Genuine question that I know is going to make me sound like a TERRIBLE nurse...

Nunya, BSN · Apr 24, 2020

41 minutes ago, LibraNurse27 said:
Nurses have to review all MD orders anyway since we are the ones implementing them, so it's not extra work to look at the orders. If I see something that doesn't look right I'll ask the doctor for clarification, and I have caught a few mistakes. The doctors were grateful that I caught them. Pharmacy has also caught MD mistakes and I have caught pharmacy mistakes. Other nurses have helped prevent me from making mistakes, and so have CNAs.
I think it's good as long as the person receiving feedback is receptive and not defensive. The gray area for me is if a doctor puts in an incorrect/unsafe order and the nurse follows it, do we get in trouble or does the doctor? Or both? For an extreme example, an MD at the clinic I worked at wanted pt to get 10 units insulin and in a rush wrote 100 units. The MA gave 100 units. (pt survived btw). So who would get in trouble if the pt sued? Orders are doctors' responsibility but nurses should be able to recognize things that look wrong, in my opinion, not just blindly follow orders. Open to opinions!

For that insulin order it's both the MD and nurse's fault, but you know who's going to get thrown under the bus if the patient died. It's unfortunate that the nurse gets stuck with double checking the Dr and Pharmacy but...because I've caught doctors and Pharmacy in mistakes, but mostly doctors. Just a fact of life.

K+MgSO4, BSN · Apr 24, 2020

One group of patients I care for areolder patients with orthopedic or trauma injuries, so elective surgery, falls with fractures needing surgery to high velocity accidents involving over 65s.

The surgeons without fail round and scribble notes such as "VS stable, wounds good, dc home". This may be true but the patient may have a rip roaring delirium, be unable to go home as both arms are out of action, SO was also in the car accident etc. All of these issues are clearly documented by nursing and allied health but the surgeon does not care. Problem is I work in a health service that requires a doctor to refer to public sub acute care. Or the reason Mavis fell over and fractured her NoF was that she has been to multiple GPs and got multiple prescriptions for HTN, and is taking 120mg lasix, 100mg metoprolol etc., she needs her meds rationalized. Again, a doctor job.

I can get Mavis a nursing service to manage her meds, I can refer to private sub acute facilities (quirk of the health system) but the assessor (nurse) will review the record and state X,Y and Z needs to be sorted before they accept.

Nurses are the care coordinators. Surgeons are a disaster at the discharge stuff, physicians are much more realistic.

But a doctor putting in an order for 100 IU of insulin instead of 10IU is usually a true mistake. They were wrong but so was the nurse for not recognizing that was an abnormal dose and administering it. That is what the 5-10 Rights of medication administration are (I say 5-10 as it is an ongoing discussion about how many rights there are).

Guest219794 · Apr 24, 2020

12 hours ago, KatieMI said:
Just letting you know: nurses are not sued for every little thing. In fact, they are not sued even for quite a big things.
About 70% of nursing calls are, unfortunately, done without much reason. It takes incredible amount of time and leads to quite a lot of clinical mistakes. Those incessant calls for "something for nausea" demanding Zofran routinely end up with prolonged QT, and those insisting on "something for anxiety and agitation" end up with delirium, falls and respiratory arrests, among other things. Those calls of "you forgot to reconcile A, B and C" lead to unnecessary polypharmacy. Nurses do not get sued for all that; we do.
I will never in my life forget a nurse who was calling for an hour to get "some orders" for INR 5.3 (calculated target was 5.2 upper). She spread her nursing wings "protecting patient and herself" and got some orders and happily implemented them. It took patient 3 hours after that to die a horrendous death from DIC.
This is not personal attack. It is the fact of life, fact of the side of medicine you simply do not know about.
Have a blessed day.

Curious what the provider ordered that killed this patient in 3 hours.

buckchaser10 · Apr 24, 2020

3 minutes ago, hherrn said:
Curious what the provider ordered that killed this patient in 3 hours.

Doesn't matter, it was the nurses fault because they called *big sarcasm here*

Tegridy · Apr 24, 2020

14 hours ago, pinkdoves said:
Does anyone else wonder why the RN has to double check other people's work? The MD puts in discharge instructions, yet I have to analyze every section and write back what they did wrong???? Isn't that...THEIR JOB???? Can't they check it themselves or have another MD look? why do I have to double check them? Another case is with respiratory therapists. At my work we have to double check they are placing the patient on a different mask when ordered...isn't that THEIR job???? I get that the patient is the center of everything, but thats the MDs and RT's patient too. I just don't get why it seems I have to do everyone's job and if I don't it's my fault???????

