Nurses I hate to follow ...

[maestrotee]

I just wanted to vent a little here. I was just assigned to a floor I don't usually work and I knew that I would be spending plenty of time locating the meds on the cart, reviewing the treatments so I could manage my time, blah, blah, blah. I ended up making about five different calls to the pharmacy to locate the medications that were not there. A couple of them were on their way, so I was reassured that they were being given. One, in particular, was a transcription error in the MAR, was not even the right medication that was written in the order in the chart. The pharmacy told me they hadn't filled the medication several WEEKS ago because the order was not the medication that they have faxed off the original DR order! The kicker is, nurses have been signing off as giving it and it has not been there! I placed the correction order with the pharmacy and changed it in the MAR so at least those nurses initialling the med can produce the med if anyone ever asked!

I'm a little neurotic, so a great deal of my nursing practice is run by, not only integrity in my own practice, but also a good dose of paranoia. What kind of response would I give a state auditor following me around for a med pass, not only unable to produce the medication, but also a confirmation from the pharmacy that it has never been sent with my initials all over the MAR?! Some of the treatments I was supposed to be giving were not available either, Triamcinolone, Lotrisome, etc.

A good friend and co-worker on my unit called me into a pt's room the other day to be witness to a pt actively dying, you could hear the fluid in the lungs from outside the door, non responsive, dropping BP. This was only two hours after shift report, in which the day shift nurse said, "so-and-so is fine" (her reports take about 10 seconds as she is walking out the door, by the way). The MAR had been initialled all day that this pt had been given meds. There is NO WAY this pt had been swallowing meds! All these situations are revolving around one particular nurse that I would not let take care of my sick tomato plant, let alone a family member. I no longer wonder why she looks rested and relaxed when I walk in, when the rest of us rarely get to sit down. It doesn't take long to sign the med book and call it a day ...

[arelle68]

I really am beginning to wonder if a couple of nurses on my unit are doing their jobs. I've seen dressings that were nine days old! NINE DAYS!

[arelle68]

I know what you're talking about. I went to apply a med that everyone has been charting that they gave. Turns out the affected area was covered with an opsite that I had put on the last time I was there. This is alert charting with, "Rsdt c/o mild pain when med was applied." NICE!

[rachelgeorgina]

I really am beginning to wonder if a couple of nurses on my unit are doing their jobs. I've seen dressings that were nine days old! NINE DAYS!

An exceptionally elderly and frail resident in the nursing home I work at has a dressing on her leg dated sixth of June. It's 6th of July today.

[Ruby Vee, BSN]

an exceptionally elderly and frail resident in the nursing home i work at has a dressing on her leg dated sixth of june. it's 6th of july today.

how old did it look? i confess that i'm perfectly capable of applying a dressing on july 6 and dating it june 6 . . . .

there's a nurse i really hate to follow. it's always the same -- he's been on the computer all day and nothing is done. once i followed him at 7 pm. "soapsuds enemas until clear" had been ordered at 9 am, but he hadn't done it because "the bucket never came up from cs." i called down, and the bucket was there before he even got his coat on. he just didn't want to do it.

[sheilagh]

OK,I've got 2 that will make your mouth drop.....

1.AAO x3 elderly female vent patient,ltc resident who though she had fragile skin had thankfully through proper nursing care NEVER had a decub.I get report and am told she has a stage 4 on her sacrum with wet to dry QD dressing changes. I had her yesterday and there was NOTHING,so I go right in after report and take a look....It was her rectum!!!!! the previous nurse(who I wouldn't let take care of ,well anyone for that matter)had thought her rectum was a decub and had packed and covered the poor woman's rectum!!!!

2.I get in report that mrs so-so ate only a little breakfast,is lethargic this morn and sleepy. I almost passed out when I did rounds cause here she was in bed with food still in her mouth and all over her,propped up in bed and oh yeah,DEAD!!!! the nurse had attempted to feed her when she was dead!!!! lethargic??? that's an understatement

[MedSurgeMess]

I have a list of my coworkers that I have given my husband, that if I end up in my hospital, he is to ask that other staff be assigned to me. Luckily, I have made it clear with local EMS that if me or my family has emergency in our area, we are to be taken to the closest facility, which is the hospital in the next county. Not that they have a great reputation, but at least I don't know all of the dirty ugly secrets....

