I am not "such a good nurse!", a vent

  1. No, no no no, no no.

    I am not "such a good nurse!" because I immediately had the thought that this patient's antiepileptics should be administered IV.

    His admitting diagnosis is epilepsy. He seized in his SNF. He seized in the ED. We are keeping him for a PEG because he frequently refuses/is too lethargic to take his meds and does not have capacity to make his own decisions.

    But sure, let's keep his antiepileptics PO. Let's continue to document, "Pt refused meds, MD aware, no further orders". Really?

    SPOILER ALERT he had another seizure.

    Because I recognized within five minutes of looking at the chart that this patient needed his meds IV, I am "such a good nurse!". This is the wrong idea. Yes, I made a good call. But, this is not "good" nursing. This is nursing. This is medicine. This is basic common sense. By saying that I'm going above and beyond in this instance, to me, you lower the bar for what is acceptable care. Because the fact that this was not addressed after he'd been in our building for 24 hours is abhorrent.

    Or maybe I'm just supernurse.
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    About Swellz

    Joined: Jun '12; Posts: 417; Likes: 550

    15 Comments

  3. by   JBMmom
    Depending upon who gave the compliment, I would think it was intended as a "good catch" sentiment, and yes, that's part of being a good nurse. We had a patient admitted from the psych unit into our med/surg unit and unfortunately, it's considered a discharge and readmission. None of the patient's medications were reordered upon admission. He got his 8am meds, and when I was covering for the nurse on break at 3am, he asked when he'd get his medicine and I realized he had no medications in the past 19 hours. Things happen, stuff falls through the cracks, somehow the first, second and third shift nurses all provided care and didn't realize he wasn't getting any psych meds. Fortunately, it clicked for me right away. The IV meds clicked for you. Are we awesome? No. Someday it will surely be us that missed something that next shift will pick up on. No one expects poor quality care, but mistakes happen and it's good that someone, in this case you, picked up on it. Just take the compliment, I don't think it brought the whole profession of nursing down a notch. :-)
    Last edit by JBMmom on Mar 12
  4. by   Swellz
    For context, which I suppose is important, I'm on a travel contract and this was just the most recent of several episodes of things slipping through the cracks. I know the person didn't mean to express anything other than positivity by her statement, which is why I vented here rather than at her lol. I'm just over what they consider acceptable care at this particular location.
  5. by   mmc51264
    i could tell you all kinds of stories about diabetics that are not medicated well. Misidentified as T2 when they are T1 and then they end up on an insulin gtt because no one has given them insulin in 12 hours. Changing from eating to NPO status, no change is monitoring or orders for insulin. It is my pet peeve as our "diabetes champion" people just don't have it on their radar. As a parent of 2 T1s, it is always on mine.
    becoming so much, I think a CDE test is in order soon!
  6. by   RockinNurse2018
    I get what you've saying, that you shouldn't need compliments to do your job. However, compliments in nursing are very minimal so I would accept the compliment and feel good about the situation, instead of wondering why you were given one.
  7. by   Susie2310
    Quote from RockinNurse2018
    I get what you've saying, that you shouldn't need compliments to do your job. However, compliments in nursing are very minimal so I would accept the compliment and feel good about the situation, instead of wondering why you were given one.
    I'm pretty sure the OP is not concerned about being complimented. I think he/she is concerned that his/her recognition of the problem was perceived as "good nursing" instead of the situation being perceived as a big wake up call for nurses to look out for this type of problem. The OP is saying: "This is basic nursing, folks."
  8. by   JBMmom
    Quote from Susie2310
    I'm pretty sure the OP is not concerned about being complimented. I think he/she is concerned that his/her recognition of the problem was perceived as "good nursing" instead of the situation being perceived as a big wake up call for nurses to look out for this type of problem. The OP is saying: "This is basic nursing, folks."
    I also misread the tone at first. Mistakes are made, it's good that someone usually catches them soon enough. I'm sure it's frustrating when you are in an environment that appears unsafe.
  9. by   Swellz
    Quote from Susie2310
    I'm pretty sure the OP is not concerned about being complimented. I think he/she is concerned that his/her recognition of the problem was perceived as "good nursing" instead of the situation being perceived as a big wake up call for nurses to look out for this type of problem. The OP is saying: "This is basic nursing, folks."
    Yeah maybe I said it poorly but that's what I meant. Of course the blame is really on the admitting doc and the neurologist, not the other nurses anyway. I was just pissed cuz the whole thing was avoidable. So much avoidable stuff happens here. But I only have to do this 26 more times, so there's that.
  10. by   Kooky Korky
    Quote from JBMmom
    Depending upon who gave the compliment, I would think it was intended as a "good catch" sentiment, and yes, that's part of being a good nurse. We had a patient admitted from the psych unit into our med/surg unit and unfortunately, it's considered a discharge and readmission. None of the patient's medications were reordered upon admission. He got his 8am meds, and when I was covering for the nurse on break at 3am, he asked when he'd get his medicine and I realized he had no medications in the past 19 hours. Things happen, stuff falls through the cracks, somehow the first, second and third shift nurses all provided care and didn't realize he wasn't getting any psych meds. Fortunately, it clicked for me right away. The IV meds clicked for you. Are we awesome? No. Someday it will surely be us that missed something that next shift will pick up on. No one expects poor quality care, but mistakes happen and it's good that someone, in this case you, picked up on it. Just take the compliment, I don't think it brought the whole profession of nursing down a notch. :-)
    What you describe is a very poor way to deal with meds. Whether he was a discharge/re-admit, a transfer, or whatever, his meds should have been an issue. Meds should not have been lost in the shuffle.

    Why didn't the doc or admitting nurse deal with this? But really, whoever set up this dangerous method needs to be read the riot act and the problem must be corrected immediately so thinking about what meds someone is on doesn't get lost for a couple of shifts or more.
  11. by   Orion81RN
    I get it. It's a backhanded compliment. It's like commenting to a Dad who is playing with his kid, "Wow, you're such a good Dad." No, he's just doing what a Dad is SUPPOSED to do.

    I personally wouldn't be annoyed at this, but I do get what you are saying because people don't understand the knowledge nurses have. It IS condescending to be surprised that a nurse knows something so basic.
  12. by   YUKONrn
    SNF's are a nightmare. Am I surprised he wasn't getting his antiepileptics? Nope. Chances are if he was on any pain medications or antihypertensives he wasn't getting those either. NIGHTMARE.
  13. by   Orion81RN
    Quote from YUKONrn
    SNF's are a nightmare. Am I surprised he wasn't getting his antiepileptics? Nope. Chances are if he was on any pain medications or antihypertensives he wasn't getting those either. NIGHTMARE.
    Or coumadin with INRs coming back super low and prescribers continually increasing the dose....when the real issue is he isn't even getting his coumadin. I remember this in a particular dementia pt, who if you didn't give him his meds early enough before he sundowned, he refused his meds. You couldn't even go near the guy for anything, he'd kick you.
  14. by   YUKONrn
    Quote from Orion81RN
    Or coumadin with INRs coming back super low and prescribers continually increasing the dose....when the real issue is he isn't even getting his coumadin. I remember this in a particular dementia pt, who if you didn't give him his meds early enough before he sundowned, he refused his meds. You couldn't even go near the guy for anything, he'd kick you.
    Amen. SNF's are a nightmare. You got CMA's not giving meds, diverting meds, nurses not giving or diverting meds. It's just downright dangerous. The 2 years I spent working SNF was the worst decision I made next to marrying my ex-husband.

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