what happened to nursing care?

  1. I recently traveled from my hometown to Kansas City to a big hospital to have my total knee replacement revised. The care I received there could not have been worse. I woke screaming literally in PACU, and spent the next 5 hours there while my pain was NOT controlled, and they attempted blocks I said I did not want, but kept giving me Versed to knock me out, and not pain killers. Before leaving, was told by anesthesiologist that he "ordered all kinds of pain meds so I would not hurt." I arrived in my room, and after all was set up asked for meds, and was told by the nurse , who never introduced herself that "YOU don't have anything but that PCA, push the button. NOW<move your toes. " I tried but due to an unsuccessful sciatc block that she evidently did not know about, I could not. She screamed at me do it, this is important. I said I would if I could but I can.t SHE LEFT!!! Returned to say that my dr. had said I could do it immediately post op do it now. I still couldn't. I again asked for meds, She ignored me. I spent the night lying in a CPM, with a pulse ox on one arm that went off everytime I went to sleep because I breathe lightly and it did not recognze the breathing pattern. and the IV was infiltrated, so it wasn't working for the PCA, but this nurse totally ignored me all night. The next morning I saw my nurse for a few seconds for her 10 sec. head to toe that consisted of heart sounds, two lung fields, and bowel sounds ONLY> Never did figure out how they wrote those up. I told her that I needed meds, and actually started to cry, and my friend and nurse, too , was in the room, and the nurse looked at me and said"Why didn't you ask last night instead of waiting,it is much easier to control from the start than to play catch up!"" DUHHHHHHHHHHHHH. She went out came back, with toradol, gave me a bolus of the PCA that was barely functioning due to the IV site, and some oral meds. THEN NEVER SAW HER TILL AFTER 4PM when she entered the room, and said "I know I have not been here, but I have been keeping track of you " RIGHT> I was there two days post op went home 3rd day, WAS NEVER offered a bed change, gown change , bath, ice water, NOTHING> I never even got a tray with my name as nobody ever ordered one I got the left over ones. I have never had such poor nursing care in my life. IF I had been the unit director or house supervisor, which is my own field, I would have flipped. The first night I asked for an ice pack to the knee and was told "We don't use ice" Because I had such a bad experience, I wrote for my chart, and called the unit director. When I got my chart, the cpm and ice to knee for 72 hours were all ORDERED by the DR. but the nurses just don't do it, and f patients don't tell the dr he will never know that it was not done. I HAD TO ASK FOR CPM AT NIGHT< In additon, when anesthesia came to start my IV, this "hot shot "that was angry he had to do it, walks in and starts pressing the call button, when answered he says "THis is DR so and so, I need a nurse in here to assist with an IV start."(LIKE I NEED A NURSE TO HELP START AN IV !!RIGHT) Anyway, he messes around and in a few minutes, repeats his call to the nurses station and they say ok. He finally decides to go ahead and stick, in a vein that is way too small for the diameter catheter he has, (AND IT is needed for blood) and then after getting the cath in with flash, walks around and calls again, but I started laughling, and he looks at me and I said "I am glad they don't respond better to you than me." HE just scowls and walks around and starts unhooking the other IV( which I would have had ready BEFORE I stuck) and gets things the way he wants comes back around, hooks it up and leaves. Naturally it was already clotted off, and wasn't working. SO 15 minutes later when a nurse finally comes in they pull it and page him again. HE won't come. !!!

    Anyway my point is this was the most disorganized, poor care that you could imagine. I never really knew who my nurse was, never saw one more than 5 minutes in a 12 hour shift. AND when I got my chart, found out that my pain levels were charted every 2 hours by these same nurses, as well as head to toe, incision, etc. NONE OF WHICH WAS DONE> AND my pain level was rated at 3. RIGHT that was why I begged for meds. This procedure was with long stems and was told by my dr that it was 10 times the surgery I had for original TKR and was going to be painful and long recovery. HE must have forgotten to tell the nurses.

