Sweating The Small Stuff - page 2

As my remaining months in the hospital comes to a close (for my 2-year work experience goal), a few disturbing happenings occurred during my hospital duties. The following are the scenarios in which the consultants SWEAT THE... Read More

  1. 1
    About Scenario 1, I'm not clear on what you meant when you said you gave the extra 0.5 later on the ward. Saying "It's just prophylaxis" and "the patient is well-off" isn't any kind of an excuse.

    In scenario 2, it would have been inappropriate to give the prescription to anyone but the patient; it would have been much more appropriate to send it to the pharmacy directly. I don't see any reason to call this an unfair circumstance or turf your responsibility to God.

    In scenario 3, I have a hard time following your narrative, but if it was your responsibility to deliver a message but someone else did because you were "busy with other stuff" -- really? And your speculations about the physician keeping people in the hospital for reimbursement, it doesn't matter because the pt has an HMO, and all that about private ward and such-- nothing to do with anything.

    I am aware that you are very new at this and you are in a different culture and English is not your first language. However I find your lack of interest in taking any responsibility or understanding underlying issues to be troubling. You will not do well in the US (if you get here) if this does not change.
    CosmicHymns likes this.

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  2. 0
    Quote from Calabria
    Regarding scenario one, if the doctor wrote the order in accordance with standards set by the Joint Commission, she would've written it as "1 gram" instead of "1.0 grams", if that's what she really wanted. Adding ".0" leads to increased risk of error.
    Indeed! Another doctor told me the same when I showed him the doctor's order!
  3. 0
    I respect your opinion GrnTea but by just trying to put yourself in my situation, you will later realize that these things aren't a big issue at all and just PETTY stuff. That's my POINT.


    Quote from GrnTea
    About Scenario 1, I'm not clear on what you meant when you said you gave the extra 0.5 later on the ward. Saying "It's just prophylaxis" and "the patient is well-off" isn't any kind of an excuse.


    Sorry for missing out the detail. But I mixed 2 vials of Cefazovit with 1 gram of dosage per vial. I took 1.5 grams. So .5 grams of Cefazovit remains in the other vial, which the Anesthesiologist, told me to just push the remaining .5 grams later in the ward. It's not an excuse actually. My point is, it's not a BIG ISSUE. And it's not my FAULT. Again READ the article.


    Quote from GrnTea
    In scenario 2, it would have been inappropriate to give the prescription to anyone but the patient; it would have been much more appropriate to send it to the pharmacy directly. I don't see any reason to call this an unfair circumstance or turf your responsibility to God.

    In our hospital, Patients have the choice where to BUY their medications, either in the Pharmacy or outside for them to lessen their financial burdens since medications in the hospital are very expensive. READ my article again why I gave it to the interpreter.


    Quote from GrnTea
    In scenario 3, I have a hard time following your narrative, but if it was your responsibility to deliver a message but someone else did because you were "busy with other stuff" -- really? And your speculations about the physician keeping people in the hospital for reimbursement, it doesn't matter because the pt has an HMO, and all that about private ward and such-- nothing to do with anything.

    It isn't my responsibility to deliver the message to the OR since my other RN partner was responsible with that surgeon's patient. Regarding the HMO, it does since the HMO would anyway pay for the patient's additional stay in the hospital since the EGD was cancelled.


    Quote from GrnTea
    I am aware that you are very new at this and you are in a different culture and English is not your first language. However I find your lack of interest in taking any responsibility or understanding underlying issues to be troubling. You will not do well in the US (if you get here) if this does not change.
    I again respect your opinion. English may not be my first language but I'm trying my very best to improve in this language. FYI, I took RESPONSIBILITY with all of these issues. I FACED the DOCTORS and EXPLAINED MY SIDE. Have you really read my article? I'm just bursting out my side through this article and I'm thankful to all those understood me.

    Are you telling me I won't make it in the US? Sorry to say but I had patients who were British, American and other nationalities who gave POSITIVE FEEDBACK regarding our SERVICE. So I really doubt your hasty generalization.
  4. 2
    Quote from cool_nurse
    As my remaining months in the hospital comes to a close (for my 2-year work experience goal), a few disturbing happenings occurred during my hospital duties. The following are the scenarios in which the consultants SWEAT THE SMALL STUFF.

