night shift not calling critical lab values

Nurses General Nursing

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OMG I think I got someone fired. Picture this.. Yesterday I went in at 7 am and the patient severe copd with MI on heparin now with acitve GI bleed.

Am lab and gases showed ph of 7.20 co2 68 po2 131 sat 93, hgb 9.5 (which has been trending down now at 9.5 a 2 gram drop in 12 hours) Pt was in trendelenburg because that was the only way they kept the blood presuure above 90 the ng tube had no bloody drainage becasue it was hooked up backward and when propperly connected began draining mod. amt fresh bloody drainage. So after jumping on the phone calling all the doctors, giving fluid boluses, tcxm blood and given 2 units, bedside EGD,

vent changes, stopping the heparin and starting antibiotics (WBC 24) I was quite tired and angry that night shift waited for me to call the lab results and vented to my boss. Well it has ended up that she is nw going to fire the night shift nurse becasue she said she has had a lot of complaints about her and she wasn't working out. Now I am guilt ridden because I didn't mean to get her fired I just wanted the lab work called and not left holding the bag all the time. Was I wrong and did I over react?

Her reasoning for not calling the abg was "Resp. said the rate on the vent just needed to be increased" Dah..you need an order. I was waiting until the hgb dropped below 9(we are not even type and crossed)but I did get the blood consent signed. I didn't even ask about the blood pressure.

Specializes in NICU, PICU, MNICU.
Well I faced her at work and at first had a hard time looking her in the eye knowing she was going to get fired but then she made the comment "He is going to die anyway" and I glared at her...I am glad she is getting canned.

How can anyone be so callous and call themselves a nurse?

Wow... I'd be glad that she's gone, too!!! There were so many major mistakes, and you did the unit and the patients a service by reporting her errors. The manager was out of line letting you know about her getting fired. I'm glad that the patient had someone careful and competent to take over care on the following shift. I doubt that person would have survived a second incompetent shift.

Also, as a night shift nurse, I've never understood why people DON'T call for things like labs, crappy blood pressure, etc. To me it makes my life easier getting interventions done when a problem starts rather than waiting for the magical nursing fairy to come take the problem away ;)

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Wow... I'd be glad that she's gone, too!!! There were so many major mistakes, and you did the unit and the patients a service by reporting her errors. The manager was out of line letting you know about her getting fired. I'm glad that the patient had someone careful and competent to take over care on the following shift. I doubt that person would have survived a second incompetent shift.

Also, as a night shift nurse, I've never understood why people DON'T call for things like labs, crappy blood pressure, etc. To me it makes my life easier getting interventions done when a problem starts rather than waiting for the magical nursing fairy to come take the problem away ;)

I could understand them not calling ..maybe..if they were busy, if there was a code on the unit but most of the time they are sitting talking and "not wanting to bother the patients...let them sleep. My God this is ICU how do you assess them if you don't wake them up, how do you know they are ok?

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:argue: In our facility, lab makes rounds about 0430, and if we have critical labs, they have to be called to the MD (remember, it's only ABOUT 0515) within 30 min BY THE NURSE WHO TOOK THE LAB VALUE. If I answer the phone and be a good joe and take the lab value for the other nurse who is elbow deep in it, OUR policy states that I have to call the MD with that value.:uhoh3: My problem with this is that, 1) I don't know this patient like the primary nurse does, and 2) when the MD asks me 50 questions about this patient, all I can say is "Sorry sir, not my patient, I don't have a clue". :chair: Does anyone know how mad the MD will be? Take it from one who DOES know, VERRRRRRRRRRRRY PISSED!!!!!!!!!!!!!!!!!!

We are tring to get this policy changed, and until they do, several of us refuse to take a "PANIC" value, which then pisses the lab off. Oh well, can't win 'em all! ' RN

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There are so many things wrong with the clinical situation you described that I would have been very angry with the nurse. There was a combination of things going on here that the nurse did not recognize.

This sound like one of those "What's wrong with this situation puzzles." BP and lab work both dropping, suction on NG hooked up wrong, vented patient in T-berg, ABG results way out of range without concern or appropriate action. Yikes, sounds like this nurse either doesn't understand her job or doen't know any better. Either way I don't think I would want her taking care of critical patients.

Don't beat yourself up. You are looking our for her and the patients.

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Well I faced her at work and at first had a hard time looking her in the eye knowing she was going to get fired but then she made the comment "He is going to die anyway" and I glared at her...I am glad she is getting canned.

How can anyone be so callous and call themselves a nurse?

That nurse sounds like a real piece of work.:trout: And..you didn't get her fired, she accomplished that all on her own.

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No don't feel bad, this is part of the factor in "nurses eating their young". Most preceptors are hard on new nurse to try to prevent such issues. If this nurse was dangerous before you got that pt. then it should have been caught and delt with a long time ago. You did the correct thing. After all it could be one our loved ones she's taking care of next.

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:confused: I'm not being a smart aleck here- how can you hook up suction to an NGT backwards? Are you saying suction was connected to the blue port and the antireflux valve was connected to the clear port? And nobody noticed for 12 hours...that would be a first in my 11 years of nursing. Glad the pt survived that night and hope he is better.:smilecoffeecup:
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:confused: I'm not being a smart aleck here- how can you hook up suction to an NGT backwards? Are you saying suction was connected to the blue port and the antireflux valve was connected to the clear port? And nobody noticed for 12 hours...that would be a first in my 11 years of nursing. Glad the pt survived that night and hope he is better.:smilecoffeecup:

Ng tube hooked up backwards = patient tubing connected to vaccum port on cannister, vaccum tube connected to patient port on cannister - does not work.

The patient lasted two more days then the family had him taken off the vent and he died.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Do not feel badly. Sounds like this is a problem with this particular nurse. The next situation could result in a very, very bad outcome. Best it not happen again. The manager made the decision to fire her, based on the facts presented to him/her. You can't blame yourself. You had every right to be very upset and unnerved by this nurse's inaction and callousness. I would not want this person caring for me or my loved ones. Think of it like that and let yourself OFF THE HOOK for good.

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