Do I report this?a long post!

  1. If this situation happened to you would you report it, and if yes how do you go about doing it?

    A nurse is pulled to my floor and is there for about 3 hrs when this happened. The wife of one of her patients stops me as I walk by his room and asks if something is wrong with her husband since it is cold in his room yet he keeps kicking off the blankets. I thought maybe he has a fever so I go in to check. The first thing I hear is the congestion of his airway, sounds like he needs major suctioning. So I proceed to do his vitals. His oxygen is at 89%. He has a nasal cannula on, so I check the connection. First of all it is not turned on, second the tubing is not connected to the wall. I then went to tell his nurse (I am a student nurse by the way)and tell her what happened. She says hook him up and put him on 2 liters, no he doesn't need to be suctioned. I put him back on and his O2 went up to 96%. I went to another nurse and asked if she would look at this pt because I think he really needs suctioning, and tell about the oxygen not being hooked up situation, where she then defends the other nurse and doesn't go in to look at him. By the way this guy had Bypass heart surgery, and then a TIA while at the hospital.The whole time I was in there with him he couldn't talk and kept his eyes closed. Well I went to lunch with a nurse and in the middle of eatting she was called out to that guys room because he went into V tach. He wound up being intubated, has pulmonary edema, and was rushed to ICU by a team of 8 people. The whole time this went on I was the only one consoling his wife who was freaking out. What would you do if you were in this situation?
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  2. 15 Comments

  3. by   canoehead
    You are a student? I would do nothing, you have more to lose than anything and probably won't make any impact other than to piss off the staff nurse. But know that when you went to that nurse with your assessment I for one would have thanked you for putting the O2 on and gone into the room to see myself what was up re suctioning. Maybe not that minute, but definitely before I left the floor, and within say 15 minutes.
  4. by   sjoe
    Don't you have a clinical instructor or other supervisor? That is the person to talk to about this, ASAP. (And make accurate notes on the incident for yourself, with names and times each event happened.)
    Last edit by sjoe on Oct 10, '02
  5. by   kookyscientist
    I think I probably miswrote what I meant in my thread. This incident happened on the job. I work as an Extern, but I am a student also as it is part of the job requiment. I put nursing student down because some people don't know what an extern is.
  6. by   JAYNE :DANCE:
    MMMMMMmmmmmmmmmmmmm TOUGH ONE.....ME I WOULD REPORT IT......I WOULD JUST NOT FEEL COMFORTABLE LETTING IT GO.........JUST IN CASE I MIGHT PI$$ OFF ANOTHER NURSE OR TWO!!!!!!!!!! I WOULD NOT CARE WHO I PI$$ED OFF, I GO TO WORK TO CARE FOR MY PT'S NOT TO GET BUDDY BUDDY WITH MY WORK MATES....IT IS SCARY TO THINK THAT THERE ARE SOME PEOPLE OUT THERE THAT HAVE A LICENSE TO BE A NURSE
  7. by   purplemania
    If you were there as an employee the fact that you are a student is not relevant. You should have followed chain of command (charge nurse, nurse manager or whatever is P/P for your facility). Otherwise, I think you acted wisely and the primary nurse is a prime example of the nurse YOU don't want to become.
  8. by   SmilingBluEyes
    I would be speaking w/my nurse manager about this incident PDQ. I know you don't want to make trouble w/coworkers, but I bet this is not an isolated thing, rather a habit with this nurse. Pretty dangerous place to be doing your externship if this is what example you have to follow.....

    Where was the house supervisor in all this? Charge nurse? anyhow, your conscience won't let you allow this to rest, Follow your chain of command like others before me suggested.
  9. by   darius000
    Speaking as an After Hours Nurse Manager (from Australia), same as a House Supervisor over there, I think that you should report this incident. As sjoe says, write down everything you can remember about the incident, because you spent so much time consoling the wife, she will remember you. In Australia, we use such reports to work out where problems are, they are not, and cannot be used as ammunition to fire somebody. Can you expain what an extern is?
  10. by   cactus wren
    At my hospital externs are student nurses who are almost finished with schooling. They are able to take patients, although only 2-4 a shift, they do all the patient care,charting ,and are gradually allowed to give meds, with their preceptor watching over them.Usually only have 1 or 2 at a time, and usually only over the summer break. And most of them have stayed with us after they graduate, and pass boards .This way they are already "oriented" to the hospital, and have an easier transition to this wonderful, stressful world of nursing.
  11. by   shygirl
    I would have reported this to the nurse supervisor and my instructor! You are going to be a good nurse!

