A bit of common sense to nursing?! (long)

Antikigirl, ASN, RN · Oct 21, 2006

BTW...all these nurses were 10+ nurses. A newer nurse I would have understood, but these were seasoned nurses who have worked ED, ICU, PCU, and Med surge all their careers! To me that makes a difference in knowing what to do...stressed or not!

smk1, LPN · Oct 21, 2006

Yikes, you need a vacation after all of that!

Antikigirl, ASN, RN · Oct 21, 2006

LOL...no kidding...and all this happened (and more) during the last two hours of a busy day too! Uhggggggg I so went home, had a beer, took a long soak in the bath and relaxed in the bubbles. I was to work the next day...but woke up with a HA and stiff neck/sore throat, cough, elevated temp, and sweats...I called in...whew...I might have been under the weather, but no way could I pull off another panic shift like that sick!

Larry77, RN · Oct 21, 2006

Thanks for making me thankful for being in the ED again...

I agree with your methods and rationality...doc going to use his "magic phone" to stop the pt from seizing in his "magic bed"?

banditrn · Oct 21, 2006

Oh Triage!!! You need a hug!!

I remember when I worked in the ICU, we had to respond to and lead all codes on the floors until a doc got there.

I responded one nite to a patient literally on the floor - half in, half out of the BR, covered in BM - big man, and every one was running around looking for a back board or something to pick him up with!! :uhoh3:

I made them stop all that, and we did our code with him on the floor - I was SO impressed - a GP happened to be the first doc in, a tall skinny guy, and he INTUBATED this man on his hands and knees!!:yelclap: :yelclap: Then he took over CPR so I could do other things. I called him later and heaped praises on his head.

The poor guy didn't make it. I don't know if he'd been down too long or what.

banditrn · Oct 21, 2006

Oh, and another thing I've seen in the LTC where I work now - calling the doctor 'before' putting O2 on a patient! Because they must have a doctors order first.

Doesn't common sense tell you that if a patient is having respiratory distress, and their sats are going down, that you place the O2, then call for the order?

nrsang97, BSN, RN · Oct 21, 2006

:uhoh3: i often have had the same issues where i have previously worked. pt came in stating inability to walk. pt had hip pain and er orders and does cxr!!! i just wanted to ask them "what the h*** are you thinking?" pt cont to have paint to touch with left hip every time turning or getting on and off bedpan. asked attending to order x-ray and he refused to let me have xray that night. asked house doc and received orders but attending ended up pissed and refused to let pt have xray that night and next morning pt had bilat hip xray and pt left hip was fractured! ugggggh!!! :angryfire so needless to say if you complain you can't walk you will indeed recieve a cxr and not hip films!

pt coding and no one started cpr until i got to the room. i was starting a iv in another room and heard the code called and walked in and no one was starting cpr!!! hello!! abc's anyone??

that same day charge nures took nyquil at 12noon and we start work at 3pm. duh nyquil is for night and dayquil is for day!!!

nurse who asked me and i quote "my pt has c/o chest pain and she just recieved a unit of blood. she says her pain was after she burped. should i call the house officer?" never never blow off chest pain. i told her to get a set of vs and call. later she came out and told me "her hr is 180!" had house officer up and i am telling them what to give. pt was in svt! duh!!

same nurse as above "do i have to crush coreg to give via peg? it's so small." yes you do if you don't want the tube clogged you idiot!! :idea:

pt has diagnosis of new onset seizures and no dialntin or anything ordered!! ok so what did you give to the pt in er. makes sense to me to put them on preventative med asap.

oh and one last one. i arrived to my floor for my shift and i was early. pt was being coded in one room and i went in to see what was going on and there are 5 nurses 1 doctor and 3 rt in the room and the secretary was doing cpr??? why i have no idea because i thought she was supposed to be at the desk awaiting orders. instead i was answering the phone. :uhoh3:

this is all i can think of for now. but general common sense is way too lacking in this world any more.

rn/writer, RN · Oct 21, 2006

Sounds like your coworkers need a refresher course in emergency priorities.

