Please share some of your stories about near misses, accurate assessments, and care provided that made you as a nurse shine to the whole team!
This week on our cardiac surgical ICU, I caught a 3/6 systolic friction rub in a heart transplant (post-op day 15) patient that 2 *residents* had missed. It totally changed the course of treatment, and was lauded...imagine that, a nurse got credit from the attending!
Let's hear your *POSITIVE* stories about how nurses know their stuff!
Yeah, I'm not really sure that telling a physician a patient is going to die followed by the patient's death is really a "booyah moment".
I understand what you're saying here, absolutely.
In the story I relayed, it wasn't the pt's dx and subsequent ICU stay that was by any means a "boo-yah" moment. It was knowing I had the assessment skills and instinct to recognize the problem, when so many times, if something goes wrong with a pt, you find yourself wondering, "was there something I missed?", even if there wasn't. I think that's the point.
Specializes in Clinical Research, Outpt Women's Health.
I understand what you're saying here, absolutely.
In the story I relayed, it wasn't the pt's dx and subsequent ICU stay that was by any means a "boo-yah" moment. It was knowing I had the assessment skills and instinct to recognize the problem, when so many times, if something goes wrong with a pt, you find yourself wondering, "was there something I missed?", even if there wasn't. I think that's the point.
Darn. Your calm and reasonable response ruined all the fun! :smokin::smokin::smokin:
Specializes in LTC, Camp Nurse, Private Duty Nursing.
As charge nurse, I was called down to assess a pt. who was diaphoretic. The LPN and I both knew she needed to be sent to the hospital, though her VS's, BS's were ok. She had a recent fall, x-rays were ok. We thought something was broken and she was bleeding internally. We rechecked her apical and radial pulse, came up with a 20pt defecit. The on-call agreed and the LPN called the rescue squad stat. (It's a 25 mile drive to the hospital) As the rescue squad was loading our pt. on the guerney and wondering why we called them stat, she started throwing up blood. We were glad we did a thorough assessment and convinced the MD.
Specializes in Trauma Surgery, Nursing Management.
In the OR, working on a little old lady with a hip fx, comorbidities, H&H in the toilet. Doing a Gamma Nail. New anesthesia resident. Clueless anesthesia attending. Surgeons are starting to ream out the femur...I hear the HR monitor going steadily faster...and faster. The surgeons are not paying attention to the monitor, they continue to ream. I look over at the monitor. What do you think I saw? Oh yeah-"Hello V-Tach!" So I alert the surgeons to stop reaming. The new resident is fumbling around like a fish out of water. I immediately page the anesthesia attending-doesn't show up. I am helping the anesthesia resident draw up meds, got the crash cart, starting putting on the pads. The surgical attending stops me and says, "This is not part of your job. You are the circulator. You are supposed to help the SURGEONS. You need to stop being so controlling." I just looked at him and kept going. The anesthesia attending still has not shown up. I go out into the hallway and snag the cardiac anesthesiologist. She immediately takes over and we shock the pt into a normal rhythm. The cardiac anesthesiologist says to me in a loud voice, "You picked up on the v-tach in time, and your swift actions directly impacted the outcome of this patient. Thanks girl!" Wow. I sent a steely look to the surgical attending. He never said a word to me then and still has not. Oh, and the anesthesia attending that was supposed to be covering the room showed up 10 minutes later.
I had a lady once who was admitted for something related to renal failure and HTN (it's been a while, I've slept since then). Her BPs had been running pretty good by the time I got her and she was due to be dc'ed home the next day. Well......for some dang reason her BP spiked to 184/102 and she had a headache...Ok Tylenol covered the H/A and let's see what you got for the BP...
What the screw? They dc'ed the prn clonidine...crap.
So @ 0200 I paged the on call Doc (I should mention this on call Doc was...how to say it nicely...a jackass). First the SOB (and I don't mean short of breath) hangs up on me. Naive me thinks that the phone just got "accidently" dc'ed. He calls back and doesn't even let me explain, just says "Don't worry about it, just let it go" and hung up again.
At this point I said some words that a saved man shouldn't say and related my story to my co-workers... What to do...
Call the consult!
Hello Mr Nephrologist? Hey man, sry to way you up but I can't get a hold of the primary and I need something.
Got her BP down, headache resolved, and everyone felt better...She didn't even have to find out what a *cough* the on call doc was.
My favorite save would have to be when I was still a nursing student: Patient was just back from the cath lab, so we were doing Q15 minute vitals. BP is going down, not a whole lot, but enough to make it a little suspicious. Then the patient starts complaining of abdominal pain. I told the primary RN, who said she would call the NP "in a minute". In the meantime, BP is dropping more, and patient's daughter is getting nervous. I went to the charge nurse, who looked at the vitals, and called the rapid response team. Patient went to CT, found a retro- peritoneal bleed. Patient was transferred to CCU. BOOYAH!
