Do I let this nurse take the blame...?

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Specializes in ER.

...or do I point out that the doc may have screwed up too, and risk breaking the faith a patient has in their doctor?

Situation...on another (nonmedical) board I post on, one of the posters related a story that happened to him yesterday. Seems that he went to his GI for a motility test for his reflux. He described the procedure as the nurse passing a tube through his nose that is supposed to enter his esophagus. He stated that, as she started to pass the tube, he began coughing violently and when he tried to talk, he was completely unable to. He described that the nurse then tried to get him to drink some water, which he was unable to swallow and coughed right back up all over. He says she then got the doctor, who came in and told him she couldn't do the test until he stopped coughing, which he was obviously unable to do. He says he was still unable to talk "I had no voice at all", and after aabout 5 more minutes, they finally pulled the tube. He says, "The doctor had no answers at all. She said that it didn't sound like an allergic reaction or a stroke (Huh?), but they would try again", which he's clearly hesitant to do.

Now, I'm not a GI nurse, but I've passed enough NGTs that if a person can't swallow at all, and certainly suddenly can't talk, it seems pretty clear that it was an accidental intubation. Since other posters were suggesting that it was an allergic reaction, I decided to explain accidental intubation. I told them that, while I wasn't there and can't say for sure, that's certainly what it sounds like. I explained that it's not a rare event, but should be recognized immediately. I'm concerned that the nurse didn't pull the tube right away, and that the doc didn't seem to want to either, but I didn't say so. This guy is a young, healthy Type A with poss GERD as his only medical issue.

Once I explained what I thought happened (and reiterating that it was just my theory from the patient's description), the poster agreed that it made sense. I encouraged him to ask the doctor about placement confirmation and Cetacaine spray, etc...but to continue with treatment. I don't want him to be frightened of further treatment, nor did I ever question anyone's skill (at least out loud!)

However, now several posters have stated that they think the NURSE is a "freaking idiot" and how they wouldn't let her near them again. My question to you guys is...should I point out that the doc also didn't recognize the situation? I mean, I'm not sure it's my place to make him question his doc's ability (even though I personally do!), but I'm getting a little defensive that the nurse is being blamed. Should I just butt out? This is a nice guy who I've known online for a while, and has helped me with various computer issues in the past. I really want to tell him to find a different GI doc, but again...I don't think it's my place. Should I just let his nurse take the heat, and hope that maybe he'll continue treatment, and maybe get lucky with an easy placement next time? What would you tell him?

Thanks!

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Doctors are not God. They make mistakes too. Why should the nurse take the blame alone. I would think the doc would suggest that maybe it was placed wrong.

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Specializes in ICU.

If the nurse was inexperienced, I could understand her not knowing what was going on (sort of--you should know there are two places the tube can go), but a GI doctor should have recognized it instantly. Scary. I always feel bad when patients get doctors that we know are terrible, but they don't know that and have so much trust.

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i wouldn't have any problem in pointing out that doctor or nurse didn't realize tube was in trachea/lungs.

before anything else, a pt has a right and expectation to remain safe.

leslie

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Specializes in LTC, assisted living, med-surg, psych.

First of all, I would caution you against offering anyone any sort of medical advice, especially when it's someone you only "know" online.

I see you are a new nurse, and the natural thing for new nurses is to try to help people in every way possible. However, in one's eagerness to be of assistance, one can inadvertently stray beyond a nursing scope of practice, in this case, trying to decide who's most at fault in this incident.

FWIW, I'd be extremely nervous about being cared for by a GE who apparently can't recognize when a NGT isn't where it's supposed to be, let alone the nurse inserting the tube. That's Nursing 101---anyone who's done more than one or two should know that you pull the tube IMMEDIATELY if it becomes obvious that it's not where it belongs! I would even go so far as to suggest that your friend try another doctor.

But beyond that, I think you'd best stay away from the blame game......it doesn't promote better patient care, all it does is clog up the court system and make lawyers richer. JMHO as an old, crusty nurse.;)

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Specializes in ER.
First of all, I would caution you against offering anyone any sort of medical advice, especially when it's someone you only "know" online.

I see you are a new nurse, and the natural thing for new nurses is to try to help people in every way possible. However, in one's eagerness to be of assistance, one can inadvertently stray beyond a nursing scope of practice, in this case, trying to decide who's most at fault in this incident.