    When I addressed this with the unit manager, I was told, that they were very sorry that my expereience had been so poor. I told her that the normal patient would not know what to expect and could not cite the things that were being not done, yet somehow found their way to the chart. HER only excuse was that she had 60% float help, which is something I had brought up as I NEVER had an ORTHRO nurse, and the others probably don;t know what to do. (Many nurses now join float pool, for higher wages, and different experiences.) SHe said the rate of surgery increased from 50 to 150 in the same amount of time. I told her NO FLOOR should be 60% float staff. MAKES NO SENSE> She assured me this would be taken care of. RIGHT>

    Please don't ignore the one reason you have a vocation. THE PATIENT! I can't stress enough that it is essential that patients be treated with respect, concern and appropriate treatment. Patients should not be left in pain, dirty, unfed, nothing to drink. Had they had their way I would never had had a drink between what was brought to me at meals, and I don;t drink milk. This was and is totally unacceptable. I don't know exactly how this happens, except that it comes from the top down. Floor nurses only get away with what their supervisor ignores, and the unit director on up to DON> As house supervisor, I visit EvERY patient in hospital, and give them my name, to call for assistance and problems and concerns. ALSO the charting treatments, exams,pain levels and so forth that are not ACTUALLY DONE< is going to kill somebody!!!! YOU MUST NOT CHART what YOU DID NOT DO> I felt the nurse who lied to me about pain meds, and would not give them to me should be FIRED> SHE DOES NOT BELONG IN NURSING>

    When I was in preop I was lamently the fact I wanted to go to the DRs private rooms above their offices, but had to be there for my procedure, and they told me "Have you seen our ortho floor? IT has all pivate rooms with 32 inch plasma tvs!!" RIGHT it DID, but I would much rather , at that point of disability, had competent nursing care, than a private room, with a big private bath and shower I did not use, and a 32 inch plasma TV!!!!!

    NOTHING CAN replace good nursing care. Think about your experiences as a patient, and over compensate as a caregiver. Had I had this surgery in a hometown hospital everyone would know I was a nurse, and it would have been different. THAT should not happen. TREAT EVERYONE like you expect to be treated. WE all need to reverse this negative nursing experience for our patients, and it is up to us individually to give the best care we can. I would hope this never happens to another patient on that floor, but I would bet it does, every day. I need a tkr on the other knee and figure he will want me to go back there, THAT will take alot of guts I don;t have right now. ALTHOUGH< since I made known my displeasure, I would probably have people falling all over me. BUT what about the others?
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    About purple1953reading

    Joined: Jan '07; Posts: 132; Likes: 39
    House Supervisor
    Specialty: ER OB NICU

    9 Comments

  3. by   chris_at_lucas_RN
    You are preaching to the choir!

    Your experience was hideous. You experienced neglect and abuse. You need to make sure this is described in writing to the director of nurses of the hospital where you had your procedure.

    Clearly you are still upset. If you truly believe (and I think you do) that there were big problems with the nursing care (and I think I agree with you), you might wish to investigate making a more formal complaint.

    But start with the DON at that hospital. Calmly, face to face, preferably with a chronological list of events, as much detail as you can remember, and anyone who observed what you experienced.

    And please make no mistake--yes we are a large group, and I'm sure a few of us aren't the best nurses all the time, but for the most part, you can bet that we are here because we have a strong dedication and commitment to our profession, to our patients, to our community and to each other.

    Again I'm sorry to hear of your experience. Be an agent of change. Start at the beginning, keep it simple, clear and (as much as possible) dispassionate. You make important points. You don't want them to be lost because someone hears your emotion and not your words, and writes the whole thing off. Future patients at that hospital are depending on you.

    Good luck.
  4. by   Susan9608
    I can totally sympathize with you. It sounds like you had a *horrible* experience, and it will probably take a while for your anger and betrayed feelings to fade away. At the very least, this experience will probably always be a very bad memory, and at worst, maybe it will freak you out about hospitals forever.

    I'm so glad to hear that you complained. Hopefully something positive will come out of your experience; maybe an effort will be made to fix those problems now.

    I had a similarly bad experience. Last November, I started having abdominal pain. I was taking fertility drugs at the time, so I just thought my ovaries were a little over stimulated. I saw my OB, who checked my ovaries, and said they were fine. So when the abd. pain persisted, I went to my regular physician. She thought the pain was from my appendix, and said I should go to the ER, as that would be the fastest way to get a CT scan and then sugery, should I need it. I get a financial break if I use my hospital's facilities (which, of course, my primary physician is not associated with) so I went to "my" ER.

