What could be the ramifications?

  1. Hi all...been a long time since I've been here. Between school and working in the ER, not much time. I had an experience a couple of weeks ago and just wondered what the ramifications could be with something like this. Right now I am an ER tech, so I know that legally it can't really affect me, but I'd like to know what can happen to the nurses involved. Thanks.

    Patient presented in private vehicle stating "I know I am having a heart attack, it hurts so much!" Patient is 46 yo. Brought into ER by stretcher and taken into trauma bay. Nurse comes in and asks a few very vague questions as patient is writhing in pain on the stretcher. Nurse leaves patient without a line started nor hooking up to monitor. Doc comes in (after listening to nurse stating that patient was a "drug seeker") and asks a few questions of fiance who accompanied patient. Doc leaves. Patient is still not on monitor and is without a line.

    A trama alert is called and tech is told to move patient to a regular room. Tech is told not to bother hooking patient up to monitor because "he doesn't need it". Patient still complaining of chest pain and extreme headache. Nurse AGAIN told of this and nothing is done. Trauma rolls into ER and patient that was moved codes. Patient is revived, put on monitor and nurse tells doc that she did this and that as soon as patient was brought into the ER (none of which is true and I knew it).

    Who is responsible for this nurses actions legally and can I be dragged in on all of it? She was reported to the nurse manager and as far as I know nothing was done. This particular nurse has also overdosed a pediatric diabetic..order read 5mg and she gave 50mg, overdosed another adult patient in the same manner and is busy flirting with the male EMT's. and having an affair with another nurse in the department, and ignoring most of her duties unless she absolutely has no choice but to do them.

    I'm very concerned that she is going to kill one of our patients someday. I understand that there is a nursing shortage, but why in heaven's name would they keep someone on staff like that? What are the ramifications for the rest of the staff that may be on staff when she does these "mistakes"?
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  2. 38 Comments

  3. by   canoehead
    She is still on staff because your boss subscribes to the "warm body" school of thought.

    She will eventually kill someone and be fired or worse. Report what you see and do not trust her assessments- do your own and always err on the side of caution with your own patients- but you knew that anyway.

    I would make sure she signed off all the treatments and meds she does, and put her down as "recorder" in a code if possible where she can do the least damage.
  4. by   CEN35
    it's difficult to say, whether the doc or the nurse is at fault? it depends on the documentation. looking at it from as a (as usual) uneducated jurror view, i say this:

    patient comes in, and claims chest pain.

    nurse: says ok and leaves him in there and doesn't do a thing about it?

    after that it's all crap down the drain. i'll explain.

    the patient had a fiancee with him. in all reality, they know what time they got there, and why they came. you as the tech have no, zero, none, nadda responsibility. the nurse was to rely on his/her judgement.

    the nurse failed to respond to patients complaint (i.e. chest pain)
    #1 - the patient was not hooked up on a monitor. (cardiac)
    #2 - a 12 lead was not done. (cardiac)
    #3 - a pulse ox was not done. (respiratory....i.e. pnx or pe)
    #4 - no evaluation of breath sounds? (se)
    #5 - no vital signs.

    jurror perspective - the nurse is definately guilty of negligence.

    this is why, no matter how many patients i have, unless one is in a life threatening situation........ the new patient always gets evaluated and checked out stat.

    we have a log at work, in which we establish a trend, of those that appear to be drug seekers. two reasons for it:

    #1 - to not feed into their demands.
    #2 - to help our case in the event of a situation like this one.

    however, even with past documentation of drug seekeing behavior......the prosacution response will always be: "how do you know, that this time it wasn't the real deal."
    so as you see that is not even full proof.

    if i was that nurse, i would be scared, real scared.

    as a tech your in the clear.


    me
  5. by   2ndCareerRN
    However, even with past documentation of drug seekeing behavior......the prosacution response will always be: "How do you know, that this time it wasn't the real deal."
    Man, isn't that the truth. Each and every patient must be evaluated, each and every time as though they have never been to you facility before.
    I have always felt it is the people who you know as drug seekers who get the short end of the stick in the ER. But, sometimes, they have legitimate complaints. And you had better be evaluting them just as you would the sweet lttle ole lady who comes through your door.


    bob
  6. by   CEN35
    as much as i hate to say it myself bob!

    amen!


    me
    Last edit by CEN35 on Aug 12, '02
  7. by   JillR
    When I have a person come in complaining of chest pain, they are hooked up to a monitor, VS taken frequently, pulse oxemetry done continuously, oxygen on, IV inserted,ect until MI or any other life threatening cause is ruled out. I don't really care how many times they have been in for drugs or any other reason. Tests that will be ordered are called for usually before the doc even sees the patient. At the very least the doc would order an ECG and cardiac enzymes.

    The only thing I can think of that you may have been responsible for is if the RN would have stated that she told you to put the person on the monitor and other stuff and then it would have been her word against yours. Luckily, the patient had a significant other in the room with him, this might have helped your case. The techs that worked with me in the ER did not have to ask permission to put someone on the monitor, they just went ahead and did it and it was expected from them.

