Here's how even experienced nurses can get into trouble:
Yesterday at the three PM shift change, I picked up four new patients and a student, all of whom were in need of something or another that the 7-3 nurse hadn't got to yet. During report, she mentioned that the patient in 221 had a heart rate in the 150s, but it had been that way ever since he was admitted the day before, he was asymptomatic, and that was "just the way he is, I guess".
My student had this particular patient, so after checking on him, I left her to do his assessment and went on to deal with the 48-year-old TKR patient whose pain level was still 7/10 despite BID doses of Oxycontin and a PCA pump, the lady with septic arthritis whose sister had about five bazillion questions, and the fellow who still couldn't void after having had his Foley pulled at 0600. It wasn't until about 6 PM that the MD who was looking in on the fellow with the rapid heart rate corralled me to ask why on earth everyone was charting it in the 150s when his actual apical pulse was in the 80s when HE listened to it........were they just using the machines, or did they actually listen to his AP?
Now, I hate few things worse than telling a doctor I don't know something, but I had to admit I had no idea what anyone else had done......all I knew was what I'd been told, and that wasn't much. He wasn't impressed one bit with my lame explanation (I wouldn't have been either), and he ordered telemetry and asked me to call him back when I'd verified a rhythm with the ICU.
So while the student was locating a tele unit, I went in and listened to the patient's heart myself, which of course was what I SHOULD have done in the first place after hearing the early-shift RN's report, and sure enough, he was taching along at over 150!! Then when we got the tele on, it took no time at all to learn that he was in SVT, with some atrial flutter thrown in just for fun..........AAAAAAAAGGGGGGGGGGHHHHHHHHH!! I called the MD back to report our discovery and to ask for a theopphylline level since the patient had been taking it for quite some time, and he agreed, but of course it was necessary to transfer the patient to the ICU because he was becoming symptomatic about this same time..........diaphoretic, nauseated, SOB, etc.
Well, as you can probably understand, I'm NOT happy with this outcome, and I share it with you as a cautionary tale to warn both new and 'used' nurses about being too complacent. Just because a nurse with about half a century more nursing experience than I have told me not to worry about the patient's fast heart rate, doesn't make it OK that I dropped the ball.........as did she, and the night shift nurse who admitted him. Hopefully he'll be OK, although his full-code status as an 89-year-old COPD/CHF'er brings up some concerns about how realistic he is about what we can do for him medically. The point is, never ASSUME anything ............you never know when it'll come back and bite you in the butt!! :uhoh21:
Specializes in Alzheimer's, Geriatrics, Chem. Dep..
Hi, thanks for all the stories..I havent posted in a while but I have to tell my story...
at the hosp. he went in cardiac arrest.... I could hardly function after that one for the rest of the night.
....... oh it was a nightmare for me...I was sure glad that night was over.....
I'm so so sorry - that is just so damn unfair. We stay in these marginally staffed situations - well sure it's fine if nothing happens!!!
{{{{{{{{{{{{{{Low Paid}}}}}}}}}}}]
Y'know, stuff like that, you couldn't pay me enough (shaking her head). But you did what you could, at least he wasn't all alone and that is one of the most important things I think.
Don't hear me wrong tho' - I am NOT excusing that kind of staffing!!!!!
I'm so so sorry - that is just so damn unfair. We stay in these marginally staffed situations - well sure it's fine if nothing happens!!!
{{{{{{{{{{{{{{Low Paid}}}}}}}}}}}]
Y'know, stuff like that, you couldn't pay me enough (shaking her head). But you did what you could, at least he wasn't all alone and that is one of the most important things I think.
Don't hear me wrong tho' - I am NOT excusing that kind of staffing!!!!!
I hear ya, I didn't stay there too long after that, it was just too scarey for me!! :uhoh21:
Specializes in ICU, PICU, Cath Lab, CSICU, Quality.
Here's how even experienced nurses can get into trouble:
Yesterday at the three PM shift change, I picked up four new patients and a student, all of whom were in need of something or another that the 7-3 nurse hadn't got to yet. During report, she mentioned that the patient in 221 had a heart rate in the 150s, but it had been that way ever since he was admitted the day before, he was asymptomatic, and that was "just the way he is, I guess".
My student had this particular patient, so after checking on him, I left her to do his assessment and went on to deal with the 48-year-old TKR patient whose pain level was still 7/10 despite BID doses of Oxycontin and a PCA pump, the lady with septic arthritis whose sister had about five bazillion questions, and the fellow who still couldn't void after having had his Foley pulled at 0600. It wasn't until about 6 PM that the MD who was looking in on the fellow with the rapid heart rate corralled me to ask why on earth everyone was charting it in the 150s when his actual apical pulse was in the 80s when HE listened to it........were they just using the machines, or did they actually listen to his AP?
Now, I hate few things worse than telling a doctor I don't know something, but I had to admit I had no idea what anyone else had done......all I knew was what I'd been told, and that wasn't much. He wasn't impressed one bit with my lame explanation (I wouldn't have been either), and he ordered telemetry and asked me to call him back when I'd verified a rhythm with the ICU.
So while the student was locating a tele unit, I went in and listened to the patient's heart myself, which of course was what I SHOULD have done in the first place after hearing the early-shift RN's report, and sure enough, he was taching along at over 150!! Then when we got the tele on, it took no time at all to learn that he was in SVT, with some atrial flutter thrown in just for fun..........AAAAAAAAGGGGGGGGGGHHHHHHHHH!! I called the MD back to report our discovery and to ask for a theopphylline level since the patient had been taking it for quite some time, and he agreed, but of course it was necessary to transfer the patient to the ICU because he was becoming symptomatic about this same time..........diaphoretic, nauseated, SOB, etc.
