Thursday, December 31, 2009

Today I got the punishment for something that was not my fault.

I got a patient yesterday from ICU. Meningitis, had a rough time of it but was pulling through. Very sweet lady who was an L&D nurse for over 20 years. Her family was at the bedside, a little anxious but generally kind and friendly. I joked around with her sons, we made each other laugh. They even gave me a recommendation for a local Middle Eastern restaurant with excellent food and low prices. Things were going swimmingly.

I was excited to have her as a patient again today. But there should have been alarm bells early on in the shift when the pt and her friend (another retired RN) asked when she was going to be moved to the other unit.

Now, I hadn't heard anything in report about a downgrade to Med/Surg, or an upgrade to Stepdown, so I said "I don't think you're going anywhere." Then I got busy enough with the start of shift that I pushed it to the side for a little while.

Then at about 1630 I got a phone call from the manager of our sister unit, who is covering for our manager while she's on vacation. She said that my pt was going to be transferred to her unit as part of a "customer service recovery" issue.

I couldn't get many details, but the gist was that the family was unhappy with her care on our unit during the NOC and AM shifts. The AM shift RN told me that one of the sons was grumpy with her, but I didn't think much of it since he has sort of a sarcastic sense of humour.

I can't imagine anyone being so upset that they request a whole new unit. Plenty of people request not to have certain RNs again, and we're very accommodating to that. But to change floors?

The manager of the other unit said "The family is happy with you. Don't worry about it too much" but wouldn't give me more than that.

So a little time passed, and the family showed up to help the pt get to the other unit. I knew it was bad when the manager was personally escorting the patient. Her son asked if he could fill out one of our "above and beyond" cards about me (we'll see if it happens; it'd be my first one!), and said that he emailed people saying that he was glad to have my care. He even asked if I could get transferred with the pt or if she could stay through the end of my shift.

So one of my best patients gets taken away from me for something other people did/didn't do. It sucked, and I was furious. But my anger doubled when about 15 min later I learned that since I now had an opening (the only free spot), I was getting a new admission from ER.

Luckily it was a pretty easy pneumonia case, walky-talky A&Ox4. Sweet older guy. Thank god.

The worst part about all this is that our unit looks bad. We've spent a lot of energy trying to get the unit's reputation out of the mud, and this is just one more stone weighing us down. "Look at Tele! People are begging to get transferred out!" When our manager comes back, we won't hear the end of it for awhile.

I hope the patient continues to recover well, and that something like this never happens again.

Sunday, December 6, 2009

One of my patients was put on comfort care today, about 2 hrs before my shift started. They had called RRT on her for non-responsiveness and trouble breathing. When I got her, she was on the CPAP and pretty much nothing else.

I tried to be as comforting and supportive to the family as possible. I think I was doing a pretty good job of it.

Until ED started wanting to send people up, and we had no nurses to take them. Since comfort care doesn't require tele monitoring, she was to be moved to the next unit over.

The family was *not* happy.

I apologized profusely, and tried to explain that I was needed to take a patient who required monitoring. Really, there's no good/nice/easy way of saying "We need you out so someone else can come in." No matter how lightly you try to put it, you sound like an asshole.

So I asked the family to try to get their things together, as there were a lot of them there with a lot of stuff.

I saw the bedside table get shoved angrily out the door into the hall. There were a lot of reddened eyes and scowls. I assured them that the transfer would be quick and painless. One of the sons was concerned about her breathing, so I hooked her up to the portable O2.

Things were not made better when we got to her new room and there was no O2 hookup in the wall. I had to run down the hallway and steal one from an empty room. More glares.

I tried the best I could, and still felt like a jerk. I hate feeling like I have no control. I tried to ignore the guilty feeling so I could continue with my shift.

Then about an hour or so later, the two sons came to the unit looking for me.

They apologized for being so harsh. It really made my day, because I was not looking forward to trying to sleep tonight with a guilty feeling.

I hope all goes well for them, and that the patient's transition is peaceful.