Bullshit's Many Levels
Last night a transfer came from an outside hospital. 50 something with a spontaneous pneumo that had a chest tube placed by another physician. When he got to us the chest tube was pouring blood (not exactly the pneumo that was presented). The soon to be second year surgical resident (aka intern) was at the bedside attempting to put in another chest tube. There was no joy in Mudville when the intern did strike out. Chest CT showed that the first tube went through the diaphragm into the liver (?!?!) and the second ended up between the aorta and esophagus. The sad part? As I was leaving the family was writing comment cards about how nice the staff had been to them.
We received an email from our nurse manager yesterday. "Concerns" have been brought up by day shift about the assignments and how busy we have been lately. Our assignments are 4 beds each with the charge nurse backing folks up and the trauma nurse having the room and possibly the drunks in the hall. Now everyone gets 4 beds, the charge nurse has 2 patients, AND has to back up the rest of the nurses. The trauma nurse is responsible for the pelvic room, which is all well and good until a sick as fuck vag bleeder or miscarriage rolls in. The other brilliant suggestions include... leaving a monitored bed open in each treatment area (uh huh... so we will tell the STEMI we can't take up the last bed), triage walking all acuity patients back from 3a-9a and triage doing patient transports upstairs during those same hours. All this is well and good until its 3am and there are still 20-some patients in the waiting room.
I have my moments where I am so over the management here. They work as charge or triage maybe once a year and haven't run a zone in 7 or more. The knee-jerk reaction is such bullshit. I learned that not spouting off to these stupid management emails is probably the more mature thing to do. I will sit back and watch.. but you don't have to make me like it!