thank you for reading, I will try to make this as short as possible.
1) started my noc shift; pm shift nurse told me about this non-compliant pt about her blood sugar being 400, and that she administered 10 units of regular insulin. husband's patient walks up and asks me to check on her because she is feeling sick, pm nurse still on the clock. pt has low BP with high pulse pressure, i think of checking her blood sugar, it's 591!! i thought i was gonna collapse. the pm nurse was supposed to call MD if blood sugar is more than 400, but she didn't. also, within 3 hours, her BS was down to 300, in the morning it was already 130. did she lie about only administering 10 units? was I supposed to call MD? what if the pt died on my shift because i believed that her bs was under control? this pt has a hx of liver disease, chronic renal (dialysis) and DM. this high blood sugar was after she went out with a pass and went to a buffet. isn't she liability???
2) that nurse also had an unwitnessed fall and never started her neuro checks; i did and charted it, i couldn't call MD or ask for X-rays at night time...
3) LVN's at night do their hair, nails and make-up at the nurse's station. not only highly unprofessional, but they are getting paid to do something else. one of them hangs out in anempty patient's room the whole night shift while I am STILL orienting and could be learning from someone for a change!!! the whole management is crazy over state coming in right now! idk what to do!
1. I would have called the MD and informed of the 591 and the time other nurse gave the insulin. Also- I'd let him know the pt was non-compliant with her diet.
2. Document the non-compliance and that MD was made aware.
3. You can ALWAYS call MD at any hour. It's a 24 hour nursing facility. Cover yourself and protect your patient! If you think something's broken- it can't wait until morning. I've never been yelled at for calling at night for a real reason like this. (Plus, who cares if they yell- they don't really KNOW you and they get into this business knowing it involves late night phone calls
4. Is the DON aware of the business going on at the nurse's station at night? That would NEVER fly in my LTC and you shouldn't have to work amongst such slackers. Horrible! We are wayyy too busy even at night to be hiding in rooms or thinking of doing out hair at the NS!
5. Even though the other nurse failed to initiate neuro checks, you're responsible for the pt now. You should have initated them. Two wrongs don't make a right. You are responsible for evaulating your patients and to keep an eye on the ones with potential for a change in condition. Post fall assessments are integral and neuro's are included to monitor for a change in condition. Of course, let your unit manager know in the morning that they were initiated late so she can follow up with the prior nurse and understand what happened. CYA, CYA, CYA!
I worked nights for 3 years in a rehab/LTC. I've followed more than one nurse who were slack on documentation and who have had falls and did not notify MD. When the pt begins to c/o pain on my shift, I have to call the MD in the middle of the night to request an Xray. There have been two instances where fractures have actually been the result of these falls and I'm SO glad I called. Don't let it wait until morning when it shouldn't. We night shifters are nurse's too! Not everything needs to be passed on to day shift
Trust me, as a day shifter now, we appreciate it!
Last edit by Cat_LPN on May 30, '12
first of all, thank you all for taking your time and writing all of this, this really helps me understand my responsibilities more. I was not trying to push the blame on the other nurse, but it was scary to deal with everything. i thought that in a perfect world, the older nurse wouldn't leave such a load on a person still orienting; it did make me frustrated and I realize that real life is different. and honestly, i didn't even realize she never called the MD.
She gave me report of blood sugar of 400, but I later discovered that on the 24-hr nursing report she wrote down "in the 500's"....I should've been more precise. I discovered the 24-hr nursing report after I decided to check her blood sugar. I "assumed" she lied because the other nurse that was orienting me told me that I shouldn't trust the other nurse, that this wasn't the first time she did that etc. she also told me to wait it out and see what happens, and so I, zero critical thinking, did.the blood sugar went down to 300 within the next two-three hours I believe.
Last edit by Linka on Jun 1, '12