    Scenario 1 (July 2013)

    A 39-week pregnant mother was scheduled for CS or Caesarian Section at 4 am in the morning. Yes, it was 4 am since the morning OR theater rooms are filled for the morning's schedule. This OB-Gyne wrote a prophylaxis medication of Cefazovit1.5 gms IV 1 hour prior to OR. This prewritten order was brought by the pregnant woman upon the arrival at ER. Then, it was endorsed at the pm shift and this was endorsed to us since we were the nightshirt that time. To cut the story short, I carried out the doctor's order and endorsed it to the OR nurse after reading the order per line. After an hour, the nurse supervisor called me and asked me why I gave 1.5 grams where in fact it was only 1.0 grams that was ordered. The OB-Gyne was angry inside the Delivery Room. I came inside the OR to explain my side and she told me (while yelling and getting angry) that I better read orders before injecting medications. The fact is, almost 5 nurses saw the order of the doctor from ER up to the OR as well as the nursing supervisor who double-checks special procedures that would occur in the hospital. Also, the number apparently looks .5 since it was superimposed with double strokes over zero as far as we can remember. I don't know if it was a matter of misunderstanding but everyone was at my side including the Chief Nurse who saw the order as well. It really looked like a .5 superimposed over zero. But to think of it, it's not actually a stuff to sweat about if it we're really just 1 gram. Besides, it was just a prophylaxis and the patient is well-off, kind and not demanding. The anesthesiologist even told the OB-Gyne to just brush it off and I just give the remaining .5 to the patient at the ward. End of story.

    Scenario 2 (First week of August 2013)

    We had a Korean patient who was in an accident who can understand and speak little English. The surgeon who was at deck that time was known to be a demanding and greedy one. During the morning rounds, he met with the patient together with her Korean interpreter who was quite demanding as well. To cut the story short, I gave the prescription to the interpreter for the medications that would be used and she would just to pick that up in the Pharmacy. After 30 minutes, I received a call and this surgeon was yelling at me, asking why I gave them the prescription and so on and so forth. His point was, there's a language barrier that might occur. I told him I gave it to the interpreter and not directly to the patient's husband who was Korean as well. In short, the surgeon wants us nurses, to get the medications directly to the pharmacy, which isn't our responsibility by the way. Since we are kind nurses, I just accepted so no further arguments would follow. Why there's a need to yell and be angry where in fact the surgeon was asking for a favor at the same time? One of my worst days.

    Scenario 3 (Last week of August 2013)

    My favorite surgeon from scenario 2 had a patient again who was scheduled for EGD. My partner carried out his orders and brought the notification to the operating room at around 10 am. To cut the story short, the surgeon got angry because he was notified at 3.30 pm that the scope was defective. It was an honest mistake of the OR nurses but what they did was to scapegoat and put the blame on us ward nurses by saying that we brought the notification at 3.30 pm. The surgeon called me at the phone and for the second time, yelled at me, telling me the patient should have been discharged already before the cut-off at 1 pm. At first I didn't know, what time my partner brought the notification to the OR since I was busy doing other stuff. But then, the nursing supervisor called my partner and she told the supervisor that the midwife brought the notification at around 10 am. The truth is, again, it seems to be not a big deal at all since this surgeon is always known to always extend the patient's admission to charge bigger professional fees based from first-hand experience from us nurses. At the phone, he was like a Saint acting like a patient's advocate who wants to discharge the patient ASAP. Second, the patient has an HMO who really don't care about their hospital charges. Our ward by the way is a private ward with a few semi-private rooms. Another non-sense duty.

    These were one of my major hurtful circumstances at the hospital which made a stronger nurse by the way. I think God wants to teach me things that I need for the future:

    A)__ For me to be more patient with these kinds of situations
    B)__ For me to be more faithful that God is still working his way even at such inevitable and unfair circumstances
    C)__ For me to develop my Emotional Quotient
    D)__ And for me as well to NOT TO SWEAT THE SMALL STUFF as these are just also petty problems not to take seriously.
    Quote from GrnTea
    About Scenario 1, I'm not clear on what you meant when you said you gave the extra 0.5 later on the ward. Saying "It's just prophylaxis" and "the patient is well-off" isn't any kind of an excuse.

    In scenario 2, it would have been inappropriate to give the prescription to anyone but the patient; it would have been much more appropriate to send it to the pharmacy directly. I don't see any reason to call this an unfair circumstance or turf your responsibility to God.

    In scenario 3, I have a hard time following your narrative, but if it was your responsibility to deliver a message but someone else did because you were "busy with other stuff" -- really? And your speculations about the physician keeping people in the hospital for reimbursement, it doesn't matter because the pt has an HMO, and all that about private ward and such-- nothing to do with anything.

