lost my license, my self-esteem, confidence and respect all in one shift

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    this man comes in from the hosp. to our ltc. he is end stage everything you can think of and in pretty bad shape. when the hosp. called in report, they told me he was a brittle diabetic...boy were they ever telling the truth! she tells me his bg's were in the 40s but some dextrose did the trick and now it's in th 90s. when he gets here, its in the bloody twenties!!! protocol glucagon and 1hr later, it dipping instead of climbing and this man is still responsive. he's DNR but the dang thing is not signed by family but the doc has written it 2wice in the admission orders for good measure. did I mention he also orders the man not be sent back to hosp???? call the family and yeah the doc discussed the dnr thing with them and they agreed, but that dang paper is not gonna sign itself and they can not come to the facility coz they are busy tonight. so is the man to be coded or not if need be??? and what the heck is the protocol for glucagon anyways?? it just says give so many mgs IM,,,doesn't say repeat times what if ineffective. Oh yeah,, we have a super, but she's trying to cover 3 nurse call ins for tonite and cover a floor. did I mention the admission orders WERE verified with the on call and he knows the family hasn't signed, and now he says what do you mean you don't have the documents?? another glucagon shot later and the bgs climb to 36 yeepie!! and oh yeah its end of shift and someone has to start a dextrose IV (not me,,not certified) and the oncoming nurse doesn't wanna hear report you are not leaving me with a dying man, she says, am going home. Oh yeah?? You and me both. what the heck do you think your job is???? And then we are told to call family and get a verbal order from them to put in the dnr form so that it can be official. is that even legal, isn't that forging someone's signature? what if the man dies and the family decides they did not authorize a dnr after all?? I know,, am rambling, but that's how my mind is working right now. how the heck do u accept an admit knowing full well he needs to still be in the hosp,,,then all the big kahunas go home for their long weekend and am left to deal with the crap!! Then to top it all off, the noc cna assigned 2 that station comes in 1hr late and wants to know why this man is laying on hosp issue linen. ain't nobody touched this man all night, she says. the man is not wet (probably can't **** and needs a foley) or soiled, she just doesnt want to have 2 do anything 2nite. So while she's still b>>>>ing I walk to the time clock and clock out then ask her do u want us 2 save the man or worry about what color linen he's laying on? I am calling in on monday and putting in ma notice on teusday and hopefully the state will not come after me. What do people do if they lose their license??? happy memorial day y'all.
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  4. 17 Comments so far...

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    You didn't lose your license.

    You didn't lose your self-esteem.

    You had a ding but didn't lose your confidence.

    and You didn't lose your respect.

    Bad shifts happen.

    They do.

    And it was evident that you were being asked to be a hospice nurse: make him comfortable. The orders COULD have been clarified. But pts come before paperwork. A call to the family and a telephone order WOULD have been ok until the paperwork could be corrected. You did have a dr's order to back you up.

    Those kinds of shifts happen.

    Take a deep breath.

    ~faith,
    Timothy.
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    Situations like that is why I quit working that part time job in LTC.
    They bring in patients who are too unstable for an LPN to take care of.
    They are practically dead when they get there.

    Why do nursing homes accept someone in this condition??

    I just don't understand these situations. The patient is right at death's door,
    you don't have a signed DNR, but the administrator accepts them anyway.
    Do they not think of the liability this can create?
    The patient would not be there if the administrator had not okayed it. Then you have to deal with this.
    That's what burns me up.

    IMHO, it's too much of a risk to work in a nursing home these days.
    Last edit by LPN1974 on May 27, '06
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    Why do you think you lost your license? Did you clock out before your shift was over? Because otherwise I don't see what you did wrong.
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    That is absolutely ridiculous and unacceptable that that patient was sent back to a LTC facility. I can't understand why.