In their defense (though there really is none and YOU obviously are on the ball) it's easy to develop tunnel vision. Even as an EMT, I was constantly reminded not to focus on the nasty-looking compound fracture until I'd managed the ABCs.

The other kind of tunnel vision is endemic to any specialty. People tend to look through the lens of what they know. We have an adopted son who required many years of psych treatment. After one of his clinicians learned about bipolar disorder in children and adolescents being underdiagnosed, it seemed like he was running a special on bipolar kids. Remember the saying, "When all you have is a hammer, everything looks like a nail."

In your case, skilled ortho nurses are focusing on ortho issues--to the detriment of silly things like airway and breathing.

This could be a great opportunity for you. I don't know how your unit works, but on mine, we have to do some kind of teaching project (for patients OR for staff) throughout the year. This sounds like a made-to-order chance for you to take everyone back to the basics. Make some posters (a good place to hang them is in the breakroom or staff bathroom). Hold a brief inservice. Remind everyone in a positive way that if your patient doesn't have an airway, pretty soon, you won't have a patient.

It's easy to forget this most humbling of medical truths. Doesn't matter if you're the premier brain surgeon in the world. You ignore airway and breathing at your--and your patient's--peril.

Good job, Triage!

P_RN, ADN, RN · Oct 21, 2006

I have the T shirt about 10x over. LPN calls me to the room, pt diaphoretic, greenish tinge, confused, unsteady on feet. She and I look at each other and say PE.

Call Dr. and he says...............I'll see him after I do this laminectomy..........call the resident and he says........I'll see him after clinic. So we call the medical attending who says "What do you want ME to do?" so I told him we need a VQ. Gosh poor guy DIDN'T have a PE. He had TWO.........

Got a nice note from the surgeon and some candy and donuts from the family. Guess which we appreciated more..........That evening I wrote out my resignation and kept it on my computer for many years. I really don't like to doctor shop, but if my patient needs it I will.

There was an old TV show called the Naked City.....It opened with "there are a thousand stories in the Naked City"......well there are a million when you are a NURSE and your patient needs something N O W.

KellieNurse06 · Oct 22, 2006

Oh Gosh!!! I hear ya! No wonder you are exhausted! lol!

I am only a student and not an RN yet but let me tell ya....I know exactly what you are saying!

My daughter has home care nurses and I can tell you some "lack of common sense" stories....

She has one who used to be an ICU nurse.....my daughter uses 120 ml of formula for a feeding...2x per day. She will open 2 cans ...1st one she will pour the remaining 120 left over into a bottle & put it in the fridge...then do the same thing for the 2nd feeding ( and the extra from both cans is put into 1 bottle)...it's like why not use the left over from the original can....duh!!!!

and suction catheters......I open a box & rip off the top ( theres 50 in a big box) and use them all BEFORE opening a new box....she will leave the empty box and open a new box and take out some from the new box & put them in the old box.......does that make sense??????

What else.....oh she sounds junky and I don't know why....ummmmm maybe because it's summer & very very humid with a 100% humidity index????? Did you give a nebulizer treatment???? her....no. :trout:

oh ya also.....her heart rate is only in the 50's...........ummm maybe because she's in a deep deep sleep.......her color is ok, & she's breathing ok, right?????? :uhoh3: .......I am not a nurse yet & I am just amazed .........

She will also tell me I need to call the doctor to have her checked because her suction machine has an odor...or her trach sponges have junk on them in the morning..................um...ya..thats not abnormal..........duh!!!! She also opened a bunch of normal saline vials one by one to put into a sterile bottle to use for g tube flushes instead of just using sterile water like we ususally do & have done for many many years...can you imagine opening enough normal saline 3ml vials to fill an 8 oz bottle??????? Must of took her forever...lol

TrudyRN · Oct 22, 2006

Oh, and another thing I've seen in the LTC where I work now - calling the doctor 'before' putting O2 on a patient! Because they must have a doctors order first.
Doesn't common sense tell you that if a patient is having respiratory distress, and their sats are going down, that you place the O2, then call for the order?

It's a money issue, I think.