Thursday, February 21, 2008

Night Shift Floor Nurses will let you die!

No, they won't. But you'd think so, if you read this article on MSN about how a "Code Blue" is more deadly at night. In other words, if you become dead in the hospital at night, you're more likely to stay that way than if you become dead in the daytime.

Now, I have to point out that it says

"Only in the emergency room was there no night-or-day difference in survival. "
Theoretically, in the ER, we have one eye on our patients all of the time, and if they go bad, we notice it right away.
"But researchers found among the late night cases a higher portion of instances where patients were discovered with no heart electrical activity, that is, too late to deliver a lifesaving shock."
Because on the floor, the nurses are running their asses off trying to keep up with their 8 patients, they don't get a tech or a CNA anymore due to cost-cutting, and who the hell can keep a good eye on 8 people at once? I sure can't.

Here's another side to this.

Lately, we've been holding anywhere from 2 to 12 admits in the ER all night long. And we're usually working at least one RN short, if not two. (They won't pay much overtime anymore, it's too expensive, so often, if someone calls off, we work short. And 'tis the season for cold and flu.) There used to be 2 ED Techs in the back every night, now we only have 1, and sometimes none.

You never know if you're going to be a ER/CCU nurse, or an ER/Med-Surg nurse, or sometimes even an ER/CCU/Ortho/Med-Surg nurse. You can have 2 CCU holds, and still be expected to help out when the next Chest Pain or Trauma comes in.

The holds take up all of the monitored beds, and you're doing full CP workups in the back corner without a monitor.

So what happens when that CP in the back corner goes into V-Fib? Are you going to catch it while he's still in a shockable rhythm? Maybe, maybe not.

But it's going to be like running a code on the floor, because you'll have to go find all of the supplies (crash cart) and people (Docs, additional Nurses) to help, and then while they're all tied up in the back corner, Grandma Susie in Trauma 3 is going to crump, and nobody will see it, because her ER/CCU nurse is helping with the code, and on, and on, and on.
"Staff who are fatigued, less experienced or too few in number could be to blame, researchers speculated."
I get sick of people saying that fatigue is one of the reasons why "bad things" happen at night. F**k fatigue. That is such a bullshit answer. Running your ass off is running your ass off, regardless of the time of day. I'll buy the "too few in number", though. Because at night, they cut the crap out of the staffing and everything else, and it's "out of sight, out of mind." So everyone is trying to get twice as much done with half of the resources.

Funny, when we're working short two RNs, holding 10 patients, and the charge nurse calls our Director to tell her we're drowning, suddenly 5 beds open up upstairs. And I'd like to be happy that we're getting 5 patients up to where they need to be, until I see the Floor Nurses. They're just as exhausted as I am, and each of them just added one more patient to their already full load.

So, tell me. When one of their new patients code, how soon will they notice it? Sooner than we would? I doubt it.

We're failing patients and risking our licenses, just to put money into the bottom line.

Is it worth it, Mr. CEO?


mielikki said...

you beat me to this one. That article pissed me off, and I was formulating my response to it, as well. But, you handled it well...
and I agree

Anonymous said...

Only 2 things matter in a code:

#1. Rhythm (shockable or not)

#2. Time the pt is in that rhythm.

If you code with anything that is not shockable, your chances of recovering are terrible.

Inpatients code from sepsis, acidosis, and multi-organ failure.

Outpatients code from cardiac disease and rarely from hypoxia/repsiratory arrest. Anyone who codes from anything else won't make it to the ER; they'll be dead on arrival.

More people may move to the ICU after a code in the day time, but they aren't leaving the hospital alive.

Does it matter if we find them earlier?

MonkeyGirl said...


Those are all very valid points.

You completely missed the point of the post.

But you made very valid points, nonetheless.

Thank you for your contribution that has nothing to do with the discussion.

Perhaps you can come back and play again sometime, preferrably when I'm bitching about running futile codes on patients that won't have a good outcome, not when I'm bitching about staffing cuts and their effect throughout the hospital.

MonkeySister said...

I don't want to side with management, but they are walking a slippery slope. They obviously want to help the sick and infirm but they are also running a business. Like with any business you sometimes have to make cuts to make a profit. I'm not saying it good. Actually, it's not. They should find other places to cut, like their own salaries. Why does some guy in the top floor office that doesn't touch a single patient a day get so much money? The main problem as I see it are two things... (keep in mind, I'm not in the healthcare profession, so I don't know what I'm talking about...) The first issue is the stupid people that come into the ER for a hang nail, cough or pregnancy test. As I recall, cough medicine and pregnancy tests are available at your local drug store and your hang nail can wait until regular business hours with your personal doctor. Another issue at hand is that insurance by definition is something that you PAY for that will help you in the off chance that it is needed. If you don't pay a dime and are only smart enough to fill out a form to the federal government that says that you are too lazy to work but you still want to go to the ER with stupid problems, it's not "insurance". (THIS IS NOT APPLICABLE TO PEOPLE WHO FILL OUT THOSE FORMS BECAUSE THEY ARE DISABLED AND CAN'T WORK OR CAN'T PAY FOR THEIR INSURANCE, SO DON'T EVEN START THE WHINING. YOU'VE GONE OFF ON THE WRONG TANGENT... But if you are physically able to work and don't... oh another can of worms...)
Oh, and don't even get me started on all those lawsuits which makes doctors liability insurance so high that they have to raise their fees just to be able to feed their families.

