Two days ago at work was a most interesting day.....
I had a patient who was sick, really sick. He was my first admit of the day into the hospital. The poor man was really large! And he couldn't breath, fluid backed up into his lungs, a heart that wasn't working....he was so anxious he couldn't talk. I was working fast to get him to a more comfortable bed, pain meds meanwhile.
Our ER beds are hard as a rock!! They are really terrible. The med/surg beds are large and luxurious and every patient that finally makes it to one of those always breaths a sigh of relief that they no longer are on the half-of-a-twin-size bed, bed.
So I asked my doc....what room do you want him in?
He wants a med/surg bed.
I call house supervisor....we need a med/surg bed.
The admitting physician also concurs....med/surg bed.
Got it.
I give report to the floor nurse and explain that this patient is also on some heavy duty respiratory machine. She seems to okay it...she can handle it.
So I get the patient ready to go. And it turns into quite the little entourage. I've got his bed, the respiratory therapist has the machine with all the tubes attached. And we've got the whole family following behind....all of the family members are quite large.
We make our way slowly down the hall, barely fit in the elevator, but we are IN!
4th floor....
Get off the elevator, slowly make our way to the room. I see the admitting physician at the nurses' desk. Take 10 minutes to pull equipment and chairs out of the way to fit the ER bed next to the hospital bed. The med/surg nurses are staring at me. No help? Okay I start making requests....you be there, you help here....i feel really bossy. But the job must be done to slide the patient from the ER bed to the hospital bed. The family member decides to lift the patient to a standing position and move him from the ER bed to the hospital bed.
It's a heavy lift! But he manages to pick up the patient. I can see the patient is quickly getting frantic, no oxygen! Its an intense moment. We gotta get him to his bed quick so he can get oxygen.
Then a family member pipes up....I thought he was on the ICU floor. What? I pause for a second. Things aren't adding up. Med/surg nurses giving me blank stares, a respiratory machine, and a lengthy diagnosis.
Okay hold on everybody, I hear myself say....I'm sweating bullets, I feel my skin get really hot and flush. I can feel the family's frustrations....one family starts letting out profanities.
I run down to the admitting physician....where did you want him??
The physician tells me he was surprised to see us up on the med/surg floor and that he needed ICU care immediately. He couldn't wait on this floor, these nurses were not equipped to handle him.
The stress mounts.....I have 3 patients in the ER that I am in charge of who are not getting care. I call down to the ER floor....is everybody okay?? I talk to Tim and he reassures me I'm ok, he's got my patients. Thanks Tim! Okay resume care.
We get a bed in the ICU.....and our little entourage starts off again with tubes clanking and people bumping into each other. We make our way down to the ICU floor.
The ICU floor nurse is frustrated, I can feel it. She isn't making eye contact. Again, the family member lifts the patient, again panic ensues with the patient, lack of oxygen....but we make it to the ICU bed this time. The family's faces are frustrated. I've broken out into a full sweat now. We hook him up to monitors and get him comfortable.
The ICU nurse and I walk out so I can give report to the nurse. She looks at me and tells me what just happened was completely unacceptable. They had no idea a patient was coming and had no time to prepare....
Perspective is interesting.....not knowing what is coming and not being prepared is what I'm learning to do all day every day in the ER, but if it isn't what the norm, then not feeling prepared in the ICU must be very unnerving.
The ICU nurse continues her lament, I take the hit.
I go back down to the ER to face what is inevitably going wrong with my patients, and to begin pulling up my slack. Tim is amazing....he has everything under control, patients are well taken care of. My ER doc comes to his desk and I take in a big gulp of my pride.....Hey, doc I'm sorry I really thought that patient was going to the med/surg floor. Must have been my misunderstanding.
My doc looks confused and then says, What?? No. The admitting physician told me he was a med/surg floor patient. That is where he wanted him. It was not your fault. You just took the hit for him. It was his mistake.
I talked to some of the nurses who began to explain to me...I had just learned my first lesson about the nurse/doc relationship and mistakes in the hospital. The nurse will take the hit. The doc is the health facilitator, the nurse is the face of the hospital.
And I'm a good cover for our docs:).