Well, as you can probably understand, I'm NOT happy with this outcome, and I share it with you as a cautionary tale to warn both new and 'used' nurses about being too complacent. Just because a nurse with about half a century more nursing experience than I have told me not to worry about the patient's fast heart rate, doesn't make it OK that I dropped the ball.........as did she, and the night shift nurse who admitted him. Hopefully he'll be OK, although his full-code status as an 89-year-old COPD/CHF'er brings up some concerns about how realistic he is about what we can do for him medically. The point is, never ASSUME anything ............you never know when it'll come back and bite you in the butt!! :uhoh21:
I LOVED your note...first of all to see someone other than me still working! You know what ASSUME means...you are so right! Take care!
I agree to everything that has been posted in this discussion. My story:
Back in November there was a gentleman on my floor that had been having belly pain over several days. It had been addressed by the nurses and the doctors had been aware.
When I came on shift, I was told that the patient had ate and was doing okay. When I went in to assess him, he was awake and alert. A couple of hours later, one of CNAs came and stated that he was acting "funny". When we called the MD he did not seem to be too impressed. However, one of the more experienced nurses took a strong stand, and the patient was sent to the ER. Unfortunately, he coded and passed away. I still think about it to this day. Assessment, assessment and more assessments is the key. If the little voice in your head is screaming at you, listen. Being a new nurse sometimes you feel like you are over reacting, but in this case, it was for the good, unfortunately, it did not help this gentleman.
I've probably posted this before, but it's always with me so bear with me, please.
If you straight-line someone from pushing Verapamil (and push very slow with the elderly, don't slam it in even if the docs are telling you to), push Calcium right behind it. The first patient I had that went into asystole was in his 40's with his HR in the 200's, and the second 5 mg bradied him down in a matter of a few seconds and into asystole. The calcium saved his life. Second patient was in his 80's post CABG, HR in the 170's--I literally drew Verapamil up in a TB syringe so I'd know exactly how much I was giving him (had bad, bad feeling about it), pushed it slowly even though people were yelling to hurry and push it--gave a minute amount (total of 1.25-2.5 mg, don't remember exactly now; was years ago) and he went asystole. Calcium didn't help him; nothing did. Yeah, he was old and had other things wrong with him, too, but I was the one pushing the medication that killed him.
Now, if the doc orders 5-10 mg, I only push it slowly until I get the desired results, even if it's only 2 mg on a 90 lb. 80-year-old woman. I've had them laugh at me for doing that, but none have written me up for it yet. I've heard so many people (including docs) say, "I didn't know that could even happen!" or "That's never happened to me!" Guess my point is that none of the drugs we give are harmless and we should never get complacent in giving them.
Specializes in Alzheimer's, Geriatrics, Chem. Dep..
Now, if the doc orders 5-10 mg, I only push it slowly until I get the desired results, even if it's only 2 mg on a 90 lb. 80-year-old woman. I've had them laugh at me for doing that, but none have written me up for it yet. I've heard so many people (including docs) say, "I didn't know that could even happen!" or "That's never happened to me!" Guess my point is that none of the drugs we give are harmless and we should never get complacent in giving them.
Now see it was news to me so well worth your posting it!
QUOTE=moondancer]Wow! how sad is that, and could've been prevented probably....what is with these docs??? We had a close call last week w/one of our pre-termers, PPROM, barely missed delivering her 27 wkr in the bed in our hi risk ante partum unit cause the docs (read: residents :uhoh21: ) didn't believe that she was contracting, in pain, etc. They held off getting her into L&D all night until finally that am after 2 RN's and the Charge had to push it, she went over. She delivered minutes after getting there....babe is in NICU of course; however can you imagine her delivering alone, no newborn resus at the ready??
I'm new at this, but this situation hit home with me and I had to have my turn. This happened to me when I was about 19 yrs old. No matter what the situation is it's important to be an advocate for the patient, and stand up to the Docs if you have to. I knew I was going to deliver at 29 weeks and I couldn't reach the attending. I went to the hospital. They said I wasn't in labor, they refused to call my own Doc, they sent my husband home, they wouldn't listen to me and kept me helplessly in the labor room. Not one person would listen to me or take me seriously, after all, the resident there knew best, right? Wrong. I KNEW BEST. My baby was in jeopardy and was stillborn, right in the bed. Remember, a nurse, just one, could have made all the difference. I went on to become an RN and I listen to my patients, with care. :angryfire
I hear ya, I didn't stay there too long after that, it was just too scarey for me!! :uhoh21:
Its scary. Thats why I will not have any member of my family in a nsg home of any kind. Not that I think those nurses are substandard, they are not, they are just not given enough nurses to work with safely.One nurse can only do so much safely. The pt/staff ratio is horrible in most HOSPITALS, never mind and assisted living/skilled nsg facility.:stone I hope you moved on to a better position
Specializes in Alzheimer's, Geriatrics, Chem. Dep..
Wrong. I KNEW BEST. My baby was in jeopardy and was stillborn, right in the bed. Remember, a nurse, just one, could have made all the difference. I went on to become an RN and I listen to my patients, with care. :angryfire
{{{{{{{{{{{iggynan}}}}}}}}}} Wow. Sounds like if you'd had a nurse like the many I have met here you wouldn't have had that problem! that breaks my heart, I can only imagine yours... Glad you found a way to fight back!
Liddle Noodnik
3,789 Posts
I'm so so sorry - that is just so damn unfair. We stay in these marginally staffed situations - well sure it's fine if nothing happens!!!
{{{{{{{{{{{{{{Low Paid}}}}}}}}}}}]
Y'know, stuff like that, you couldn't pay me enough (shaking her head). But you did what you could, at least he wasn't all alone and that is one of the most important things I think.
Don't hear me wrong tho' - I am NOT excusing that kind of staffing!!!!!