Incompetent nurses

i think you guys are being a bit hard on this prodigy. he was the first laugh i had tonight after getting home from the er. show appreciation where needed.

UGHHHH!! Find a different profession or pursue counseling.

I will admit I did come off harsh. The statement of having RN's block traffic was uncalled for. Consider this statement withdrawn.

Keith, I thought your post was very well written and had many valid points.

I am a seasoned ER RN with quite a bit of trauma experience. But I have not had first responder training. If I was first on scene, then I would be better than a lay person. If EMS was there first, then I would defer to their judgement, including me directing traffic, if that's what was needed.

The problem with nursing school and new nurses, is that you only get a tiny bit of exposure to many, many disease proccesses, procedures, medications, teaching strategies, etc. Nursing has come a long way in the past 40 years. There are many specialized areas that need specialized knowledge. Even the "simple" area of med/surg is now a specialized floor.

I graduated in 1991 and did not receive ANY teaching in regards to arrhythmias. It wasn't until I was a practicing RN that I took a class and ACLS. Even now, my knowledge is sufficient for the "down and dirty" rhythms that I need to know in the ER. But I doubt that I could read the subtle rhythms that a non-licensed monitor tech can.

What's the answer to this problem? Not more general nursing school or an advanced degree. I think we need longer internships or orientation that teaches and tests for knowledge that is specifically unit based. I think we need more required annual CEUs to renew our nursing licenses. (My home state doesn't require ANY!)

How many nurses do we all know, that once they get their license - well, that's it. No more studying. No more questions. No more learning. We've all worked with "experienced" nurses that when asked for the rationale behind a procedure say, "That's the way we've always done it." At one time they may have known the reason, but now everything is done by rote. Just because someone has been a nurse for twenty years doesn't mean that they have twenty years of experience. Maybe they've had ONE year of experience twenty times. (That's not original, so I can't take credit for it.)

Keith, the other issue that you addressed was respect (or the lack of respect) shown by RNs to ancillary personnel. You have a point. But I don't think that this is a problem with only RNs. I think this is a pervasive problem throughout our society right now. I see this everyday, from the way we all speak to each other (MD, RN, LVN, CNA, P-EMT, EMT,etc) (management to staff)(patients to staff)(children to parents/ teachers), the way we drive (road rage, running red lights, giving the finger to somebody, cutting somebody off in traffic), the devaluation of certain members of our society (the elderly, the unborn, religious conservatives - whether they be Christian, Jew, Moslem, or any other denomination), just the general lack of common courtesy or "home training" as my Mom would put it.

This problem I don't have an answer for, except maybe a little less of me, me, me, and a little more of "How can I make the next guy's load a little lighter?" And yes, I also need to work on that one myself.

Sorry if I got off track here.

Keith, while I appreciate the kudos to the "ancillary staff" such as your fellow nurses LPNS, I must say that you were a little harsh, Dude. Don't get me wrong, I think paramedics are pretty amazing people, and would rather one respond to my car wreck rather than a medical professional who is not used to the field, but rather a controlled environment.

However, I wouldn't want a paramedic to touch me in an OR. You might have superior training in some areas, but you are only taught to work out of an ambulance. I'd like to see you make sense of a surgical tray. Before nursing school, had you ever seen a Koker or a Balfour?

I have a close friend that works the field. He amazes me with the things that he's done, delivering a two pound baby alone, rescuing a kid from a burning car, but he's pretty impressed with my ability to set up an OR for a stat section in less than two minutes or to step in and actually assist with surgery if a second doc or midwife can't make it.

It's obvious that you miss the field. I'm sorry that you can't make ends meet doing a job that you love. But that gives you no right to diss our profession!

Yo, Keith, you think you could insert some paragraphs in there?

And if initials don't really matter, why did you use yours and single out a group by theirs?

May I quote you?

In response to the opening post: You have some valid points regarding some of the personnel at your facility, however, overall your post strikes me as generally hostile and disdainful towards RNs in general. I've worked with some people with this attitude, it's a good way to shut down communication and make people hostile to even your valid points of view. I suspect that you might be coming across as arrogent and holier than thou with your co-workers by the tone of your opening post.

If I or any other RN's is doing something detrimental to a patient, stop them, don't put up with this higherarchy BS that they have taught themselves.