[Nursey103, ADN, RN]

2.I get in report that mrs so-so ate only a little breakfast,is lethargic this morn and sleepy. I almost passed out when I did rounds cause here she was in bed with food still in her mouth and all over her,propped up in bed and oh yeah,DEAD!!!! the nurse had attempted to feed her when she was dead!!!! lethargic??? that's an understatement

WOW...

[lamazeteacher]

"I no longer wonder why she looks rested and relaxed when I walk in, when the rest of us rarely get to sit down. It doesn't take long to sign the med book and call it a day ... " Quote of part of OP

Doesn't the pharmaceutical dispensing system record the time and date the medication was actually removed? If you have no real proof that the meds weren't given, you might leave the nurse a note, expressing your belief that it was not possible for the dying patient to have swallowed oral medication. Ask him/her to go to medical records, where the chart will have gone, to circle the meds charted, to show they weren't given.

Of course, if those meds were essential to keep the patient alive (like K, or dig; and you know how big those K oral tabs are...); and the nurse hadn't ask for the IV version.......... you might not have to follow him/her any longer.

[quezen]

Oh come on, she probably wasn't actually dead when whoever it was was feeding her.

I am not trying to vindicate the stuff that is discussed here, I have seen most of it, or a similar version myself.

A lot of you nurses are going to be like me, you won't last, whereas these you are complaining about will be home sucking up on a nice retirement someday.

A large part of the problem, the way I see it, is the belief that the modern health care system can cure anything, even death.

A LOT of patients, or their families, should take a realistic look at their conditions and make themselves DNR, (and yes I know that does not mean 'don't treat'), and when the time to go on to whatever comes next is coming , there should be some way to address that in a humane manner.

After all, even a dying animal has enough instinctual 'smarts' to stop eating.

In the LTC you have to go through the motions, even if it against all good sense.

The patient was probably fed by some CNA who tried to do what they were told they must do in order to get their paycheck.

The 'savy' CNA would have done what the 'savy' nurses who are sitting at the desk or out smoking are doing.

Let nature take it's course, and hang in there so they can make a couple of bucks to support themselves and their families.

Just playing Devils Advocate, but say the truth, sometimes preforming, or not preforming nursing care is just another way of saying 'look at me, I work so much harder than so and so".

If no one had fed this patient then the battle cry would have been, she was lethargic and no one even fed her so she got so weak she died.

[suanna]

OK,I've got 2 that will make your mouth drop.....

1.AAO x3 elderly female vent patient,ltc resident who though she had fragile skin had thankfully through proper nursing care NEVER had a decub.I get report and am told she has a stage 4 on her sacrum with wet to dry QD dressing changes. I had her yesterday and there was NOTHING,so I go right in after report and take a look....It was her rectum!!!!! the previous nurse(who I wouldn't let take care of ,well anyone for that matter)had thought her rectum was a decub and had packed and covered the poor woman's rectum!!!!

2.I get in report that mrs so-so ate only a little breakfast,is lethargic this morn and sleepy. I almost passed out when I did rounds cause here she was in bed with food still in her mouth and all over her,propped up in bed and oh yeah,DEAD!!!! the nurse had attempted to feed her when she was dead!!!! lethargic??? that's an understatement

I think they could have charted " patient resting comfortable and offers no complaints of pain" -accurate if not very clear. I amazed that a little detail like a lack of pulse, resp, or body temprature isn't overlooked more often. The dead patients often are the quietest patients on the ward. If you tell somone thier dead you are going to have to fill out a lot of forms, do a bath, change the bed and after all that you are going to get a new real live patient that is going to DEMAND nursing care. Some nurses just don't have your eye for subtle details that indicate a change in the patients status.

[ladymahoghany]

Sheilagh, how long have that nurse been working at your hospital or had her license for that matter?