    My experience in my ER was horrible. I waited 5 hours to be seen by the doctor. My husband had to go out to the nurse's station and drag a nurse into my room to give me pain medicine. The nurses, PAs, and MDs kept insisting that the pain had to be coming from my ovaries. The CT scan showed that the pain was actually in my appendix, which was severely inflamed. While I came into the ER at 0900 in the morning, I didn't get taken to the OR until 2200 that night. Before going into the preop area, they took my glasses. Then they brought me my consent to sign. When I said I couldn't read it without my glasses, the nurse told me, "OH you don't have to read it; it's just a piece of paper that lets us give you anesthesia." 4 different people - 1 surgeon, 1 anesthesiologist, and 2 nurses - came up to me in the preop area and said that they would be "assisting me" with my gallbladder removal. Since I was having my appendix removed, that didn't exactly inspire confidence in me.

    After my sugery, they put me in a semi-private room with a patient with MRSA. They also talked so loudly to and about this patient that I heard every single detail about her medical care. So much for HIPPA. I asked for medicine for nausea, then I asked for ice because my mouth was dry. My nurse told me I could have one or the other, because if I needed medicine for nausea, then I didn't need to have any ice. My husband, irate at this point, said she better bring both. She did - 2 hours later. Then she made my husband leave, threatening to call security if he didn't. I called out for pain medicine repeatedly. She gave me half my ordered dose of demerol, and then never came back to assess how effective it was. I called and called for more pain control; she finally came back after 2 hours and told me I couldn't have anything else. I told her I was a nurse, too, and that I knew that if a patient was having severe, unrelieved pain despite the ordered pain medicine, then it was her JOB to call the doctor and get a different order. She then looked at my chart and said, "Oh yeah, you can have some oral stuff." She gave me tylenol with codiene. I'm allergic to codeine. Which I told her. Which was written on my allergy band and on my chart. She had looked at the wrong chart and brought me the wrong medicine. After 45 minutes, she finally figured it out, and brought me Vicodin. I never saw her again.

    The PCA "helped" me to the bathroom. I was holding my IV pole for support. She grabbed my hand, wrenched it off the pole, and forced me to grab the IV pump itself, saying it was sturdier. So I grabbed it, and of course, it wasn't screwed on correctly, and it slid down the pole, causing me to stumble and almost fall. I declined the PCAs assistance to help me back to bed.

    I couldn't go back to sleep so I turned on my light to read. The PCA came in 3 separate times and turned my light off, telling me, "You should be asleep." So I had to turn it back on.

    In the morning, when my husband arrived, I told him about my night. He was furious. We called the day shift charge nurse into the room and complained about my night. She went out to the desk, called the night nurse at home, and then came back to my room. She said, "Well, I just called Nurse Nancy at home, and she said that everything you said isn't true. You must just like a lot of attention." I thought my husband would blow a fuse. I told her to get my doctor into the room asap, otherwise, I was leaving AMA. My day shift nurse then came in and said that she had 6 patients that day, so she didn't have a lot of time, and if I needed anything, then I should tell her now. I told her as well that if my doctor didn't get here within an hour or so, I was leaving AMA.

    When my doctor showed up, he wrote my D/C orders immediately. I had to take out my own IV, and even though hospital policy says a patient has to be wheeled out in a wheelchair, I walked because my nurse was too busy to find a wheelchair for me.

    It was a horrible experience. I wrote complaint letters to the nurse managers of the ER, OR, and the floor where I stayed, plus the CEO of the hospital and the medical director. I never heard anything back from anyone.

    I was tempted to quit my job at that point and work for a better facility, but I like my job, and my unit is nothing like that. Sometimes I still wonder fi that was the best decision to make.

    Some people have told me that the financial break should have made it all worth it. The total bill for the ER visit, surgery, and overnight stay was $36,000. We only paid about $300. But I don't think so. I'll never go there for care again, no matter how much it will cost elsewhere.

