An 18-year-old was admitted to our ICU with a questionable diagnosis. The drug screen did not reveal what he had taken. Our ICU intensivist speculated he ingested bath salts. Bath salts came to the U.S. around the 2010s. It was cheap and, even better, considered a “legal high” as it was not detectable in drug tests. Josh came to the emergency room psychotic, paranoid, and hallucinating, with hypertension and SVT. He was quickly admitted to our ICU.

Bath salts, a term for synthetic cathinones, are also known as White Lightning., Cloud 9, or Ivory Wave. Bath salts can be considered worse than a combination of cocaine, PCP, ecstasy, LSD, and methamphetamines. Potential symptoms can also be respiratory distress, seizures, cerebral edema, MI, and persistent hypertension.

Because of his erratic behavior and clinical symptoms, our intensivist, Dr. Zack, ordered an ongoing nurse assistant (CNA) or a sitter to stay in his room 24/7. Our ICU manager at the time would not honor this doctor’s order, stating, “We cannot always honor a doctor’s order.” To compensate, the charge nurse would assign his room and another patient’s room right next to each other so they would be within close proximity.

Night shift, and it is my turn to handle this patient. He had already punched a hole in his wall in his ICU room. He had already dived to the floor out of his bed. We attempted to sedate him with IV benzodiazepines, but he was 18 years old. Young and strong, paranoid, and hallucinating. He was unstoppable.

I was considered a “troublemaker” with management. I called out when protocols and procedures were not followed appropriately. I was a loudmouth, and I did not pick my battles because I considered everything my battle. I was management’s target.

When I accepted this assignment, it was immediately changed. I would not have ICU 14 (the bath salts patient) and ICU 15. The charge nurse assigned me to ICU 14 and, across the room, ICU-03. It was impossible to watch both patients at one time, especially without a sitter or CNA. The patient in ICU-03 climbed out of bed screaming that the day shift never gave her a bath. She also required me to give her RBCs that night. The night was chaotic. It was an impossible assignment.

And the patient in ICU 14 climbed out of bed and knelt on the ground that night. There was no physical harm to the patient, and we placed him back into his bed. Immediately, the charge nurse wrote an incident report on me for failure and negligence in patient care.

The next day, I was called into the manager’s office and terminated for “allowing my patient to climb out of bed.” I was in shock and disbelief. I appealed my termination immediately.

It went up the management chain to the CNO. She discovered that the MD’s order was not followed. No 24/7 CNA or sitter was ever assigned. The doctor’s order was never followed through. It was a cruel “punishment for me.” I had been in this ICU for over 24 years as a dedicated night shifter.

I won my appeal. I won back pay of over $8,000. I was also invited back to work in the ICU. Considering I had that target on my back, I declined.

Eventually, that ICU manager was terminated. That charge nurse continued with her bully-like attitude until she retired. And during this ordeal, in a strange conversation with this charge nurse, she let me know that she was “more Christian” than I.

Bullying, hypocrisy, and I am thankful that I no longer have to clock in to that pitiful environment. At one time, we had the best ICU nurses. We were a team. Camaraderie. It was a great ICU, until it was not.

Debbie Moore-Black is a nurse who blogs at The Critical Care Nurse.