmas party...

Hope things get better on your floor soon!

At 08:28, Blogger universal health said...

Total care patients are high INTENSITY, but they may not be high acuity , and that's what the metrics look at.

Intensity is looking at how much nursing care and presence is required. Acuity looks at how much highly skilled treatment/care is needed.

Ergo, an actively dying patient, for example, may be a 100 on the intensity scale, but rate very low in acuity.

That's why the nurse's PROFESSIONAL JUDGMENT about how much and what type of nursing care should be the bottom line measure.

I'm sorry about your case load. Hope that things get better soon, and that you and your colleagues all hang together through it.

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