    I sure hope you get a better response to your complaints than I did. I also hope you find a way to heal from your experience. Obviously mine is still causing me a lot of anger. I hope you fare better than me. My thoughts are with you.
  5. by   gitterbug
    I am so sorry for your pain and suffering. This is a prime example of neglect, abuse, overwork and understaffing. High tech, paperwork, and rules and regulations that often do not reflect reality have replaced nursing care in many instances. I wish you the best and hope you expressed you lack of care in the questionaire you received after surgery and to the physician.
  6. by   crissrn27
    I think poor pain control in itself should be a centienal (sp?)event. There is really no reason, as many options as we have now, that a person should suffer. My sis had a ORIF of tib/fib about a year ago at my hospital. Her doc was a BIG jerk, didn't do the ORIF until 3 weeks post break (had alot of pain control issues then too), keep saying had to wait until the "swelling went down" well, the swelling was no better at week 3 than after week 1 so whatever. After the surgery she was in ALOT of pain, I have never seen someone in so much pain (and I work OB!) keep giving percs po, didn't even help a little bit.I even suggest an epidral, lol. Finally I called the charge nurse and of course he was a friend of mine, we had went to nrg. school together (now he won't talk to me, lol) and told him to get the doc there ASAP, cause she couldn't do this all night. Well, after hemming and hawing, he did, doc comes in really mad and says "looks like she is just going to have a bad night" I threw a major fit, I was the pts family member we all talk about, but it got her a hospitalist and 3 mg dilaudid IV push q 4 hours that controlled her pain every nicely and we spent a half-way decent night without screaming and crying and uncontrolled pain! All during this time the nursing staff, for the most part, we not helpful, refused to call the doc about the pain until I called the charge nurse, one actually said "she would be much better if you would just go home". The one nurse that she had that was great was the 7-3 nurse on one shift, we'll call her ann. Ann was great! She called the doc and notified about pain, elevated and actually assessed leg, etc. When we made our formal complaint about this we made sure to say ann was a great nurse and played no part in the "bad" stuff. Anyway, we know what you are going through. They were probably understaffed and busy, but pain control should be the first thing we take care of, if you take care of the pain pts are much better pts! Sorry you had such a bad time and hope you are feeling better
  7. by   Ophelia78
    What a shame you both had to undergo such terrible experiences...Does anyone know if there is another way to complain about poor care if the organization is not responsive to your complaint? JCAHO perhaps?
  8. by   purple1953reading
    The unit director first ignored my complaint, by saying she looked at my chart, and of course,found everything charted according to code. The problem was the things charted were never done. So I wrote out a specific, detailed, report of all the happenings and submitted it to her. She gave me a call back and asked that I give her a couple of days and she would call again. She apologized on all calls. In addition, though I did not know the nurses names, I cited the shift and day and they could be easily looked at on the chart. Her final dsposition was the float pool stuff. My physcian apologize through his assistant that he "never wanted that to happen to me." IT should NEVER happen to anybody was my point. I can take care of myself but what about the uneducated? My GP has urged me to contact JACHO as she says pain management is one of their biggest issues now. I am considering it. My point was for the director to directly supervise those nurses I mentioned for awhile, and see how much time was spent with patients and how much charting. They do use computer charts they carry with them. But nurses who are always at the station and available are not taking care of patients. There are many subtle hints. I also told her I thought they needed ORTHO classes and instuctions on Ortho equipment before being allowed to use it. I am passionate about patient care, and hope it improves there, though it probably was more for show than me. Perhaps, I will submitt the same letter to the DON. and see if it ever got mentioned.
  9. by   TraumaICURN
    I can't believe that you went through this. I am so sorry for your experience. I would definitely write letters to everybody that I could think of!

    Did they not know that you were a nurse, a house supervisor at that?
  10. by   CritterLover
    so horrible.
    [color=#483d8b]
    [color=#483d8b]this is what ends up happening when they increase the patient load, the charting, and all of the "extra" duties.
    [color=#483d8b]
    [color=#483d8b]as a kicker, administration only cares that the documentation looks good.
    [color=#483d8b]
    [color=#483d8b]i'm sure that, if asked, they would say that they care if the things that are charted are actually done.
    [color=#483d8b]
    [color=#483d8b]however, their actions don't support it.
  11. by   TazziRN
    Those nurses can be reported to the BON for falsifying documentation and not following MD orders.

    It doesn't matter if the staff had been 100% floats, basic nursing care is basic nursing care. A float nurse may not have a lot of ortho experience but all nurses know how to manage pain, assess CSM distal to surgical site, use ice, etc. That's basic nursing care. Got nothing, not a thing, to do with knowing ortho.

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