Boneheaded Nursing: A Cautionary Tale - page 2

Here's how even experienced nurses can get into trouble: Yesterday at the three PM shift change, I picked up four new patients and a student, all of whom were in need of something or another that... Read More

  1. by   KacyLynnRN
    Thanks for sharing these stories, guys, to help make all of us more aware. I have to admit, being a young and relatively new nurse, I do tend to trust the older/more experienced nurses statements in report, when they say "oh, that's normal for him...oh he's been that way....oh, he'll be OK, etc..." and I know that is a bad habit to get into. Thank again.
  2. by   Liddle Noodnik
    Quote from KacyLynnLPN
    Thanks for sharing these stories, guys, to help make all of us more aware. I have to admit, being a young and relatively new nurse, I do tend to trust the older/more experienced nurses statements in report, when they say "oh, that's normal for him...oh he's been that way....oh, he'll be OK, etc..." and I know that is a bad habit to get into. Thank again.

    Sometimes the fact that we have seen so many come through the doors, we get a bit jaded or casual. A new pair of eyes is ALWAYS a wonderful thing! Don't ever feel like you're bothering anyone when you aren't satisfied with an answer. You could be the very thing that patient needs!

    Same with our CNA's, us nurses really need to treat them well and listen to them when they say something just isn't "right". They are the ones with their eyes and ears a lot closer to the patient than WE get sometimes! They are priceless!

    {{{{{{{{{{{{{CNA's, students, new grads, LPN's of course!!! and anyone else I left out??? hee hee}}}}}}}}}}}}}}}}}}

    I suppose I could thank the doctors too, sigh ... if I must!

    {{{{{{{{{{{{{{Docs}}}}}}}}}}}]]

    Hey some of them are quite good!

    (I think I hear a cat in here, )
  3. by   NurseFirst
    A few years ago a physician ordered an EKG, which showed nothing, and then a holter monitor for me when I c/o of the length of my breaths changing. It was very strange; sometimes my breath cycle would be 2 sec and sometimes 3 sec--without doing anything different. I just thought it was odd; he actually thought it could be a sign of something more serious.

    Even with the physiology I know now, I still don't understand what that something would have been, but I apparently didn't have it!!!


    NurseFirst



    Quote from CardioTrans
    This may or may not go along with these lines, but also do not believe that all MI's will present in textbook fashion.

    True story, 2 wks ago I went to see a pt ( I work home care), her daughters were telling me that about 15 min before I got there that "mom had a breathing spell". Pt said that she got short of breath and had a pain shoot through her chest that took her breath, but no numbness or tingling in arm or jaw.....I took her vitals.... all normal........ pt denied pain. While I was there, she had another "spell" I immediately took her vitals again, her BP had shot up to 160/110, her HR was 112. It lasted about 1-2 min. I was talking to her about other symptoms, all of which she denied. And none could be seen. She had a 2nd episode.... I got on the phone with the MD and told him that I thought she needed to be evaled in the ER because this was not "normal" for her. MD said "it doesnt sound like a heart attack" While I was on the phone she had another one. I politely told the doctor that I was sending her to the ER. Fast forward 6 hrs......... the lady had been taken to the local ER, had to have NTG on the way, was transported to a larger hospital. Underwent an ateriorgram the next day....... wound up in ICU.... and died this past Thursday from a massive MI.

    Textbook is not always real life..........
  4. by   JBudd
    Long time ago, doing LTC, I came on after 4 days off, and was told a LOM had been c/o CP for the last 3 of them. He was ambulatory, mostly selfcare, old ETOHer, report said he'd gotten hold of a bottle somewhere, they'd found the empty. No one had vitaled him, listened to him, or given him so much as a Tylenol.

    He was textbook pneumonia, dead space, phremitis, fever, pain changing with resps, whole nine yards. The doctor actually laughed at me when I called with the assessments, but sent him for an Xray, then called back and apologised. He wasn't used to anyone from that place doing much I guess. :angryfire

    Thanks from me too, MJ, good reminder, its a bad habit to fall into; never assume anything!
  5. by   SharonH, RN
    Good for you Marla to post this for all of us to see. It's a great reminder as we have all been there. My story:


    Several years ago, on a 3-11 shift I took report on an 89-year old gentleman who came in with mental status changes. Well when I made rounds before taking this report, the man appeared comatose to me. At report the day shift nurse reported that he has been "sleeping" for her entire shift and that he has slept all night also. When I asked if he was usually nonverbal, nonresponsive she shrugged and said that he was 89-years old as though that were an excuse for his status. Well it took me about an hour and a half to finish report, do opening assessments and get settled in. I stopped to read this man's chart more thoroughly to try to get an idea of what was really going on with him.