FWIW, I'd be extremely nervous about being cared for by a GE who apparently can't recognize when a NGT isn't where it's supposed to be, let alone the nurse inserting the tube. That's Nursing 101---anyone who's done more than one or two should know that you pull the tube IMMEDIATELY if it becomes obvious that it's not where it belongs! I would even go so far as to suggest that your friend try another doctor.

But beyond that, I think you'd best stay away from the blame game......it doesn't promote better patient care, all it does is clog up the court system and make lawyers richer. JMHO as an old, crusty nurse.;)

I totally understand what you're saying, and I appreciate it. And I guess that's what I'm asking. I'm comfortable that all I did was give a basic A&P example, that anyone who has a decent knowledge of the body would know. He was concerned that it was an allergic reaction, and that was preventing him from from following up. I have no problem correcting an erroneous misconception, in an effort to make someone more knowledgeable with their care. I didn't give medical advice, rather encouraged more communication with his doctor.

But now other folks are blaming the nurse, and like you're saying...I don't want to get in a blame game. However, it burns me that the doc is getting a free pass. I have three options....1) Posting something along the lines of, "Hey now...doc didn't recognize the situation either!... B) Just letting it go, and hope my friend communicates with the doctor, and let everyone involved think it was the nurse's sole fault....or Pi) Sending a PM to each person who is calling the nurse an idiot and reminding them that doc screwed up to, but leaving the OP out of it.

I really want to scream, "OMG! Run, don't walk to another doctor! I wouldn't let that doc put air in my tires, let alone tubes in my body!" But obviously, I'm not gonna do that :D (Unless you guys think that would be ok! LOL!)

FWIW, I may be a new nurse, but I'm also a crusty old paramedic. :smokin: I'm comfortable with my line between helping and interefering. I just hate leaving some poor nurse as the sacrificial lamb...

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i'm sorry zamboni, but i'm still not understanding why one wouldn't point out that the doc also missed this?

and as marla said, this is nsg 101.

i would expect 2nd yr students and new nurses to know this...that the placement was way off.

frankly, it is very scary that both missed the mark.

and if anyone can explain to me why these forum members shouldn't know that the doc was off too, please tell me.

leslie

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How about suggesting that the patient ask his doctor if the tube entering the larynx is a possible explanation for what happened, rather than an allergic reaction?

You will have done patient teaching (anatomy and complications of NGT placement) and you will have promoted self-advocacy. You won't have made a medical diagnosis.

You will have suggested that the doctor has some assessment responsibility here without blaming, and you may, if the patient actually follows through, have indirectly delivered the doc a much needed whap upside the head.

Could be the doctor was shielding the nurse all along - though why s/he didn't pull the tube right away makes no sense.

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How about suggesting that the patient ask his doctor if the tube entering the larynx is a possible explanation for what happened, rather than an allergic reaction?

You will have done patient teaching (anatomy and complications of NGT placement) and you will have promoted self-advocacy. You won't have made a medical diagnosis.

You will have suggested that the doctor has some assessment responsibility here without blaming, and you may, if the patient actually follows through, have indirectly delivered the doc a much needed whap upside the head.

Could be the doctor was shielding the nurse all along - though why s/he didn't pull the tube right away makes no sense.

That seems like the perfect solution. Great idea.

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Specializes in Adult Cardiac surgical.

"Now, I'm not a GI nurse, but I've passed enough NGTs that if a person can't swallow at all, and certainly suddenly can't talk, it seems pretty clear that it was an accidental intubation."

Of course the pt. is intubated--there is a tube inside the pt. The question is whether the tube was in the esophagus or trachea. Be careful of using the work "intubation" in general terms. A pt. may be "intubated" but not intubated via the trachea.

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Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

Ahem....could it be she is NOT A NURSE? That might explain a few or a lot of these questions. If friend goes back he shoud insist the doctor do the procedure himself and let the nurse either leave or just observe.

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Specializes in med-surg.
Ahem....could it be she is NOT A NURSE? That might explain a few or a lot of these questions. If friend goes back he shoud insist the doctor do the procedure himself and let the nurse either leave or just observe.

Amazing how many MAs in MD offices present themselves as nurses. I started having an issue with this over a decade ago when a 'nurse' turned my mom's arm black and blue with a venipuncture. I later found out the MD had gotten rid of his RNs and replaced them with MAs to save money. Needless to say, we quit using that physician. Invasive procedure=RN, LNP, PA or MD.

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