    And I too cannot understand what exactly it was that you did wrong.
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    Document, document, document! I can't say this enough. A nurses best back up in case of legal action is her documentation. I would have taken some time at the end of the shift and document everything that happened all phone calls and docors orders recieved in the pts nurses notes and be sure to be factual with no blame placing ( thats the hard part). You did all the right things if the pt had died you did have a legal DNR because it was in the doctors orders and a verbal from the family would have sufficed fine as long as you document the person time etc that the verbal was recieved. obviously the family was not that concerned about their loved one surviving if they were too busy to come in for a few minutes to sign papers. Take a deep breath and remember to document everything! You can even go back and make an ammendment to your notes the next day as long as you note the date and time that you are currently writing them and that it an addition to the previous days nurses notes. I think it is very poor that a nurse coming on would leave her shift because a pt may die. You work in LTC, ltc pts die all the time. she sounds like she's in the wrong profession. not to mention that she could face repercussions for pt abandonment. But no matter what happens in a case like this or any time you feel like things are out of control, document everything you do. My nursing instructors pounded it in to our heads that if its not on paper it wasn't done according to the law. best of luck.
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    Quote from ahsitters
    Document, document, document! I can't say this enough. A nurses best back up in case of legal action is her documentation. I would have taken some time at the end of the shift and document everything that happened all phone calls and docors orders recieved in the pts nurses notes and be sure to be factual with no blame placing ( thats the hard part). You did all the right things if the pt had died you did have a legal DNR because it was in the doctors orders and a verbal from the family would have sufficed fine as long as you document the person time etc that the verbal was recieved. obviously the family was not that concerned about their loved one surviving if they were too busy to come in for a few minutes to sign papers. Take a deep breath and remember to document everything! You can even go back and make an ammendment to your notes the next day as long as you note the date and time that you are currently writing them and that it an addition to the previous days nurses notes. I think it is very poor that a nurse coming on would leave her shift because a pt may die. You work in LTC, ltc pts die all the time. she sounds like she's in the wrong profession. not to mention that she could face repercussions for pt abandonment. But no matter what happens in a case like this or any time you feel like things are out of control, document everything you do. My nursing instructors pounded it in to our heads that if its not on paper it wasn't done according to the law. best of luck.

    I agree that documentation is the best defense.
    But what makes situations like this so hard is that this is not the only patient this nurse had to take care of, and she had many other duties to do also, and probably a med pass to do.
    I realize tho, that this patient is severely ill and must be taken care of.....
    but how does a nurse do all that she must do when she's the only one there to do it?
    How can she babysit this patient and do accuchecks every 15 minutes and stay at his bedside and keep giving him glucagon and still get her meds passed?
    {I'm assuming she had a med pass to do.....I did when I was in LTC, and a situation very similiar to hers happened to me also. It was horrible, and that's why I quit that job. I had and still do have my regular fulltime job.}
    When I was in that situation, I called my administrator, my DON, and got NO help. The only help I had that night was another LPN....just the two of us, and she had to also let go some of her work to help me.
    That patient we got eqarlier that day was "dumped" on us. I was told by other people, INCLUDING an attorney, that he was dumped on us, because several other nursing homes refused him, and the one I was in that night is the only one that would take him. And he was dumped on us in a nearly dead condition, and he did die, and now the wife, who never showed up that night to see about her husband is suing the nursing home.
    He was dumped and was nearly dead when we got him, but the nursing home is the one getting sued. Not the VA who discharged him, or even the ambulance crew....who conveniently lost their papers that night, and where the patinet coded in the ambulance that night, and was STILL brought on to the nursing home.
    I will never go back to LTC, even if I have to pick corn with the chickens.
    Last edit by LPN1974 on May 27, '06
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    Yikes....what a situation. As long as you gave report, counted and passed the keys to the other nurse.. you are okay. If you aren't getting any info from the doc on call I would call the medical director. I'd also pester the hell out of the ADM and DON. You could have gotten a verbal DNR with the family and had another nurse witness/ listen to it. Documentation is your friend in this case.
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    Quote from RealNurseWitch
    That is absolutely ridiculous and unacceptable that that patient was sent back to a LTC facility. I can't understand why.

    And I too cannot understand what exactly it was that you did wrong.
    LTC facilities are often just dumping grounds/wastelands for the old and unwanted. We can try to sugar coat it but that is the bottom line.
    It's sad but what can a person do? We just have to accept that we cannot always be guaranteed everything/person will fit neatly in a labled category. I'm sorry about your trouble. I blame the legal system. You did the best you knew to do with the judgement you knew to use.


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