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

[Antikigirl]

OH man..the other day I had a heck of a time, it was one of those days where we had three urgencies at one time and we were running the floor big time! However, there was a point when I felt like my charge nurse and I were the only ones that were handling the situation with good old fashioned medical common sense! Uhggggg! Let me explain...

Seizure in one room, so I ran to the room with my charge nurse and the nurse had a pt on the toliet totally bent down and out! Her concerns were get him into bed fast...my charge and I...AIRWAY! Here I was trying to climb over her and supporting his head (you could hear he wasn't getting breaths in since his chin was at this chest and limp). I raised his head and got his airway open and he actually started to respond a bit. SO what if it is on the toliet? Then I suggested that instead of us three gals fireman carry him to a bed...to grab a chair and we could transfer him to that first...keep airway..then transfer to bed with more help (he was dead weight!). It took forever to get it all done, and my back was hurting something fierce from that crowded bathroom and heavy head/chest I had to support on my own! Patient finally gets back to bed and the next emergency happened!

Little old lady on the floor. I go there, and again a nurse felt it was more important to get her to the bed (what..are these beds magical?). Charge and I said no...had her put her legs out to see if there was any rotation or shortening of the legs (hip check..hi we are ortho nurses!), checked the head for injury, body check...all this must be done before movement! Uhgggggg! I also suggested the same thing with the chair again, we did it..got her to a chair for more assessments, then to bed for more assessments and the fact her MD was just there, and I had him paged. She was fine, but no x-ray done on this very fragile woman...I disagreed with that since she had hip pain...but I told the next shift to get one if her pain increases...just then another little old lady was out of bed and trapped in a corner with her walker and about to fall....

Tended her, seizure two in first room again, fell off bed (rails were down because they were putting on pads..UHGGGG! (keep those UP when unattended...pads or not...a hit on a plastic side rail doesn't match the floor hit!). Again..didn't secure airway...I had to...they were too concerned again with getting him on the bed and calling the MD...how about the here and now with the patient folks????

Little old lady who fell climbed over the rail, on floor again! OH CALGON! They took the pulse ox on seizure dude postdictal and it was in the 80's...REALLY NOW? Of course it is...no airway open and hasn't breathed in two minutes..open that airway and let him breath...get some O's on him! (for those that don't know...you do NOT breath during seizures, so top priority post seizure is to get that airway clear so they can get that first deep breath...or just in case...a safe head position for vomit or drewl without aspirating on it!!!!).

I just was in flabergast mode by this point? I can't be the only nurse that does this...it is simple abc and safety issues! Thank goodness I am a rather proactive person and shared my views proactively while I was helping instead of barking them...but oh brother I really wanted to bark them and say "what is wrong with you guys...patient first...stablize!".....

Oh well...

Anyone have similar experiences where you were just like "duh...why aren't you doing this first????".

[TrudyRN]

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?????? .......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

I actually had a paramedic who took us to a doctor appt because we had to have her brought by ambulance due to her vent...who actually said to me "it's scary that she was an ICU nurse"......

She also reported an ambulance she had to go in years & years ago for getting lost because the roads were blocked off in a big city when they got there & the ambulance didn't know how to get to the hospital they were going to because the roads were all blocked off for the normal way they went there.....gee it's not like they knew it was like that....:trout: Kills me everytime I think about it..........Thankfully I have common sense.....which is a good thing...

As a mother, you know your own child best. Try not to be too haughty, though, as you might find yourself in someone else's home someday and they might think YOU do some things that aren't "common sense". Try to be more charitable, try to educate instead of getting angry or critical. Educate people. Do it with respect and trembling because, as stated, the tables could one day be turned.

[TrudyRN]

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.

Right on re: patient advocacy. As for "The Naked City" - well, it was New York, I think. And I'm thinking it was more like a million stories. It's been a long time, not really sure.

I hope that everyone here who is amazed that their coworkers panic or are ignorant about something or just, for whatever reason, don't seem to know exactly what to do at any given moment will never find himself or herself in that position. We all mess up so I think we should try to educate each other, coach and remind each other nicely, not feel superior, shocked, or angry. Just my opinion.

[Kyrshamarks, BSN, RN]

(for those that don't know...you do NOT breath during seizures, so top priority post seizure is to get that airway clear so they can get that first deep breath...or just in case...a safe head position for vomit or drewl without aspirating on it!!!!).

Actually you DO breathe during seizures. We have kids on our unit that are actively seizing for 3 or more HOURRS before we can get them finally under control. Yes you do want to maintain a patent airway and some people may stop breathing but to say that you do not breathe is wrong info. A study has recently been done showing that the low pulse ox reading may not truely be a accurate reading because the brain in some people during a seziure shunts blood flow away from the cappilary system to the brain and they are getting 02 and are adequately oxygenated but the pulse ox can be reading in the 30's. Rule number 1: trust your eyes and assessment and not just the machine's numbers...

Speaking as a long time neuro Nurse...

[Kelly_the_Great]

Actually you DO breathe during seizures. We have kids on our unit that are actively seizing for 3 or more HOURRS before we can get them finally under control. Yes you do want to maintain a patent airway and some people may stop breathing but to say that you do not breathe is wrong info.

My understanding is that there are all kinds of different seizures with varying levels of physical distress and severity. Hmm...I wonder, in some seizures, do patients not experience difficulty in breathing and oxygenation? I'll have to check it out. Thanks for making me think...

A study has recently been done showing that the low pulse ox reading may not truely be a accurate reading because the brain in some people during a seziure shunts blood flow away from the cappilary system to the brain and they are getting 02 and are adequately oxygenated but the pulse ox can be reading in the 30's.

Speaking as a long time neuro Nurse...

Wow, pretty interesting, Kyrshamarks! Do you have access to the study? Do you have a link to it or anything?

Rule number 1: trust your eyes and assessment and not just the machine's numbers......

Yeah, what's the saying?...Treat the pt not the monitor, right?

[KellieNurse06]

As a mother, you know your own child best. Try not to be too haughty, though, as you might find yourself in someone else's home someday and they might think YOU do some things that aren't "common sense". Try to be more charitable, try to educate instead of getting angry or critical. Educate people. Do it with respect and trembling because, as stated, the tables could one day be turned.

Oh I am not being "haughty" believe me....I am saying this from the point of making way more work for yourself than you need to.....I love the lady, she's very sweet! I am very respectful to her..I would never say anything hurtful or mean to anyone.....I would ask how things are done in the place first....that's all..... We get along great & she loves my little munchkin which is why I like her alot......lol