Published Jun 30, 2003
twinmom2k
9 Posts
I swear I am so tired of nurses that can't think for themselves and don't think for themselves. I am the weekend house supervisor for my LTC facility. This means I am in charge of pretty much everything. I love my job don't get me wrong. I just don't understand some nurses thinking process. Such as: Last Saturday we had a patient that began doing poorly. There was confusion as to whether this patient was supposed to be comfort measures only or not. Basically the family was arguing amongst themselves about what they wanted. But this really has nothing to do with my point. I was called to the unit to assess the patient. When I get there the CNA for that patient tells me she can't get a blood pressure or a good pulse ( the patient did have both she just couldn't get it) I ask the nurse what she got, and she tells me she didn't try. She just sent the CNA down to get it. With an electronic BP to boot. Now I know CNA's are trained to get vitals in our state, but come on. If you have a critical patient is that really who you want to depend on to get your vitals? And I would never use an electronic BP cuff to assess a critical patient. They are fine for routine purposes but we all know they sometimes are not reliable especially in a difficult case. The nurse was completely oblivious to the fact that she should have gotten the vitals herself.
I ended up getting the vitals myself and sending her out to the hospital. This kind of stuff just drives me crazy. It happens all the time where I work. The last weekend I worked a similar situation happened where the nurse did the exact same thing and called me to the room. I get there and there are THREE other nurses standing there all looking at me to do something. They hand me a sheet of paper that has the vitals written on it. It says b/p 78/41, Pulse of 97. So I ask who got the vitals. The CNA in the room says I did. I asked her with what and she gives me the electronic bp cuff. So I get the manual bp cuff and stethescope and take them myself. I get 108/64 and a AHR of 54. Now does this not sound ridiculous to anyone else? That not one of the other three nurses in the room doubted the accuracy of the electronic bp cuff? Not only this but once I get the vitals I go to call the doctor on this patient who is lethargic and very pale, and her nurse goes to lunch leaving me to send her out to the hospital by myself without even offering to do anything.
Okay I am done ranting. I just get so frustrated that some nurses cannot think for themselves. Sometimes they call me to a residents room and haven't even gotten vitals yet. They just want me to do everything. I don't mind helping them and usually I do it all for them. But it would be nice if they would at least offer to help and stay around to see what is going to happen.
Well thanks for letting me vent and I apologize if this is not the forum to voice my concerns.
renerian, BSN, RN
5,693 Posts
I PMd you. I am interveiwing for a role as yours. Sounds like the nurses need to be mentored on how to react in a situation like that or do you think they are being lazy waiting for someone else to give them the right thing to do or to do it for them?
renerian
duckie
365 Posts
Tired of stupid nurses, you bet and I work with plenty of them. As for "Miss or Mr. Nurse" running off to eat their lunch to leave you doing their work, I would have showed that person a seat and told them to plant their brain....I mean rump, and get busy!!!! After all, if they cannot assess a patient perhaps they could a least do the paperwork.......okay, I'll shut up now!
moonchild20002000
288 Posts
Hard to say if the problem is lack of knowlege or just laziness. Seems like renerian has the solution.
I think its time for you to talk to administration. Good luck.
4XNURSE
145 Posts
Originally posted by moonchild20002000 Hard to say if the problem is lack of knowlege or just laziness. ........ Good luck.
Hard to say if the problem is lack of knowlege or just laziness. ........ Good luck.
As one of the nurses at the hospital ER who has recieved a lot of those patients, I have to believe it is both. there are a lot of you at the LTCs that do a great job, and work at or above the "standard of care." Unfortunately there are a few who don't know what they are doing, and furthermore, are just too lazy to care. :(
Just another $0.02 from the peanut gallery.
ken
debRNo1
139 Posts
Originally posted by twinmom2k The nurse was completely oblivious to the fact that she should have gotten the vitals herself.
The nurse was completely oblivious to the fact that she should have gotten the vitals herself.
I have walked in you shoes (unfortunately) Im in a meeting and called by DON to ask WHY my resident was being sent out ????
Well the (LPN) charge nurse never did call me to assess the pt and I wasnt even AWARE that she was being sent out (for unresponsiveness) Id been here a LONG time and knew my staff well. Covering charge nurse and CNA who always tries to get her pts shipped out in this senario, furthermore this pt was difficult to say the least. I go to the room to assess her, shes not unresponsive she is ASLEEP. I ask for the vitals- CNA and nurse say "we are getting them now", however MD, family, ER, and amb had ALL been called already
Wound up not shipping her out there was no reason what so ever for her to go. Nurse pissed, CNA starts CRYING and saying how I dont trust her judgement. Since when is it the CNA's judgement to ship them out. All this poor lady needed was a diaper change and to stay in bed a little later. This was the saddest CNA I ever knew, was there for 33 years !!! When she ever told me somebody had a temp I would say, "lets retake it- come on Ill go with you............" By some miracle the pt would now be afebrile :imbar The happiest day of her life was the day I resigned.
Another time eve supervisor sent out one of my (few) "walkie-talkies" who was sent right back, another case of "unresponsiveness". Went to see her ASAP in AM and she told me they "woke me up and made me get on a strecher" Look at the chart to see what the heck went on, No VS to be found but there was a page-full of documentation about what jewery she was wearing when transferred !!! Great assessment in the diamond district but come on this is scary.........