    Shygirl
  12. by   kookyscientist
    Actually I did follow the chain of command because the nurse that I told was the charge nurse for the night. She was the one that defended the other nurse.Next step up is supervisor. But anyhow I appreciate all the input from you. It is bothering me because I haven't worked since the incident so I don't know if the man survived or what. Also, cactus gave a pretty good description of an extern, except we are not allowed to give meds at all. Our murse manager won't even let grad nurses pass them until they pass their boards. I'll keep you posted.
  13. by   RNed
    You did the right thing by informing the nurse of your findings, actions and concern. The O2 was started and his sats went up to 96%. The question of suctioning is subjective. Should he have been suctioned or not who knows?

    I somewhat agree with canoehead, here.
    Report ? What are you going to report except your findings and actions? You did that to the nurse. If you are drawing a conclusion that this patient would not have gone into V-tack if the patient had been suctioned - that is an assumption. The patient could have gone into V-tack at the time of suctioning, before suctioning or after suctioning.

    If asked as to what actions you preformed related to this event then answer truthfully and fully, but don't assume there is a fault because the other nurses did not act in the matter you felt they should have. You may find out later after your reporting - the patient had a potassium of 2.2 or 6.8 or some other abnormal lab finding which could have attributed to his V-tack. Hypoxia is only one of many reasons a patient may go into V-tack.

    It would be appropriate to inform the charge nurse that during this time a family member was present and needed help. Do we have a policy that identifies a spokes person for this family need during a code event? If not should we develop one? Would Social services be an appropriate referrel?

    I hope you get the idea here, there are many factors why patients do what they do. Sometimes even with the best nursing and medical care the outcomes are not good. I am not saying that you do not report things, you do. However, you report the facts and leave the conclusions, assumptions and analysis up to those skilled in that side of nursing. Strong clinical, experienced, long time staff can get "away" with making some conclusions and guide the investigations of quality care provided by other staff and this is done usually around the corner and quietly with the charge or management staff. Seldom do students and the inexperience get "away" with this. If there is a need for more information, they will come to you and ask.
    Last edit by RNed on Oct 10, '02
  14. by   Youda
    You didn't say what kind of facility you are in. LTC? Step-down?

    A concern I have is that we don't really know what the other nurses did or didn't do for sure. They may have slipped in the room while you were somewhere else, did an assessment, and believed the guy to be OK. (Although I don't know how they'd come to that conclusion if he had pulmonary edema and an abnormal heart rhythm!!!)

    Another concern I'd have is the patient outcome. Would his condition have been significantly changed by earlier intervention? Was emergency transfer avoidable? (probably not, by the way). However, if the patient should expire, and the wife remembers that she was trying hard to get someone's attention . . . it is possible that this could end up in court. So, like sjoe said, document for your own records.

    I also suspect that you are unsure of yourself so you didn't press the issue when "the nurse" said he didn't need to be suctioned when you felt that he did. In the future, you need to get more insistent. Say something like, "Please come assess Mr. So-S0 now. I believe he is in distress." You say it that way because you did not do an assessment, so you really didn't KNOW he needed to be suctioned. You arrived at a conclusion before you had all the facts. That's OK, I'm just wanting you to develop critical thinking skills, too! You report what you actually see and hear, not your conclusion. So, report to the charge nurse that Pt. is cold, nonresponsive, audible wet labored respirations, family member at bedside is upset, etc. Report what you see and hear, not your conclusion.

    After you report that, your responsibility ends. If the nurse won't go assess the pt., you can ask him/her why or what her rationale is for not seeing the pt. That will also give you an opportunity to report to her in more detail why you believe the pt. is in distress and needs immediate attention.

    I think part of the problem here was a communication problem. Some of the suggestions above might help eliminate those. However, if there were true negligence, then, yes, it needs to be reported as high up the chain of command as you need to go to have the problem dealt with. But, again, once you report it, your responsibility ends.

    I'm so glad to see someone who is caring and concerned about your patients! You're going to be a great nurse! Love your avatar, too!

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