A reson why nursing is a bad career choice...

Published

Specializes in Telemetry.

first of all sorry i didn't spell reason right in my title.

to make a long story short, i had a patient who needed abdominal surgery. the patient did and because of other reasons ended up staying for a good length of time. after 4 days the abdominal incision came open a very tiny amount...not much to worry. unless you consider that the wound had been closed for 4 days and the patient had been up and down out of her beed several times a day. then it came open more and more. over the period of 5 days the wound went from approximated to 2 inches wide and tunneling 1.5 inches deep. at discharge no granulation tissue had formed...in fact slough had in some areas, and the wound was still continuing to get bigger. the patient had no underlying diagnosis as to why she would have dehisced in the first place. i work nights so i don't know what the doctor was aware of. i do know i told the shift after me and documented. i knew that when i would give or get report the nurse would say something along the lines of, "they need to quit messing around with this wet to dry dressing change and take her back to surgery and see what is wrong!" i also know that it is the mds responsibility to look at the wound every day. i knew when this patient got discharged that the patient would be back very soon. a few days later the patient was. the patient had to have surgery to repair a bowel that got nicked in the first surgery. the patient is again having complications in a stay that should have never occured had the proper action been taken before the patient was discharged. i told the patient that i did not believe that the patient should agree to pay for the second stay. i'm sooooooooooooo angry about this! do not missunderstand. mds make mistakes and a nicked bowel is a potential of abdominal surgery. i'm mad because to me it was obvious that something was not right and the md should have taken her back to surgery to find the problem before she left. now i'm going to have some of you chastise me for saying anything to the patient, but when do we stand up for the patient? i'm not saying that the patient should sue, i'm just saying that the hospital personnel didn't catch something that should have been caught and thus the patient should not have to pay for the second visit. all we do is cover the hospital's butts for providing patients with sub standard care through poor doctor to patient and nurse to patient ratios. (hospitalists work for the hospital...surgerons and other mds are different i know.) how can anyone feel good about doing this job? the definition of a nurse is: a person who cares for the sick or infirm; specifically : a licensed health-care professional who practices independently or is supervised by a physician, surgeon, or dentist and who is skilled in promoting and maintaining health according, to the merriem-webster dictionary. we don't give care, we tick off tasks and allow doctors to intimidate us and/or talk down to us in a manner that damages our confidence in our skills.

this is the worst profession anyone one could choose to go in to mostly because you are damned in most any course of action you take. you stick up for the patient you get a bad wrap for being hired at hospitals. you tell a doctor who is being a piece of poo to you or your co-worker to back off and you get told by management that you need to work better with people. not to mention that patients can just walk all over you if they feel like it because we are there to provide them with "customer service". i also love all the stories that i read in my nursing board bulletin where a hospital gets sued and suprise, suprise it's the nurses' fault and not only is she/he getting fired but their license is also on probation or revoked. and when i read these stories i clearly see where the nurse is being held responsible for something that i would assume is the doctor's responsibility or that the hospital was making the nurse do some sort of stupid hospital activity that interfeared with the care he/she was giving....not to mention the ones that just sounds like the nurse had too many patients but was probably afraid to say anything because then she could a) get fired b) get accused of patient abandonment or c) be reprimanded for not being a 'team player'. futhermore something like 80% of the stories i read that are not about nurse drug abuse make me feel this way. nursing is not a profession, it's bullying made legal.:mad::crying2:

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Specializes in Telemetry.

Just a little addendum. 10 months ago I got an award for catching an almost deadly medical error at a hospital I worked at. Shortly after I had to go to the ER my self and since there were posters everywhere with my face on them and what had happened, the MD caring for me made mention of it. He said he had recently read that if air traffic control had the same amount of deadly error that medicine did there would be four plane crashes a day. Really? How many people are we going to let DIE because ratios are to high and communication is poor?!

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I feel your pain. I don't think I am "strong" enough for nursing, at least not hospital nursing. :(

I wish I were, but I can't change my personality. Now, after graduating last year... I don't know which direction to go

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Specializes in Pediatric/Adolescent, Med-Surg.