    I am aware that you are very new at this and you are in a different culture and English is not your first language. However I find your lack of interest in taking any responsibility or understanding underlying issues to be troubling. You will not do well in the US (if you get here) if this does not change.
    Quote from cool_nurse
    I respect your opinion GrnTea but by just trying to put yourself in my situation, you will later realize that these things aren't a big issue at all and just PETTY stuff. That's my POINT.



    Sorry for missing out the detail. But I mixed 2 vials of Cefazovit with 1 gram of dosage per vial. I took 1.5 grams. So .5 grams of Cefazovit remains in the other vial, which the Anesthesiologist, told me to just push the remaining .5 grams later in the ward. It's not an excuse actually. My point is, it's not a BIG ISSUE. And it's not my FAULT. Again READ the article.



    In our hospital, Patients have the choice where to BUY their medications, either in the Pharmacy or outside for them to lessen their financial burdens since medications in the hospital are very expensive. READ my article again why I gave it to the interpreter.



    It isn't my responsibility to deliver the message to the OR since my other RN partner was responsible with that surgeon's patient. Regarding the HMO, it does since the HMO would anyway pay for the patient's additional stay in the hospital since the EGD was cancelled.



    I again respect your opinion. English may not be my first language but I'm trying my very best to improve in this language. FYI, I took RESPONSIBILITY with all of these issues. I FACED the DOCTORS and EXPLAINED MY SIDE. Have you really read my article? I'm just bursting out my side through this article and I'm thankful to all those understood me.

    Are you telling me I won't make it in the US? Sorry to say but I had patients who were British, American and other nationalities who gave POSITIVE FEEDBACK regarding our SERVICE. So I really doubt your hasty generalization.
    I wanted to post the OP, GrnTea's response; and your response.

    In your OP, it seems as though you think that the incidents were, "small"; however in each incident, you may stated you took responsibility; however, still calling it "small" almost makes the risk that the next thing that may be "small" to you, may actually be HUGE.

    I think that's what GrnTea is getting at. In the US, where there are coming down on everything, including med errors as this one; the patient may have "no complications", but the wrong dose-not enough, could have predisposed the pt with a HAI; if the pt gets one, they don't look at the Dr.; the look to the nurse who GAVE it; Dr keeps job, nurse looking for one.

    At least in my area, interpreters never get the prescriptions. , so small perhaps, but again, in the US, we do the patient teaching and if needed, provide the prescriptions; again, with the CMS coming down on readmissions on certain chronic health issues; the responsibility of teaching and managing resources is part of our practice; you never know what specialty you may be working in the future if you practice here.

    I also wanted to point out in your response to GrnTea about "It is not my responsibility" because your coworker was "responsible" for your patient; yet were you aware of it??! If you were, communicating to your coworker and notifying the OR would've had a better outcome in the last scenario.

    One of things that is a pressing issue in our business is COMMUNICATION. The statements like "It is not my responsibility" are leading statements in med errors, near misses, and deaths in healthcare in the US. Making sure one is clear in orders, procedures, plans is a beneficial part of the Nurses's practice; anyone in contact with the patient bears some responsibility in the US; if something is missed, even if you helped the patient, best believe that they will question YOU if something is missed; and "It's not my responsibility" will not fly.

    Just wanted to make clear, what your words mean and how they can be interpreted in our healthcare system; hence the response.
    CosmicHymns and GrnTea like this.
  5. 1
    Also if you work in a unit and someone wants to talk to another nurse, either take a message and pass it on or go physically grab that nurse to talk to the person.

    We work as a team as nurses.
    CosmicHymns likes this.
  6. 1
    My thoughts exactly! While no one is perfect, the lack of accountability demonstrated by your post was concerning.

    Quote from GrnTea
    About Scenario 1, I'm not clear on what you meant when you said you gave the extra 0.5 later on the ward. Saying "It's just prophylaxis" and "the patient is well-off" isn't any kind of an excuse.

    In scenario 2, it would have been inappropriate to give the prescription to anyone but the patient; it would have been much more appropriate to send it to the pharmacy directly. I don't see any reason to call this an unfair circumstance or turf your responsibility to God.

    In scenario 3, I have a hard time following your narrative, but if it was your responsibility to deliver a message but someone else did because you were "busy with other stuff" -- really? And your speculations about the physician keeping people in the hospital for reimbursement, it doesn't matter because the pt has an HMO, and all that about private ward and such-- nothing to do with anything.

    I am aware that you are very new at this and you are in a different culture and English is not your first language. However I find your lack of interest in taking any responsibility or understanding underlying issues to be troubling. You will not do well in the US (if you get here) if this does not change.
    CosmicHymns likes this.
  7. 0
    I don't really think these incidences are "small stuff"...


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