    I guess what I am saying is to be real careful and cover your butt. If this nurse did not have a problem lying about putting the patient on a monitor, I doubt she would have a problem saying she delegated a task to you and that you did not follow through.

    Another thing we do is take a strip as soon as the person is hooked up to the monitor, so you can see what time that happened.

    I would tend to agree with CEN, that the RN may be negligent, but that you are in the clear.
  8. by   Y2KRN
    Great advice here. As an emergency room nurse, and for you a soon to be nurse, look at everyone as a first time client, regardless of your personal feelings. Two things you always do with a chest pain patient, hook them up to a monitor, listen to their lung sounds. Draw blood. I don't know what your policy is at your hospital, I have worked where techs could draw blood and where they can't. If you can, say to the Doc. look this patient is really complaining of severe chest pain, yadda yadda can I go ahead and get some blood?? He/She will probably say sure and get a portable EKG as well.

    As a tech there is no reason why you cannot hook the patient up to a monitor. This is a judgement that you can make that you don't need a nurse to tell you to do. That is not a crime, if the nurse says anything to you say we need a baseline or it is protocol. If he/she gives you too much grief get another nurse or your charge nurse and tell them your concerns.

    I don't think that you will have any worries here!!! But, I don't care if you are a nurse or an EMT or a Doctor or the janitor, if you don't feel that it is right go with what you would do. Worst case scenario for hooking the patient up to the monitor is vitals are stable and there is a normal sinus rhythym on the monitor. A nice baseline that I would want to see.

    This nurse sounds dangerous, stay away from her as much as you can. Question her, and if you have a bad feeling get another nurse that you trust and would do an action any prudent nurse would do.

    I appreciate all the help I get from a good PCT, don't be afraid to question a nurse or a physcian, I know sometimes that is easier said then done. We are all here for the goal of one thing and that is to take care of and advocate for our patients. All of the ER team members are there for this purpose.

    Hang in there, and document things closely when you work with her or are assigned to her team. As mentioned above, watch for her to say I told the tech to do that. Keep a little note book in your pocket just for writing down the tasks she does or does not delegate to you. I am glad that you told someone your concerns if your manager doesn't do something about it, and you continue to see non-prudent judgement, go higher than your manager, or go to QA.

    Hang in there!

    Y2KRN
  9. by   2MagnoliaTrees
    All I can say is document what happened with who, what, when, where and how and report it. She will eventually cause a death and then who will she try to drag down with her. She burnt out and needs to change occupations. God Bless.
  10. by   CEN35
  11. by   l.rae
    boy oh boy l hate these frequent flyers that holler Chest Pain cause they know they will get a stat work up...we have one very frequent flyer...female, young thirties...no risk factors...pulled this the other night on one of the worst shifts of my entire career!...Our policy is an EKG must be done within 10 min of arrival w/ c/o c.p.....we usually do the whole shebang..monitor, blood and line b-4 doc ever sees them...Well my frequent flyer of the other nite pulled thisstunt at the worst possible time..every bed filled, lowest staff #'s..critical patients....sorry to say that the situation essarge describes could have happened to me....thanks for the sobering reminder...........LR
  12. by   psychomachia
    Let this be one of those "lessons" in how NOT to be a nurse. I would discuss the matter with your charge nurse/ supervisor and write down everything that happened, even if you don't have to turn in an incident report. Writing it down now will help should something happen later and your memory isn't as clear as it might be now. Continue to pay attention to how pt.s are treated while you work as a tech. It's the best learning experience for what you'll have to do as a nurse - in other words - learn from others mistakes.
  13. by   CEN35
    jill said:

    "the only thing i can think of that you may have been responsible for is if the rn would have stated that she told you to put the person on the monitor and other stuff and then it would have been her word against yours."


    actually, according to most state laws they view everything as a chain.
    the delegator (rn in this case) is ultimately the liable party for the patients care. the rn could tell, 2 medics, and a tech everything she wants done on a patient.

    if it doesn't get done, it then falls back onto the rn (legally).

    as a tech you are in the clear 99.9% of the time. unless you do something out of the scope of a techs practice in your state.

    me
  14. by   JillR
    CEN,
    You are probably right about the delegation thing, but I was thinking not just in legal terms, but in the terms of this techs reputation at work. Not that the work was not done due to laziness, but the tech was actually told not to hook the patient up to the monitor because the nurse did not believe the patients complaints. This whole situation is just down right scarey, and I think she should cover her action with this one.

    Either way, I would still suggest being really careful around anyone you are not sure you can trust to be honest. I guess I am not a very trusting person, but I have seen people lie in order to hurt others reputation just because they don't like them or were too lazy to do their own work. I could see her and possibly management trying to use you as a scapegoat.

    I also agree with writing the event down, it helps not only to recall the situation later if needed but also to allow you to vent some frustrations about the situation.

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