We would work so hard to fill the beds only to have them shipped out. If I call an MD and say a pt is unresponsive- of course he will say ship them out. How do you call MD without VS didnt he ask for them ? Priority inappropriate while you sit at the desk making calls and no staff is actually tending to this unresponsive resident ?
Another pet peeve of mine. They would call 911 for "non emergency" type transfers, here would come EMS and the police with sirens blaring to take out this pt who had been running a temp !! How embarrasing and god help the person having an MI while EMS is transferring a febrile demented pt who could be treated at a supposedly SNF.
Im in the hospital now and see the other side of the coin. I get the nursing home pts who got shipped out for no good reason. We give them a day or 2 of IVAB then ship them back on PO meds
LUNCH whats that ?? Im lucky if I get off the floor for lunch by 3-4 PM To shove food down my throat and my (new grad) orientee disappears for an hour and a half on fri and mon. When he returns he asks me if I gave his 1400 meds for his 2 pts. WHAT ??? He is so un-serious about everything and scared me good when he drew up .7 cc of insulin in a TB syringe instead of the 5 "U" that pt should have gotten. OK he read the scale wrong I realize he is a new grad but shouldnt you know that upon graduation. I tried to stress what a powerful drug insulin is and showed him what 5 u looked like compared to .7 cc and he placed the blame on "whoever" put that TB syringe in the drawer marked INSULIN syringe !!!! Then he whacks me on the back and says what great critical thinking skills I have !!??
Yesterday his ONE pt ( I had 7) had a dry dsg to her foot- I asked did you do the dsg YET (1800) he said, Why dont you walk me thru it !!! Translation- do it for me !!! Cant kill anyone with a dsg so I said just change it.................
Lack of knowledge, laziness, of work ethic ? DUNNO
OK done venting TY
deb
Sometimes I really have to wonder how these nurses passed their boards. It never ceases to amaze me how clueless some nurses are. I can now understand why we have house supervisors. The really sad thing is the nurse who "went to lunch" was one of the house supervisors just before I got the job. That is really scarey. It just goes to show that management just wants to fill a position and doesn't really care who takes it. Which doesn't make me feel "special" about getting the job. But at least I know how to supervise and can take care of my patients. Before I took this position I was the one the supervisors would call when they had questions etc. This is why I felt so comfortable taking the job, I was already doing it.
Oh well. I just feel bad for the patients who are getting substandard care.
One thing I am grateful for is my college. When I was going through nursing school I hated this school. I felt like they were too strict and their grading scale was ridiculous. 80% was a C and considered failing. I got A's and B's, but still felt like it was too strict. They also were very strict about attendance and made us wear Dresses on Wednesdays. It was supposed to teach us professionalism. Well it worked. And I have never met a nurse who graduated from this school who didn't know their stuff. The nurses who worry me are not graduates of this school. So now I thank them everyday for the education I received. And when I go back for my RN next year I am going back to this school.
Anyway thanks for letting me know I am not alone.
Huq
75 Posts
I have worked with wonderful nurses and not so wonderful nurses.
In my experience the Lack of knowledge, laziness of work ethic group are the ones who are so tight with administration that nothing would get them out.
Hellllllo Nurse, BSN, RN
2 Articles; 3,563 Posts
Originally posted by Huq In my experience the Lack of knowledge, laziness of work ethic group are the ones who are so tight with administration that nothing would get them out.
Exactly.
Liann
131 Posts
Actual conversation with cardiovascular intensive care nurse:
Nurse: Heres a specimen for a type and cross. (pink top tube)
BB Technologist: OK, thanks
Nurse: Is it supposed to do that?
BBT: do what?
Nurse: Turn into a gel like that
BBT: That would be the CLOT.....
Nurse: Oh, Ok
gwenith, BSN, RN
3,755 Posts
Okay - it sounds like you need a little intervention on the nurses in question but teh question is what?
First thing to ask is Could they do it if thier life depended on it?
If teh answer is no then you need education.
Just because they have been through college does not mean that they know how to assess correctly - never mind that assessment if a major study in some places there are some major fallacies within the theoretical unperpinning of patient assessment - but that is another thread. All I will say for now is check and see if they have been taught to assess normalacy or abnormality. i.e. Do they understand teh significance of Korotkoff sounds and how these will affect an electronic BP measurment.
If the answer to our question of could they do it is yes tehn we have to ask why they will not do it and here we have several possibilities
1) motivation
2) lack of self-confidence
3) personal factors
4) laziness
Sometimes it is a matter of the "stomaltherapist effect". In hospitals who have a stomaltherapist nurses do not bother to learn how to assess and treat wounds - tehy call the stomaltherapist in hospitals that do not have this position the nurses are forced to do it themselves.
They may be sitting back because they think you will do it. In this case an inductive talk would be the best strategy. DO not "lecture" them because they will only close thier ears as they have "heard it all before". Instead have a teachig session that asks questions that challenge thier knowledge e.g. Why would you do an apical heart beat on a patient with an irregular pulse?
I hope this helps.
maah
12 Posts
The other day I went for an interview for a Nursing job. Which the Nurse interviewing me stated that she didn't think LPNs are allowed to do assessments.