careless nurses

[sasha2lady]

Well...I had a post a while back about slack, sloppy nursing....here is a PRIME example. The other day a pts daughter came to me thinking I was her moms nurse..which I wasnt. ...to tell me that mom had a big bruise on her inner thigh. I told her that I wasnt her moms nurse but that i would tell her nurse about it...and I did...plus...i wrote the daughters phone number down for that nurse , who Ill call "Lisa". I have no idea if Lisa ever followed up on it or not....Im assuming not. I was off the next day....and when i went back the DON tells me that Lisas pt was on 2 antibiotics plus coumadin which interacted and caused her PT to be guess what?? over 120! The INR was too high to be read at the lab. .....Its a miracle that this woman didnt have blood pouring out of her! We have our own PT INR machine which a neat thing...looks like an over sized glucometer. The PT's are to be done on day shift...they are not actually timed....on the mar...it just says 7-3....which a few months ago I asked the DON why they couldnt be timed....one hall do them at 8 am , the next hall do them at 830 am and the last hall do them at 9 am....then these labs would be right there in front of our regular md to see when he's there or on his off days...they can be called to him timely (we give coumadins at hs). One particular nurse, never ever does hers on time...she waits til 2nd shift (my shift) comes in and 1) sometimes she gets them at 3 or 230pm or later or 2. she says "i didnt have time. or "they left for bla bla bla...before i could get it"....well...last night she did that on a dialysis patient. we have a different md covering for our regular one this whole week and he is a real JERK! Nobody can stand him ....anyhow....the other nurse handed me his lab at 8pm! THe first thing i said was " why do you have this? did you have to do it? why wasnt it done this am before he left for dialysis? and she told me that the day nurse said she didnt have time to get it before he left.....I knew it wasnt gonna be pretty when I had to call that MD Jerk. ...and it wasnt. He said to me " now tell me why you are telling me this now? why was this not done this am before he went? this is absolutely unacceptable!"...so I told him what happened.....and then I proceeded to tell him about the other pts PT INR lab b/c she had had 2 doses of vitamin K b/c of her high PT/INR. I then wrote out his orders and I notified the DON of what he had said and why. I told her that this very thing was why I suggested that the PT's be TIMED for a specific time instead of just 7-3....she finally seemed to agree with me. I told her that I would not be the one to take the heat for other nurses lack of initiative nor would I take any responsibility for anyone other than myself. She didnt argue with me on it. I told her that I consider coumadins and related labs to such meds as a LIFE or DEATH type of med and that the other nurses need to get on board with this already. She agreed. Our doc is going to retire soon and so that leaves it open for the jerk MD to take over...and when he does...its gonna be ON! I have known him to get nurses fired and get their licenses taken by the board for things at his other facility and at the hospital. Jerk has to have things just so ...you wont talk to him or call him but one time unprepared b/c he will chew a nurse up and spit her out like a bad peanut. then he will write out complaints about such nurses himself and take it all the way up the chain as far as it goes...even if its the BON. ...thats just how he is...he wont tolerate any sloppiness. My ? is ....how does your facility or hospital handle such occurences? IS there not some fine line of responsibility for nurses to report these kinds of labs? Im just not understanding why or how some nurses can just turn their cheek to these kinds of things and feel no responsibility for their patients? Instead....they just wanna shove it under the rug and find any excuse not to do things or lay it on someone else to do and get the heat for it. I just simply wont accept this.......Im tired of it and I am not putting my license on the line for someone elses slack. What are your ideas? suggestions?