The doctors have a lot more patients than you and often pharmacists are checking med orders, nursing are checking nursing orders, etc. the nurse is the last line before something is given or administered to a patient. So naturally you would be checking orders. Often discharge planners evaluate discharge orders also. So essentially you are griping about doing your job. You are not doing everyone’s job.

Are you the only one who doesn’t need your stuff checked? You must be an amazing individual /s

we should be monitoring each other for mistakes. I’ve been saved on both ends from others as has everyone else even if they do not admit it. The OP just wants to rant at docs and other hospital staff and it’s unwarranted. Do your job and protect your patients.

I've administered the wrong med. I’ve written orders for the wrong med. I’ve caught other nurses mistakes. I’ve missed other nurses mistakes. Instead of pissing on each other fix the system. We all have and will make errors. Luckily we are stricter on more dangerous meds and usually we slack up on ones that don’t matter as much. A mistake is a mistake and you OP will and have made them too

KatieMI, BSN, MSN, RN · Apr 24, 2020

54 minutes ago, hherrn said:
Curious what the provider ordered that killed this patient in 3 hours.

4 units of FFP, double dose of vit K IV. The patient was more or less stable on LVAD; he developed DIC during plasma infusion.

nursey · Apr 24, 2020

17 hours ago, KatieMI said:
Just letting you know: nurses are not sued for every little thing. In fact, they are not sued even for quite a big things.
About 70% of nursing calls are, unfortunately, done without much reason. It takes incredible amount of time and leads to quite a lot of clinical mistakes. Those incessant calls for "something for nausea" demanding Zofran routinely end up with prolonged QT, and those insisting on "something for anxiety and agitation" end up with delirium, falls and respiratory arrests, among other things. Those calls of "you forgot to reconcile A, B and C" lead to unnecessary polypharmacy. Nurses do not get sued for all that; we do.
I will never in my life forget a nurse who was calling for an hour to get "some orders" for INR 5.3 (calculated target was 5.2 upper). She spread her nursing wings "protecting patient and herself" and got some orders and happily implemented them. It took patient 3 hours after that to die a horrendous death from DIC.
This is not personal attack. It is the fact of life, fact of the side of medicine you simply do not know about.
Have a blessed day.

not trying to pick sides but...you really did attack him/her because you didn't agree. I.e your entire paragraph starting with "sorry I'm going to be very blunt here." sounds like youre getting mad because youre getting called out.

nursey · Apr 24, 2020

17 hours ago, KatieMI said:
Have a blessed day.

..........

beachbabe86 · Apr 24, 2020

19 hours ago, LibraNurse27 said:
For an extreme example, an MD at the clinic I worked at wanted pt to get 10 units insulin and in a rush wrote 100 units. The MA gave 100 units. (pt survived btw). So who would get in trouble if the pt sued? Orders are doctors' responsibility but nurses should be able to recognize things that look wrong, in my opinion, not just blindly follow orders. Open to opinions!

This is why Medical Assistants or Medication Aides are not to give insulin in my state,.

beesnest · Apr 24, 2020

KateMI

That sounds appropriate, but what were you thinking should have been done differently? I’m missing the error.

KatieMI, BSN, MSN, RN · Apr 25, 2020

3 hours ago, beesnest said:
KateMI
That sounds appropriate, but what were you thinking should have been done differently? I’m missing the error.

Reversal of INR which is 0.1 over target was inappropriate by itself. And, of course, reversal of INR of 5.3 with relatively normal liver function and without active bleeding and with huge risk of thrombosis already there should not include FFP.

But, in the first place, a random provider who was covering ICU at night should not be informed about this "critical value" as a single reason "to do something about it". And, if out of something there were orders to reverse INR, they should not be implemented. In essence, nothing should be done at all except continuing to monitor the patient and check INR every so many hours, just as it was done before.

beekee · Apr 25, 2020

3 hours ago, KatieMI said:
But, in the first place, a random provider who was covering ICU at night should not be informed about this "critical value" as a single reason "to do something about it". And, if out of something there were orders to reverse INR, they should not be implemented. In essence, nothing should be done at all except continuing to monitor the patient and check INR every so many hours, just as it was done before.

As a RN, my employer requires me to notify the provider of any “critical” lab value. I have no choice. They providers love it when they get the daily 6 am pages that a dialysis patient’s creatinine is 14. They know it’s ridiculous and the nurses know it’s ridiculous. I usually page with a note “no need to call, ESRD/dialysis.”

I’m not a provider and I don’t work in an ICU, so I’m not going to opine on whether the order was appropriate or if the nurse should have implemented it. The situation sounds awful for all involved, however.