Last night I floated to the OB-GYN floor, as I often do, and walked right into a near-disaster: a suddenly obtunded 29 year-old vag hyst patient with a respiratory rate of 7 and 02 sats in the upper 70s. And how she came to be that way reminded me, yet again, why I hesitate to take a job on that unit even though I love working there: the lack of basic nursing knowledge and skills among the regular staff.
I was just outside the room, writing down the pt's information on my worksheet, when the off-going shift nurse grabbed me and said "I think I need some help here!" I mean, this pt. was out of it---she was arouseable only if you shook her and yelled her name, what little speech she had was unintelligible, and her respirations were shallow as well as infrequent. And I had this nurse looking at me like, now what the hell do we do?
Of course, the first thing I did was grab an 02 setup and put it on, which improved the pt's sats almost immediately, and got a set of vitals, which were more or less OK. That's when the nurse confessed to me that she'd just given 100 mg. of Demerol w/ 50 of Phenergan *IV*
She said "Well, I thought it was a lot to give IV, but I went ahead and did it anyway because she was in so much pain". I couldn't believe it. I've never given more than 25mg of Demerol via that route, especially not with that much Phenergan!! We got the patient stabilized pretty quickly, thank God, but then I had to walk this nurse through the entire follow-up. I actually had to tell her to call the MD to report what had happened, and to write an incident report. (I ended up doing the progress note myself because she forgot.)
Luckily for all concerned, things turned out well, and the small amount of Narcan I gave the pt. made her come around without completely undoing her pain control. But it makes me wonder, not for the first time, what happens to some nurses who go into specialty care that makes them completely forget the basics. Common sense should tell you NOT to give 100mg of Demerol through an IV line, just as it should tell you NOT to ignore the little voice telling you to question something. It wasn't even busy on the unit, so there was no excuse for it.......and when I looked at the MD's original order, I saw that while it was scrawled, the order stated the dose was to be given IM. (Someone had transcribed it onto the MAR wrongly as IV.)
Then, the nurse didn't even know what to do for the patient when her sats went into the toilet.....how much critical thinking does it take to run for the oxygen?? Her reason for not doing so was, "I've never had a patient de-sat like that before". I'm sorry, but even when I was a CNA I knew enough to grab the 02 equipment at times like this.
The stink of it is, this girl isn't the only nurse I've encountered on that floor, or elsewhere, whose grasp of the basic nursing skills we all supposedly learned in school is tenuous at best. Some of them haven't started an IV or given insulin in years. They don't change the team worksheets as patients' conditions change. They don't even know how to change a central line dressing or give blood transfusions (I've literally had to walk OB nurses through the entire procedure).
I hope this doesn't sound like I'm superior just because I knew how to handle the situation, but somebody not knowing the nuts-and-bolts stuff is just incomprehensible to me. It's just common sense nursing that we're all taught in school.......how tough is that??