Your story reminds me of a lady I have taken care of recently. Pt had chest tube and once it was pulled, the dressing kept seeping clear fluid, to the point the dressing would be soaked twice a day or more. I have never seen a former chest tube site do this before. The pt went home, then presented to the hospital again a few days after discharge with difficulty breathing. She had developed a pleural effusion as well as some other resp complications. Me and the other nurses are just frustrated she was even allowed to go home like that in the first place.

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You are right that we have a responsibility to the patient. It is our job to advocate for them. It is not your job to tell a patient what the MD or any other health professional taking care of them should or shouldn't do. Those are things that you address with the other person and if necessary, you address them with administration. Even though you worked night shift, if you were unaware of what the doctor knew or didn't know, you should have contacted the on call doctor about the wound. Had they documented anything about it? What were they writing in the chart every day that they assessed the wound? If you thought the patient needed an intervention, you should have made that happen. You follow the chain of command until you get the results that the patient needs. Does this irritate people? Absolutely, because noone likes being told what to do. However, you are an advocate for the patient. It is your job. The best nurses are often the ones that doctors and other staff don't like, but they are the ones that make sure they advocate for their patients.

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I had to register when I read this post. One of the problems could be your working nights...perhaps.

You hit the nail on the head TheMrsRN. I second everything you said!

Nursing is a wonderful profession and shouldn't be bashed because you are frustrated.

to the OP: You as the night nurse should have informed the surgeon immediately of the change in the wound when you found it. If the patient was stable and was not bleeding you could have called prior to your shift ending. It was YOUR responsibility to let it be known to the surgeon and if he decided to do nothing and you found that nothing was done the next shift you were on, nursing admin should have been made aware. All this should be documented in the patient record. If you need to call fifty times throughout the night you do it because you are advocating for the patient. If you feel that the patient should not be discharged you bring it to your manager. Ultimately when a patient is harmed or negligence is alleged it is everyone's responsibility. Legal is going to look at What did you do to prevent harm. Did YOU notify who you needed to. You were at the bedside not the surgeon. What did your assessment reveal and what were YOUR actions?

Understand your role before you bash the profession. Being a nurse is to be that fighter...that advocate for the patients entrusted in your care. If you are not willing to go to bat for your patients then maybe you should step aside. I'm just saying. Stop blaming others for you not understanding YOUR role.

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Specializes in Home Health.

I hear you clearly and agree with what you said. As far as the doc goes, what he does and doesn't do is his problem and his insurer's problem. You are a nurse, you can not make medical diagnoses only the doc can. You did your best.

The patient you referred to had a would that would NEVER heal because of the nicked bowel. Amazing if the body knew there was something wrong and caused the wound to reopen to call attentioin to it - gives me goose bumps.

I don't work in hospitals anymore and never will.

You're right about nursing.

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My sister-in-law just gave birth via c-section and was sent home after one day. She came back one week later because she was VERY VERY ill and it turns out the wound was infected. She went to the ICU and it was amazing she lived through the first few nights. She needed a wound vac and all kinds of care. Turns out, the hospital has changed a few of their policies to include not sending home c-section patients so quickly. Had they not been so eager to get her out the door, they would have caught this almost deadly infection.

Seems to me like hospitals are too eager to get people in and out of the door.

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first of all sorry i didn't spell reason right in my title.

to make a long story short, i had a patient who needed abdominal surgery. the patient did and because of other reasons ended up staying for a good length of time. after 4 days the abdominal incision came open a very tiny amount...not much to worry. unless you consider that the wound had been closed for 4 days and the patient had been up and down out of her beed several times a day. then it came open more and more. over the period of 5 days the wound went from approximated to 2 inches wide and tunneling 1.5 inches deep. at discharge no granulation tissue had formed...in fact slough had in some areas, and the wound was still continuing to get bigger. the patient had no underlying diagnosis as to why she would have dehisced in the first place. i work nights so i don't know what the doctor was aware of. i do know i told the shift after me and documented. i knew that when i would give or get report the nurse would say something along the lines of, "they need to quit messing around with this wet to dry dressing change and take her back to surgery and see what is wrong!" i also know that it is the mds responsibility to look at the wound every day. i knew when this patient got discharged that the patient would be back very soon. a few days later the patient was. the patient had to have surgery to repair a bowel that got nicked in the first surgery. the patient is again having complications in a stay that should have never occured had the proper action been taken before the patient was discharged. i told the patient that i did not believe that the patient should agree to pay for the second stay. i'm sooooooooooooo angry about this! do not missunderstand. mds make mistakes and a nicked bowel is a potential of abdominal surgery. i'm mad because to me it was obvious that something was not right and the md should have taken her back to surgery to find the problem before she left. now i'm going to have some of you chastise me for saying anything to the patient, but when do we stand up for the patient? i'm not saying that the patient should sue, i'm just saying that the hospital personnel didn't catch something that should have been caught and thus the patient should not have to pay for the second visit. all we do is cover the hospital's butts for providing patients with sub standard care through poor doctor to patient and nurse to patient ratios. (hospitalists work for the hospital...surgerons and other mds are different i know.) how can anyone feel good about doing this job? the definition of a nurse is: a person who cares for the sick or infirm; specifically : a licensed health-care professional who practices independently or is supervised by a physician, surgeon, or dentist and who is skilled in promoting and maintaining health according, to the merriem-webster dictionary. we don't give care, we tick off tasks and allow doctors to intimidate us and/or talk down to us in a manner that damages our confidence in our skills.