Mother Jones RN said...

That article really pissed me off, too. I was the only nurse with 9 patients and a tech one night, and my nursing supervisor told me I HAD to take another admission from the ER. I told him, Fu*k NO! He said he would send the patient up to the unit with a security guard to watch him until I had time to admit him. I asked, "Does the guard have his nursing license? I'm not accepting the patient, so I guess this shits going to fall on YOUR license when something happens and you end up in court." It's strange how he changed his mind and that patient wasn't dumped on my unit.

The system sucks.


Babs said...

They obviously want to help the sick and infirm but they are also running a business. Like with any business you sometimes have to make cuts to make a profit.

That's the problem. It wasn't always that way. There was a time when the vast majority of hospitals were non-profit. In, of, by, and for the community.

Just as a side note, when it comes to rounding up help, there's also the fact that you can't call a code over the intercom after 9pm....

JD said...

tell me you didn't really expect a fair and balanced story from MSN. . . That wouldn't get them ratings. . .Next your going to tell me you expect them to research this and tell the real truth. . .

Amy said...

This article, and your post about it, beautifully sums up all the reasons I got out of the patient care business altogether. I could make way more money than I do now if I went back to acute care nursing, but I get paid a respectable salary just to sign My Name, RN 100 times a day. The pay cut is worthwhile if it means I never have another sleepless night worrying about my personal responsibility for the health and safety of another human being.

Orthette said...

MJ makes an interesting point about the "not-for-profit" status of hospitals. Most hospitals, including the ones paying seven-figure salaries to their executives, are technically not-for-profit. As long as they aren't paying dividends, they can get away with a lot,and keep that status. Illinois' attorney general recently challenged the not-for-profit status of a downstate hospital, and it's interesting to watch the posturing of other hospitals since then.

Kacey said...

I quit hospital nursing eleven years ago, because of the shortage of staff. I was a wreck worrying about how to prioritize the patient care, the paper work, stocking the med drawers, just everything. I used to keep my assessments on a big piece of paper and then clock out and come back to do my charting on my own time. That even made them mad. I still have dreams where I cannot get things done and cannot get anything in order. I wake up in a panic. My last couple of years were spent in maternity. The last twelve hour shift, I had 4 C-Section moms, 1 new delivery and all five of their babies. Everyone needed assessments q.4.h., all moms wanted pain meds, the babies needed Hep-Vac, feedings, diaper changes and the nursery was closed, because no babies were sick. I tried to chart with five cribs in a circle around me and was a basket case, because I was the only scrub nurse on duty for Emergency Sections. I decided that the hospital didn't care if they killed me, so I retired early. What started out as a love affair with nursing ended with me hating whole thing. You are a hero for staying under these conditions. And when did hospitals change from serving the needs of the ill to big, for profit businesses?

Orthette said...

I don't know what the average floor nurse's shift is like. I know that in the OR I work at, almost every nurse gets asked to stay late every single freakin' day. They've cut our agency help to improve the OR's budget, so we have even fewer people. (It's hard to believe the hospital can't afford agency nurses when I have to walk past the 3-story marble waterfall in the lobby every day.)

AngelMD-No-More said...

hello monkeygirl...hope you wouldnt mind that i leave a comment here.

i just couldnt help but be surprised by this post of yours. all the while i was thinking that this only happens in the 3rd world country where i belong. i was always whining about this crap system here in our place - you know, we health care professionals risking our licenses because of the inadequacy of the hospitals we are working in. aside from this, we always get the blame from the patients or their relatives should something wrong happen, since we are the frontliners at the er or in the wards...definitely not the administrators. i feel for you.

Anonymous said...

Amen, sister. As a paramedic I always have admired nurses, and have always wondered when the hell the POS admins were going to quit assuming 1 nurse can handle 10 freaking pt's....hmm let's see I'll bet 2 or 3 would be traumas, a couple on vents, a full arrest, then you've got one over here stroking out but no one to take him to CT and pharmacy's backed up, not enough docs, no help to run your arrest, no doc to order the TPA, vents alarming every 5 minutes with no RT's around because there aren't enough of them either!~
Much, much love to all nurses. I prefer you all to a doc any damn day of the week.

Spook, RN said...

Thanks for that post MG.

As a night shift nurse on an acute orho-med-surg floor, that article pissed me off too. I routinely have 8 patients a night with 1 fucking tech for a full floor of 34 patients.

Some days I'm tempted to ask my administrators if they'd like/choose to be a patient up on my floor....

Freadom said...

I never saw that article, probably because I was on vacation or doing CPR on somone who coded at night.

I think your response hear pretty much covers it for all us nocturnal workers.