Description of how your undertake team
My schedule was Day shift on Monday. In the morning Clinical Charge Nurse (CCN) allocated me to the monitored team leader during the hand over time. I have previously experienced a few times to perform the team leader in the monitored room. I understand how to run the monitored room as a team coordinator but I needed to consolidate its leading position.
Other staff nurses were clinical nurse specialist (CNS: P, pseudonym) and staff nurse (New Graduate: A, pseudonym) and resus nurse for the day in the monitored room. I divided into two parts and allocated them for their responsibility effectively to perform the job, such as room 1 to room 4 as the first staff nurse and room 5 to room 8 as the second nurse. I checked their tea break time and lunch time for their rest. I also checked the equipments in Monitored area with the checklist book as usual.
I was overseeing at that time 8 monitored cubicle rooms, 3 corridor areas, 3 resus areas, and 5 patients who are on micropaqs, which means that 13 plus 3 resus patients needed cardiac their monitoring due to their condition. Micropaq is a device that is convenient and efficient in continuous monitoring of patients’ cardiac rhythms. It is wireless and wearable and ideal for monitoring vital signs of higher-acuity overflow patients and ambulating patients (Welch Allyn, 2010). I also need to check telemetry, which is a technology that allows remote measurement and reporting of information to coronary care unit (CCU) available to roughly get an idea for monitor capacity in North Shore Hospital.
It was good to start until 10:30 in the morning. I had to keep updating the patients’ progress, such as checking troponin level of blood results to determine the patients’ medical condition more specifically keeping monitoring for the patient, updating their plan, checking telemetry request to CCU for patients while they are staying in wards, and organizing transit nurse while they are transferring to X-ray or to the wards. It is important for team leader to keep updating the patients’ status. If I make sure those procedures, I can handle patients with safety in a hurried situation.
After tea break, ambulances including R40’s calls and triage nurse brought the patients to the monitored room. The monitored rooms and corridor were full. I had to ring to acute coordinator and observation coordinator to find out any space for patients who didn’t need any more monitored patients. In this case I kept contacting with doctors to find out the patients’ plan, especially whether patients needed to keep monitoring or not.
I have to report to the CCN to alert the Monitoring area situation as there is not enough space for patients in Monitored room. At this time we collaborated with duty nurse manager to make process faster. On Monday after GP’s referral the patients came to hospital to assess their medical condition to find out their cardiac problems.
When I reflect on the situation, I concern for the patients’ safety. Firstly, patients who stay in corridor don’t have call bell. When they have questions or any request urgently, it is not easy for them to communicate between patient who are staying in corridor and staff. They have to shout or yell. Otherwise, they have to wait for the staff’s approaching. Staff nurse in monitored area or in ECC need to share any information for patients’ safety.
Secondly, in a hurried situation staff’s stress level is increasing and energy level is decreasing. Staff wanted to have a lunch break but was reluctant to have a break considering the patients’ safety. P, staff nurse, asked me any nurse but there was no extra staff because everybody in ECC was busy at that time. I paged to ECC area to let staff need to be assisted in monitored area, even though I knew there was no extra staff on that day.
We have to focus on ourselves’ wellbeing as well as patients’ safety and comfort care as best as we can. As team leader, I have to look out for the staff’s condition physically and emotionally. I boost the staff’s morale, and support their emotional feelings, and offer them to have a proper rest for their shift time.
All staff members in Monitored and Resus worked hard and spent all their energy to take care of patients’ medical condition for the day. Many patients came to the Monitored and the Resus to be checked their medical conditions or to be treated their symptoms. At the end of the shift the CCN came to us to encourage our job done, and gave a good feedback. I felt like ‘band of sisters’. Next time someone has to do this job as team leader, who is I, I would like to do the job as best as I can.
Welch Allyn (2010). Micropaq. Retrieved from 25/10/10. http://www.welchallyn.com
Wikipedia. (2010). Telemetry. Retrieved from 25/10/10. http://en.wikipedia.org/wiki/Telemetry