this is the worst profession anyone one could choose to go in to mostly because you are damned in most any course of action you take. you stick up for the patient you get a bad wrap for being hired at hospitals. you tell a doctor who is being a piece of poo to you or your co-worker to back off and you get told by management that you need to work better with people. not to mention that patients can just walk all over you if they feel like it because we are there to provide them with "customer service". i also love all the stories that i read in my nursing board bulletin where a hospital gets sued and suprise, suprise it's the nurses' fault and not only is she/he getting fired but their license is also on probation or revoked. and when i read these stories i clearly see where the nurse is being held responsible for something that i would assume is the doctor's responsibility or that the hospital was making the nurse do some sort of stupid hospital activity that interfeared with the care he/she was giving....not to mention the ones that just sounds like the nurse had too many patients but was probably afraid to say anything because then she could a) get fired b) get accused of patient abandonment or c) be reprimanded for not being a 'team player'. futhermore something like 80% of the stories i read that are not about nurse drug abuse make me feel this way. nursing is not a profession, it's bullying made legal.:mad::crying2:

if it is demonstratable that there was a problem in surgery the insurer near certaily won't pay, or not for the full amount. the hospital may be able to charge something for her care, but unlikey the physician will get paid for a second surgery. least that's how i think it works.

my .02:

don't worry about ruffling anyone when you're worried about a patient outcome. by all means take advantage of the resources available.

call the doctor each shift and document that you did so and the scope of the reason why. that documentation in the chart has a way of making them take notice... call your clinical director and express your concerns. that works well too. was there a house doctor or code nurse expert that could have been consulted? unfortunately or not they're often listened to when others aren't. you seem like a nurse with good critical thinking skills. would hate to see you leave.

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Your story reminds me of a lady I have taken care of recently. Pt had chest tube and once it was pulled, the dressing kept seeping clear fluid, to the point the dressing would be soaked twice a day or more. I have never seen a former chest tube site do this before. The pt went home, then presented to the hospital again a few days after discharge with difficulty breathing. She had developed a pleural effusion as well as some other resp complications. Me and the other nurses are just frustrated she was even allowed to go home like that in the first place.

Agree that sounds outrageous especially as you obviously had recognized and were documenting an outlier condition. In less obvious cases or where nursing doesn't adequately call it to attention, the problem is the hospitals (doctors) are under so much pressure by insurance companies to discharge them and get them out the door and requires additional documentation and justification that many view as impeding their schedules. For this reason when you know or suspect something isn't right it is really important Nursing make some noise if you will.

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You bring up a lot of focal points op.

Here is one I would like to zero in on and address:

In light of your expressed passion to be an advocate for your patients, why did you not pick up the phone and notify the dr on your shift? Based on the information you have shared, prompt notification appears fitting.

Congrats on catching the error.

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Specializes in Cardiovascular, ER.

I wondered the same thing, I work nights too - I have called the surgeon at 1 am d/t surgical wound dehiscence. He came in right away and the pt was taken to emergency surgery pretty quickly. I let the nursing supervisor know as well. Some things are not ok to just pass on to the next shift.

Not trying to say you did wrong, I only have the info you posted - but I would rather call on something that could have waited than the opposite. It's their job to answer call. It's our job to inform them of changes, even in the middle of the night.

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