night shift not calling critical lab values

  1. 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.
    Last edit by burn out on Feb 4, '07
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  2. 20 Comments

  3. by   manna
    I wouldn't feel too badly about it... if your manager said this is not the first problem they've had with her - that's not your fault.

    Our policy/PI is that critical labs must be called to the MD within 30 minutes of release from lab (lab must also call them to the RN).
  4. by   burn out
    I've got to get ready for work now and go face her again..for another round. Darn I should have called in sick but I was to busy on allnurses.com. Wish me luck.
  5. by   Tweety
    Do not feel bad. You reported a potentially dangerous situation up the chain of command. What happens after that isn't your concern, but management.

    You did not get her fired. She got herself fired by getting numerous complaints. Be thankful she didn't kill someone with her poor judgement.

    The manager was wrong for telling you she was going to fire this person.

    Good job.
    Last edit by Tweety on Feb 4, '07
  6. by   grammyr
    She would get fired at my facility based soley on the fact that she failed to follow a very important policy. Lab has 15 minutes to nofity us of critical values and we have 15 minutes to notify MD. This is changing to 30 minutes for us to notify MD shortly. Don't feel bad for her, she knew better and if she didn't know better there is a whole lot more wrong than her just not calling MD.

    I would be worried that the manager might talk about me to another nurse also.
  7. by   GardenDove
    Wow, that was totally irresponsible and that nurse sounds incompetant. I will call the doc for much smaller things than that! Isn't that the whole point of having labs drawn? And what about the BP? That's ridiculous.
  8. by   glasgow3
    Although I may not have "liked" a couple of those lab values, I'd have been much more concerned that she didn't call when the patient couldn't maintain a blood pressure >90.

    I wouldn't feel too badly. This person was not merely having a bad night---she's clueless.

    R
  9. by   nj1grlcrus
    Quote from burn out

    she has had a lot of complaints about her and she wasn't working out.
    This is why she is getting fired, not becuase of you, do you really want her taking care of patients, if things like this happen on a regular basis? Don't second guess yourself, your actions were correct, and the patient is better for it, just think what could of happened if you didn't come in, and this nurse cared for this patient for another shift.
  10. by   UM Review RN
    Quote from glasgow3
    Although I may not have "liked" a couple of those lab values, I'd have been much more concerned that she didn't call when the patient couldn't maintain a blood pressure >90.

    I wouldn't feel too badly. This person was not merely having a bad night---she's clueless.

    R

    I agree with glasgow. Also with whoever said that your manager really shouldn't have discussed this nurse's employment status with you.

    I've uncovered some doozies of mistakes, some really dangerous, but to my knowledge, no one's actually been fired over them.
  11. by   GardenDove
    I agree about that, the manager was not being very discreet to share that (that she was firing the nurse) with the OP. I'm pretty chummy with my manager, but she never would have crossed that line.
  12. by   burn out
    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?
  13. by   jill48
    Not your fault. Period. What is more important, your patient's safety or the other nurse's feelings? You did what needed to be done, and after that it was all up to the manager about what to do with that information.
  14. by   kate1114
    Quote from burn out
    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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