Oh yeah-"Hello V-Tach!" So I alert the surgeons to stop reaming. The new resident is fumbling around like a fish out of water. I immediately page the anesthesia attending-doesn't show up. I am helping the anesthesia resident draw up meds, got the crash cart, starting putting on the pads. The surgical attending stops me and says, "This is not part of your job. You are the circulator. You are supposed to help the SURGEONS. You need to stop being so controlling." I just looked at him and kept going. The anesthesia attending still has not shown up. I go out into the hallway and snag the cardiac anesthesiologist. She immediately takes over and we shock the pt into a normal rhythm. The cardiac anesthesiologist says to me in a loud voice, "You picked up on the v-tach in time, and your swift actions directly impacted the outcome of this patient. Thanks girl!"
That is a real life "there is a fracture, I need to fix it" story.
I think my best "save" so far was a walk-in patient who came to clinic c/o dizziness.
She had a long hx of dizziness and had been dx'd with "low autonomic tone" by cardiology. I asked her all the standard dizziness work-up questions and she gave me nonsense answers. She basically said yes to everything (not very health literate). She couldn't answer me why she had come in with this today, when this was usually a chronic c/o for her. Her vitals were WNL. She wasn't orthostatic. I was perplexed.
Then I took a minute to look back in the chart. She was being treated with Ribavirin for Hep C. About a month ago, her Hep C provider had noticed some mild anemia and told her to decrease the dose.
I asked the patient if she had decreased the dose. She didn't know what I was talking about.
Did a STAT H&H - Hgb of 4.3, admitted her for transfusion.
I was working telephone triage for a children's hospital and took a call from some worried parents one night. The baby was 3 weeks old and "just not acting right." It was taking the bottle *okay* but not as well as before. It was sleeping more than before and crying differently than before. No coughing or congestion, no vomiting or fever. Nothing that just jumped out at me. The parents were totally focused on the feedings. Then the baby started crying and the mom picked the baby up while we were talking. I heard a barely perceptible wheeze. One wheeze. I couldn't really tell what was going on, but the parents were panicking and I had that weird feeling--you know, a 6th sense that something is VERY wrong. So I told them to take the baby to the ER for evaluation.
Two hours later I got a call from an outlying ER...
As they drove up to the ER door, the baby ARRESTED. The parents were screaming, the dad as frantically doing CPR, the nurses grabbed the baby and whisked it to trauma. Turns out that baby had a major, undetected heart defect! Within minutes they life-flighted the baby to the children's hospital and had it on the operating table 10 minutes later. Saved that baby's life.
My favorite save would have to be when I was still a nursing student: Patient was just back from the cath lab, so we were doing Q15 minute vitals. BP is going down, not a whole lot, but enough to make it a little suspicious. Then the patient starts complaining of abdominal pain. I told the primary RN, who said she would call the NP "in a minute". In the meantime, BP is dropping more, and patient's daughter is getting nervous. I went to the charge nurse, who looked at the vitals, and called the rapid response team. Patient went to CT, found a retro- peritoneal bleed. Patient was transferred to CCU. BOOYAH!
I was on the recieving end of something similar once. In the ICU, the IMC calls for a guys post-cath that had fallen earlier. No c/o at the time, just a little lightheaded when up for the first time. About 4 hours later, get a frantic call that they are bring the patient over with a BP in the toliet.
Patient arrives and we start all the right meds for low BP with no response. Looking at the patient's back there is this "bruise" from where the patient fell earlier. HUGE bruise. I call the on-call for a stat H&H to no avail. Talk to the house supervisor who tells me to get it anyway. I do....6 and 20! Call the on-call and report the results, got the order for transfusion. CT the next morning shows retro bleeding.
Got wrote up for the effort, but an attagirl from the ICU manager behind closed doors.
:smokin:
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The parents were screaming, the dad as frantically doing CPR, the nurses grabbed the baby and whisked it to trauma. Turns out that baby had a major, undetected heart defect! Within minutes they life-flighted the baby to the children's hospital and had it on the operating table 10 minutes later. Saved that baby's life.
cherrybreeze, ADN, RN
1,405 Posts
I understand what you're saying here, absolutely.
In the story I relayed, it wasn't the pt's dx and subsequent ICU stay that was by any means a "boo-yah" moment. It was knowing I had the assessment skills and instinct to recognize the problem, when so many times, if something goes wrong with a pt, you find yourself wondering, "was there something I missed?", even if there wasn't. I think that's the point.