A bit of common sense to nursing?! (long)

  1. OH man..the other day I had a heck of a time, it was one of those days where we had three urgencies at one time and we were running the floor big time! However, there was a point when I felt like my charge nurse and I were the only ones that were handling the situation with good old fashioned medical common sense! Uhggggg! Let me explain...

    Seizure in one room, so I ran to the room with my charge nurse and the nurse had a pt on the toliet totally bent down and out! Her concerns were get him into bed fast...my charge and I...AIRWAY! Here I was trying to climb over her and supporting his head (you could hear he wasn't getting breaths in since his chin was at this chest and limp). I raised his head and got his airway open and he actually started to respond a bit. SO what if it is on the toliet? Then I suggested that instead of us three gals fireman carry him to a bed...to grab a chair and we could transfer him to that first...keep airway..then transfer to bed with more help (he was dead weight!). It took forever to get it all done, and my back was hurting something fierce from that crowded bathroom and heavy head/chest I had to support on my own! Patient finally gets back to bed and the next emergency happened!

    Little old lady on the floor. I go there, and again a nurse felt it was more important to get her to the bed (what..are these beds magical?). Charge and I said no...had her put her legs out to see if there was any rotation or shortening of the legs (hip check..hi we are ortho nurses!), checked the head for injury, body check...all this must be done before movement! Uhgggggg! I also suggested the same thing with the chair again, we did it..got her to a chair for more assessments, then to bed for more assessments and the fact her MD was just there, and I had him paged. She was fine, but no x-ray done on this very fragile woman...I disagreed with that since she had hip pain...but I told the next shift to get one if her pain increases...just then another little old lady was out of bed and trapped in a corner with her walker and about to fall....

    Tended her, seizure two in first room again, fell off bed (rails were down because they were putting on pads..UHGGGG! (keep those UP when unattended...pads or not...a hit on a plastic side rail doesn't match the floor hit!). Again..didn't secure airway...I had to...they were too concerned again with getting him on the bed and calling the MD...how about the here and now with the patient folks????

    Little old lady who fell climbed over the rail, on floor again! OH CALGON! They took the pulse ox on seizure dude postdictal and it was in the 80's...REALLY NOW? Of course it is...no airway open and hasn't breathed in two minutes..open that airway and let him breath...get some O's on him! (for those that don't know...you do NOT breath during seizures, so top priority post seizure is to get that airway clear so they can get that first deep breath...or just in case...a safe head position for vomit or drewl without aspirating on it!!!!).

    I just was in flabergast mode by this point? I can't be the only nurse that does this...it is simple abc and safety issues! Thank goodness I am a rather proactive person and shared my views proactively while I was helping instead of barking them...but oh brother I really wanted to bark them and say "what is wrong with you guys...patient first...stablize!".....

    Oh well...

    Anyone have similar experiences where you were just like "duh...why aren't you doing this first????".
  2. Visit Antikigirl profile page

    About Antikigirl

    Joined: Oct '04; Posts: 2,757; Likes: 415
    Happily in Nursing Education!; from US
    Specialty: 13 year(s) of experience in Education, Acute, Med/Surg, Tele, etc

    16 Comments

  3. by   Antikigirl
    BTW...all these nurses were 10+ nurses. A newer nurse I would have understood, but these were seasoned nurses who have worked ED, ICU, PCU, and Med surge all their careers! To me that makes a difference in knowing what to do...stressed or not!
  4. by   smk1
    Yikes, you need a vacation after all of that!
  5. by   Antikigirl
    LOL...no kidding...and all this happened (and more) during the last two hours of a busy day too! Uhggggggg I so went home, had a beer, took a long soak in the bath and relaxed in the bubbles. I was to work the next day...but woke up with a HA and stiff neck/sore throat, cough, elevated temp, and sweats...I called in...whew...I might have been under the weather, but no way could I pull off another panic shift like that sick!
  6. by   Larry77
    Thanks for making me thankful for being in the ED again...

    I agree with your methods and rationality...doc going to use his "magic phone" to stop the pt from seizing in his "magic bed"?
  7. by   banditrn
    Oh Triage!!! You need a hug!!

    I remember when I worked in the ICU, we had to respond to and lead all codes on the floors until a doc got there.

    I responded one nite to a patient literally on the floor - half in, half out of the BR, covered in BM - big man, and every one was running around looking for a back board or something to pick him up with!!

    I made them stop all that, and we did our code with him on the floor - I was SO impressed - a GP happened to be the first doc in, a tall skinny guy, and he INTUBATED this man on his hands and knees!! Then he took over CPR so I could do other things. I called him later and heaped praises on his head.

