#icu rn

[shroudedwillow]

Back at the overnights 🥲

Help me stay awake. 🤗

Just don’t be fuckin weird.

[patientthings]

So we got a TV in the break room.

So we recently got a new ICU manager. (Basically the last one got sick of administration and went back to bedside, can’t blame her at all at my hospital.)

He came from within the organization, but from a different hospital in the system. (And we’re basically the red-headed stepchild of the system, holiday pay is terrible, no weekend differentials, equipment is old, matrixes are terrible, etc, etc) And he seems nice or whatever, but basically he's been asking us what we need, and we’ve all been stating that triples need to be removed from the matrix, and we need to hire more staff, stop letting our CNAs get pulled off the floor, everyone’s overworked and not getting lunch breaks, etc. Mainly our biggest concern is patient safety!

FOR SOME STRANGE REASON this guy puts this stupid TV as one of his first priorities. I mean, he’s been working so diligently on getting us a TV in the break room, they have to run wires, move bulletin boards, pay for the large flat screen from the budget. So “you all can enjoy your much deserved breaks.”

I’m sorry, what? What lunch break are we taking when everyone is tripled, and the charge nurse has a fresh 1:1 open heart that she can’t leave their bedside? I honestly rarely spend more than 5 minutes in the break room at any given point in time (unless I get there early for my shift and camp out till report time.)

We’ve all been talking amongst ourselves and no one can figure out where or who gave him the idea we even needed a TV?

It’s honestly more annoying than anything and we keep turning it off cause the noise gets in the way of our pre/post-shift talking in the break room.

[patientthings]

Situation - my patient is oriented x4, but saying off-the-wall stuff, definitely confused, hasn't slept in days, developing ICU psychosis.

Patient: Are you married?

Me: Nah, I'm only 26. 😄

P: What about that guy who came in here earlier?

M: Who? The tall one or the short one?

P: The short one! You should marry him!

M: That's Dennis(name changed), and thank you, but I don't need to be set up.

Multiple coworkers: *snickering outside my patient's room*

Coworker: Awww, why won't you let your patient play matchmaker, it sounds like so much fun?!

[patientthings]

Me: *Helps coworker 1 turn patient to clean back/change sheets for bath time*

Patient: (confused but pleasant) *looks up at me* "You got some pretty titties!" *Pats boobies approvingly*

Coworker 1: *horrified face* Later, I tell coworker 2 about experience.

Coworker 2: You know I'm gonna call you that from now on, right?

I was called "Pretty titties" for a good two weeks after incident. 😂🤷🏼‍♀️

[patientthings]

Patient: *pleasantly confused, developing ICU psychosis, never needs anything when you ask, just curses all the time with no real reason as to why*

P: .....S***!

Time passes

P: .....F***!

Time passes

P: ..... Aw S***!

Charge nurse: Yea that's gonna be me when I'm 80 years old and confused. Just shouting expletives with no rhyme or reason behind it. 🤷🏻‍♂️😂🤣

[patientthings]

Situation - Tonight I'm charging with a full unit, no beds open and I get a call from house supervisor that a patient is crapping out on the med/surg floor and needs to be intubated ASAP. (Heart rate shooting up, tachypneic, despite BIPAP, etc).

House supervisor: Is there anyone you can triage out?

Me: Yea, the inappropriate Rapid y'all sent me from the same floor earlier tonight. But for real, probably this patient that a smaller hospital "couldn't wean off the ventilator" and sent for pulmonary management that self extubated right after getting here and has been fine since on 3LNC since.

The only problem with this is that this pt belongs to a float pool nurse who we often give the "easier" pts just because they don't get pulled to us that often so they're not super familiar with ventilators, arterial lines, Swan-Ganz catheters, etc. She will have to triage her pt out and admit this pt to intubate.

So thankfully my ICU team is great, pulling together all the needed supplies, pulling up sedation and paralytics for the intubation per MD order, bagging, hooking up CO2 detectors, putting down OG tubes, etc. It's almost like a chaotic ballet, crazy but synchronized at the same time. Everyone is doing everything without even talking about it, and moving quickly and efficiently.