    Sure enough, he was mowing his own lawn just 3 days prior and had been alert and oriented on admission! There was no mention of an event to explain his current obtunded state. I put out the page to the doc, went down to the room to assess him again and the poor man coded.


    Imagine how that situation could have been avoided if there had been a thorough assessment of his neurostatus 8 or even 16 hours before with prompt intervention. Unfortunately, the whole thing came falling down around my ears.
    Last edit by SharonH, RN on Mar 15, '05
  6. by   plumrn
    I think these stories help us all to 'take another look', and help us all be better nurses. We all have these stories to tell, unfortunately.
  7. by   VivaLasViejas
    Thank you all for sharing! It's good to know that my co-worker and I aren't the only ones to allow ourselves to be blindsided like that........BTW, the patient in the original post did make it, he spent a couple of days in ICU getting his heart rhythms back under control, and he went home a few days later.

    Last night, I'm happy to say, I picked up on some changes in a patient I'd admitted earlier in the afternoon and got the doctor involved IMMEDIATELY, as I knew he was headed for the drain if something wasn't done. Sure enough, he proceeded to have his fourth stroke of the day (!) and by the time the doctor got there, the formerly A&O pt. had started seeing bugs on the walls, then became obtunded and weak on the left side. I'm not sure if there was anything that could have been done to prevent it, but I'm glad I was on top of it.
  8. by   mattsmom81
    Something I learned quickly as a new RN teamleader was get out and make physical rounds myself first thing on my shift, and get a feel for my patients. NEVER just go on report from someone else. Tooo many variables. doesn't mean the nurse ahead of you is bad, but this patient is now YOUR responsibility.

    I also learned quickly that when a nurse gives me info such as 'he's got a heart rate of 150 but he's OK', what that means is He was 'OK' for her, in her opinion, that this was his baseline..and she accepted it. Doesn't absolve me of MY responsibility. This is MY patient now.

    I hate to say never trust the nurse ahead of you; but always keep an open mind and follow your OWN instincts.

    I always try hard NOT to immediately judge the nurses' actions/inactions before me because I didn't work her shift and I don't know what else she may have been dealing with, and she may also not have my level of competency/experience. I've been a resource/charge for years so I also try to take an educational stance vs punitive when treatment is delayed due to a nurses' inaction.

    Of course, if someone's inaction/nursing decision was below the competency expectation for that unit, then we have to look at that objectively...and if we run into things like this consistently our managers need to know.
  9. by   Tweety
    I agree! Never let your guard down. But it's hard when you have to supervise students and the ratios are so high, but don't get me started.

  10. by   acutecarenp
    Quote from zoeboboey
    Sometimes the fact that we have seen so many come through the doors, we get a bit jaded or casual. A new pair of eyes is ALWAYS a wonderful thing! Don't ever feel like you're bothering anyone when you aren't satisfied with an answer. You could be the very thing that patient needs!

    Same with our CNA's, us nurses really need to treat them well and listen to them when they say something just isn't "right". They are the ones with their eyes and ears a lot closer to the patient than WE get sometimes! They are priceless!

    {{{{{{{{{{{{{CNA's, students, new grads, LPN's of course!!! and anyone else I left out??? hee hee}}}}}}}}}}}}}}}}}}

    I suppose I could thank the doctors too, sigh ... if I must!

    {{{{{{{{{{{{{{Docs}}}}}}}}}}}]]

    Hey some of them are quite good!

    (I think I hear a cat in here, )
    With regard to the "CNA thing":

    I have been in practice for 23 (wow, that long???) years. I could not do my job with out the CNAs and techs that I work with.
    Of the many caveats I follow in my day to day practice, the one that is reinforced most often is the following:

    If the CNA comes to me and says "I just don't like the way that guy looks"...There is a pretty good chance I'll be transferring "that guy" to the ICU before the end of my shift!

    Oh.. and Cardio...
    Dixieland is lucky to have you!