    The poor guy didn't make it. I don't know if he'd been down too long or what.
  8. by   banditrn
    Oh, and another thing I've seen in the LTC where I work now - calling the doctor 'before' putting O2 on a patient! Because they must have a doctors order first.

    Doesn't common sense tell you that if a patient is having respiratory distress, and their sats are going down, that you place the O2, then call for the order?
  9. by   nrsang97
    i often have had the same issues where i have previously worked. pt came in stating inability to walk. pt had hip pain and er orders and does cxr!!! i just wanted to ask them "what the h*** are you thinking?" pt cont to have paint to touch with left hip every time turning or getting on and off bedpan. asked attending to order x-ray and he refused to let me have xray that night. asked house doc and received orders but attending ended up pissed and refused to let pt have xray that night and next morning pt had bilat hip xray and pt left hip was fractured! ugggggh!!! :angryfire so needless to say if you complain you can't walk you will indeed recieve a cxr and not hip films!

    pt coding and no one started cpr until i got to the room. i was starting a iv in another room and heard the code called and walked in and no one was starting cpr!!! hello!! abc's anyone??
    that same day charge nures took nyquil at 12noon and we start work at 3pm. duh nyquil is for night and dayquil is for day!!!

    nurse who asked me and i quote "my pt has c/o chest pain and she just recieved a unit of blood. she says her pain was after she burped. should i call the house officer?" never never blow off chest pain. i told her to get a set of vs and call. later she came out and told me "her hr is 180!" had house officer up and i am telling them what to give. pt was in svt! duh!!

    same nurse as above "do i have to crush coreg to give via peg? it's so small." yes you do if you don't want the tube clogged you idiot!!

    pt has diagnosis of new onset seizures and no dialntin or anything ordered!! ok so what did you give to the pt in er. makes sense to me to put them on preventative med asap.

    oh and one last one. i arrived to my floor for my shift and i was early. pt was being coded in one room and i went in to see what was going on and there are 5 nurses 1 doctor and 3 rt in the room and the secretary was doing cpr??? why i have no idea because i thought she was supposed to be at the desk awaiting orders. instead i was answering the phone.

    this is all i can think of for now. but general common sense is way too lacking in this world any more.
  10. by   rn/writer
    Sounds like your coworkers need a refresher course in emergency priorities.

    In their defense (though there really is none and YOU obviously are on the ball) it's easy to develop tunnel vision. Even as an EMT, I was constantly reminded not to focus on the nasty-looking compound fracture until I'd managed the ABCs.

    The other kind of tunnel vision is endemic to any specialty. People tend to look through the lens of what they know. We have an adopted son who required many years of psych treatment. After one of his clinicians learned about bipolar disorder in children and adolescents being underdiagnosed, it seemed like he was running a special on bipolar kids. Remember the saying, "When all you have is a hammer, everything looks like a nail."

    In your case, skilled ortho nurses are focusing on ortho issues--to the detriment of silly things like airway and breathing.

    This could be a great opportunity for you. I don't know how your unit works, but on mine, we have to do some kind of teaching project (for patients OR for staff) throughout the year. This sounds like a made-to-order chance for you to take everyone back to the basics. Make some posters (a good place to hang them is in the breakroom or staff bathroom). Hold a brief inservice. Remind everyone in a positive way that if your patient doesn't have an airway, pretty soon, you won't have a patient.

    It's easy to forget this most humbling of medical truths. Doesn't matter if you're the premier brain surgeon in the world. You ignore airway and breathing at your--and your patient's--peril.

    Good job, Triage!
    Last edit by rn/writer on Oct 21, '06
  11. by   P_RN
    I have the T shirt about 10x over. LPN calls me to the room, pt diaphoretic, greenish tinge, confused, unsteady on feet. She and I look at each other and say PE.

    Call Dr. and he says...............I'll see him after I do this laminectomy..........call the resident and he says........I'll see him after clinic. So we call the medical attending who says "What do you want ME to do?" so I told him we need a VQ. Gosh poor guy DIDN'T have a PE. He had TWO.........

    Got a nice note from the surgeon and some candy and donuts from the family. Guess which we appreciated more..........That evening I wrote out my resignation and kept it on my computer for many years. I really don't like to doctor shop, but if my patient needs it I will.