Two floor nurses stayed cause they wanted to watch the intubation.

Floor nurse 1: What are they doing?

Floor nurse 2: I don't know, but whatever it is, they're doing a lot of it.

The float pool nurse is doing very well, considering this is not something she does regularly at all. I'm helping talk her through everything, our next steps, getting a STAT chest x-ray, calling ancillary staff on my vocera, hooking up propofol, dropping IVs in, getting an EKG, how to find the Cardizem/Propofol protocol orders in the computer chart, how to program boluses on the IV pumps, etc.

Float pool nurse: I love ICU nurses.

Me: (unsure if she's being sarcastic) Why?

FPN: Because you do this all the time so I don't have to! I'm just glad you're here! These are the pts that I'm usually like "They're too sick, they need to go to ICU," and pass off the responsibility to y'all! Now I'm looking around and I am the ICU nurse! It's like uh-oh!

Glad to know someone appreciates it. ❤️

[patientthings]

So my hospital isn't a teaching hospital... Yet

So we've never had residents/interns and I don't even know if I'd know how to talk to them, considering the horror stories I hear on Tumblr...

But our hospital just made an agreement with a teaching hospital 3 hours from us and all our doctors are gonna be changed over to their staff so I'm not sure how this is gonna go. Someone mentioned that they wondered if we'd be getting residents and a bunch of the ICU staff was just like.

The realization/horror is real y'all.

[patientthings]

So I'm done

So I'm working a ton of mandatory overtime right now. On top of this, staffing sucks, unit is bursting at the seams, every time they transfer a patient to the floor, a new patient is right around the corner. Triples are built into our matrix, and with staffing like it currently is, more often then not you're tripled.

So the other night my charge nurse says "I heard you ran to the other side screaming you needed help to move that patient I asked you to move. You know you don't have to be so overdramatic, right? It wasn't an emergency." I WANTED TO SLAP HIM IN THE FACE.

So I'll give a little background to my "dramatics..."

I was tripled, 2 vents, and a walkie talkie DKA (ya know, Q1H accuchecks and all that jazz). It's 5am and all my patients have 6am/7am meds, so I'm trying to get a headstart. I do my accuchecks, gather my meds, IV tubing's, syringes, etc to make my med passes. I go in one vent room, pass meds, finish up, go to my other vent room, pass meds and I smell it. Poop. I don't have time to deal with this and she's in a diaper so I ask the aid to get the stuff ready (which she's helping another nurse so she'll be a bit), and I'll meet her as soon as I finish meds in my other room. I do my accucheck and pass his antibiotic, in the process his labs come back and his Gap is closed. Fabulous! But now I have a ton of changes to make, give Levemir, turn off insulin drip in an hour, change fluids, etc

Okay, I go pull Levemir and am heading to his room to give it and run to my other room to clean my vent #2 up. But I pass vent #1's room. And I smell it. Poop. Now I've got to clean her up too. Okay, I give Levemir, put the conditional orders the doc gave into the computer. Okay, time to clean up vent #2. I'm literally gloved up ready to start cleaning. "Hey the charge nurse is on the phone." I'm aware he went up to help the med surg floor intubate a patient, but why does he need me? Pick up the phone. "Hey I need you to move your DKA patient to the surgical (clean) side of the unit. Can you put him in (room number)?" I say okay, hang up the phone. Look around, no one is to be seen. So I walk to the other side, talk firmly to get their attention because I know no one wants to move from their desk cause it's almost shift change and they've got charting to finish (and I also talk loudly as that is my natural volume and I talk with my hands) and ask for help. My patient can walk, but he has an IV pole, a recliner, a bedside commode, and a bed that have to be moved because housekeeping is coming to clean that room and I've got patients to clean. I get it done, quickly and efficiently and go start cleaning my other patients. Let's ignore the fact that I was there till 9am cleaning my patients because one wouldn't stop pooping as we turned her and I had to call doctors, give report, chart, etc.

So all this to say, don't judge other nurses if you think they're being "dramatic" or whatever cause they could be having a night like mine, or worse.