    Tony
  11. by   UM Review RN
    Precepting a student one time, gave her an "easy" patient. That is, the patient was a/o X3 LOL, but difficult to assess because she had a hx of GERD, arthritis, and various other complaints, but in general, we felt that she was needy and had a GI problem, not so much a cardiac problem. I thought the patient would be a great example of someone who just needed a few doses of Prevacid and to have her NSAIDs D/C'd or something.

    And she was very needy. All through the shift, it was "get me this," "get me that." We'd no sooner leave the room than the light would go back on. "I just can't get comfortable," and we'd move the pillow another inch to the right, left, or whatever.

    "She just wants attention," I told the student.

    And on went the complaints of the general aches and pains. I assessed the patient several times, and the area of discomfort always was different. It'd be "my back hurts" or "my legs hurt," or she'd manage to scrunch down flat in the bed after eating saltines and drinking juice, and then "my stomach hurts."

    Around 0400, the student told me that she'd about had it. Which I understood. Which is why I gave her this patient. The student went on to say that the patient had worked herself into such a tizzy that she vomited a little bit and that her blood pressure was up a little bit, and now she was c/o epigastric pain that radiated to underneath her left breast.

    Not to miss out on a good learning opportunity, I instructed the student to get an EKG and some Nitro SL since the patient was already on O2.

    Well, honey if looks could kill! :chuckle I'm sure this poor kid thought I was just the wicked witch of the East. Mainly because about an hour before we came on, the nurse before us had done the whole EKG and nitro bit and it was all NSR and no perceptible relief from the NTG.

    But the student went ahead did what I asked, and so I moseyed on down to the patient's room to observe the EKG being set up and the complete assessment. "It's indicated, based on her complaints," I assured her.

    And lo and behold! The EKG said ********ACUTE MI******** ! My student freaked, and I was pretty surprised myself.

    The patient survived her Big One and we all learned something important.
  12. by   hollyster
    Quote from Angie O'Plasty, RN
    Precepting a student one time, gave her an "easy" patient. That is, the patient was a/o X3 LOL, but difficult to assess because she had a hx of GERD, arthritis, and various other complaints, but in general, we felt that she was needy and had a GI problem, not so much a cardiac problem. I thought the patient would be a great example of someone who just needed a few doses of Prevacid and to have her NSAIDs D/C'd or something.

    And she was very needy. All through the shift, it was "get me this," "get me that." We'd no sooner leave the room than the light would go back on. "I just can't get comfortable," and we'd move the pillow another inch to the right, left, or whatever.

    "She just wants attention," I told the student.

    And on went the complaints of the general aches and pains. I assessed the patient several times, and the area of discomfort always was different. It'd be "my back hurts" or "my legs hurt," or she'd manage to scrunch down flat in the bed after eating saltines and drinking juice, and then "my stomach hurts."

    Around 0400, the student told me that she'd about had it. Which I understood. Which is why I gave her this patient. The student went on to say that the patient had worked herself into such a tizzy that she vomited a little bit and that her blood pressure was up a little bit, and now she was c/o epigastric pain that radiated to underneath her left breast.

    Not to miss out on a good learning opportunity, I instructed the student to get an EKG and some Nitro SL since the patient was already on O2.

    Well, honey if looks could kill! :chuckle I'm sure this poor kid thought I was just the wicked witch of the East. Mainly because about an hour before we came on, the nurse before us had done the whole EKG and nitro bit and it was all NSR and no perceptible relief from the NTG.

    But the student went ahead did what I asked, and so I moseyed on down to the patient's room to observe the EKG being set up and the complete assessment. "It's indicated, based on her complaints," I assured her.

    And lo and behold! The EKG said ********ACUTE MI******** ! My student freaked, and I was pretty surprised myself.

    The patient survived her Big One and we all learned something important.
    This is why I always instruct the Nurses and Paramedics that sometimes difficult pts are acutually experiencing " the impending doom syndrome" and that any increase in complaints, nervousness or inability getting comfortable calls for a full assessment including O2 sat, EKG, BG, medication review and MD notification. Sometimes they are just difficult pts but I would rather go overboard then not react enough.
  13. by   SmilingBluEyes
    I have done several boneheaded things in my career; fortunately NONE wound up harming anyone. I agree w/the advice to listen to students and new nurses. Their fresh, unjaundiced eyes see things MINE miss oftentimes. They always can teach me a thing or two. So can the patients themselves. I try to keep my mind and eyes open, and I need to learn to shut my mouth more.

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