    There was an old TV show called the Naked City.....It opened with "there are a thousand stories in the Naked City"......well there are a million when you are a NURSE and your patient needs something N O W.
  12. by   KellieNurse06
    Oh Gosh!!! I hear ya! No wonder you are exhausted! lol!
    I am only a student and not an RN yet but let me tell ya....I know exactly what you are saying!
    My daughter has home care nurses and I can tell you some "lack of common sense" stories....
    She has one who used to be an ICU nurse.....my daughter uses 120 ml of formula for a feeding...2x per day. She will open 2 cans ...1st one she will pour the remaining 120 left over into a bottle & put it in the fridge...then do the same thing for the 2nd feeding ( and the extra from both cans is put into 1 bottle)...it's like why not use the left over from the original can....duh!!!!
    and suction catheters......I open a box & rip off the top ( theres 50 in a big box) and use them all BEFORE opening a new box....she will leave the empty box and open a new box and take out some from the new box & put them in the old box.......does that make sense??????
    What else.....oh she sounds junky and I don't know why....ummmmm maybe because it's summer & very very humid with a 100% humidity index????? Did you give a nebulizer treatment???? her....no. :trout:
    oh ya also.....her heart rate is only in the 50's...........ummm maybe because she's in a deep deep sleep.......her color is ok, & she's breathing ok, right?????? .......I am not a nurse yet & I am just amazed .........
    She will also tell me I need to call the doctor to have her checked because her suction machine has an odor...or her trach sponges have junk on them in the morning..................um...ya..thats not abnormal..........duh!!!! She also opened a bunch of normal saline vials one by one to put into a sterile bottle to use for g tube flushes instead of just using sterile water like we ususally do & have done for many many years...can you imagine opening enough normal saline 3ml vials to fill an 8 oz bottle??????? Must of took her forever...lol
    Last edit by KellieNurse06 on Oct 23, '06
  13. by   TrudyRN
    Quote from banditrn
    Oh, and another thing I've seen in the LTC where I work now - calling the doctor 'before' putting O2 on a patient! Because they must have a doctors order first.

    Doesn't common sense tell you that if a patient is having respiratory distress, and their sats are going down, that you place the O2, then call for the order?
    It's a money issue, I think.
  14. by   TrudyRN
    Quote from KellieNurse06
    Oh Gosh!!! I hear ya! No wonder you are exhausted! lol!
    I am only a student and not an RN yet but let me tell ya....I know exactly what you are saying!
    My daughter has home care nurses and I can tell you some "lack of common sense" stories....
    She has one who used to be an ICU nurse.....my daughter uses 120 ml of formula for a feeding...2x per day. She will open 2 cans ...1st one she will pour the remaining 120 left over into a bottle & put it in the fridge...then do the same thing for the 2nd feeding ( and the extra from both cans is put into 1 bottle)...it's like why not use the left over from the original can....duh!!!!
    and suction catheters......I open a box & rip off the top ( theres 50 in a big box) and use them all BEFORE opening a new box....she will leave the empty box and open a new box and take out some from the new box & put them in the old box.......does that make sense??????
    What else.....oh she sounds junky and I don't know why....ummmmm maybe because it's summer & very very humid with a 100% humidity index????? Did you give a nebulizer treatment???? her....no. :trout:
    oh ya also.....her heart rate is only in the 50's...........ummm maybe because she's in a deep deep sleep.......her color is ok, & she's breathing ok, right?????? .......I am not a nurse yet & I am just amazed .........
    She will also tell me I need to call the doctor to have her checked because her suction machine has an odor...or her trach sponges have junk on them in the morning..................um...ya..thats not abnormal..........duh!!!! She also opened a bunch of normal saline vials one by one to put into a sterile bottle to use for g tube flushes instead of just using sterile water like we ususally do & have done for many many years...can you imagine opening enough normal saline 3ml vials to fill an 8 oz bottle??????? Must of took her forever...lol
    I actually had a paramedic who took us to a doctor appt because we had to have her brought by ambulance due to her vent...who actually said to me "it's scary that she was an ICU nurse"......
    She also reported an ambulance she had to go in years & years ago for getting lost because the roads were blocked off in a big city when they got there & the ambulance didn't know how to get to the hospital they were going to because the roads were all blocked off for the normal way they went there.....gee it's not like they knew it was like that....:trout: Kills me everytime I think about it..........Thankfully I have common sense.....which is a good thing...
    As a mother, you know your own child best. Try not to be too haughty, though, as you might find yourself in someone else's home someday and they might think YOU do some things that aren't "common sense". Try to be more charitable, try to educate instead of getting angry or critical. Educate people. Do it with respect and trembling because, as stated, the tables could one day be turned.

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