RN's get over yourselves! You are not God's gift to modern medicine! Without the full circle of staff, we could not provide patients with any type of continuum of care. (I do understand there are more like me, so this is not to include everybody. But those that needed the previous statement- you know who you are.)

I know there are some very appreciative, competent RN's out there. I'm sorry if I have offended you this was not my intention. I wanted to try to explain the whole circle of care from pre-hospital to discharge nurse. Are there any suggestions on how we can correct these problems?

Keith Smith, NREMT-P, RN

So, I've gone back and completely reread Keith's original post and I'm not sure what's got so many people so fired up. He has not trashed ALL nurses, or ALL RNs. He's made it very clear that if he was about to make a mistake, he would want somebody to stop him, no matter what their credentials were. Maybe a lot of nurses that post here DON'T ever work with incompetent RNs. But that hasn't been Keith's experience. And to tell the truth, it hasn't been mine either.

I've worked with quite a few incompetent RNs. And MDs. And Pharmacists, lab techs, x-ray techs, RTs. There's a whole lot of people out there, in every profession, that don't have a clue to what they're doing. It's not just the medical profession, it's lawyers, politician, auto mechanics, nannies, dry cleaners, the bagger at the grocery store, the customer rep at your cable provider. You name it.

So I think calling Keith a "troll" was unneccessary and harsh. His post was not disrespectful; I didn't find it inflammatory. In fact, he may have started a thread where we can actually come up with some answers to the questions that he's posed.

Personally I could not work for a cardiac unit who doesn't monitor their own telemetry. I see trouble and death flying in the wind. I think you assume the problem is the nurse's are incompetent because your frustrated. I would be frustrated if I saw VT on a monitor and was only able to make a phone call? I like seeing my patients on telemtry monitor. I can see their HR going up and check that they are ambulating. I like to watch it after critical IV meds are given. I don't think your nurses are incompetent, I think they are disassociated from a critical monitoring tool.

I agree, it's a system problem. Good point lesly. It's a little like A-V disassociation. In my hospital we CCU nurses monitor the Med/Surg patients who require tele and I notice the same thing when I alert them regarding a rhythm change. Some of them just won't take heed. It sort of become a turf thing with some of the nurses. They don't like being told what to do.

I would definately not like the system that the OP is describing and I think it lends itself to these types of communications breakdowns.

I don't think your nurses are incompetent, I think they are disassociated from a critical monitoring tool.

Excellent point. I agree.

The situations you described wouldn't have happened in the tele unit or the CCU I worked in. I worked nights, and we didn't hesitate to call a doctor at 3 am if the pt's condition warranted it.

Nursing is like any other profession, and there are exceptional nurses just as there are incompetent nurses (and most of the rest fall under the bell shaped curve.) I've been exposed to both--as a pt and as a nurse.

Sometimes what I might see as incompetence, might be a nurse who has too many pts to manage, or a nurse who sets priorities differently than I would.

As a diabetes educator, I regularly encounter nurses who make incorrect decisions about insulin administration or don't see a late or missed insulin injection as a medication error. We are working to educate the nurses and the MD's so that our pts with DM will have better outcomes.

I worked extremely hard last week to get a pts BG controlled. I had to talk to the MD and convince him that "regular insulin according to a mild sliding scale" was not appropriate for a pt whose BG was over 500 on admission. I convinced him to order basal/bolus insulin. The next day the pts FBG was much improved, but BG ac lunch was still high. I spoke to the MD again and we revised the doses.

The pt was transferred from CCU to a tele floor late that afternoon. I returned to the office from a conference at 10 pm. I decided to check on the pt. No one could tell me what the pts' last BG was or when he last received insulin. The pt told me that the insulin I gave him at lunch was the last injection he had received. He was, however, given food in the unit before transfer. His BG was checked when he arrived to the tele floor (I had to check all the glucose meters on the floor to get this info because it wasn't documented anywhere). He was given dinner, but no insulin. (I reminded him to wait for insulin before eating, and to keep calling for the nurse until he gets the insulin).

When I checked his BG, it was again back up to the mid 300's. I don't know if the nurse omitted the insulin accidentally, or decided not to give it because his BG was 75 (not a reason to hold mealtime insulin). The nurse who was taking care of this pt had no clue what his last BG was ("I didn't get that in report.") and she had her hands full trying to complete the paperwork on a new admission.

I wrote a medication variance incident report. This is the first time I've resorted to filing such a report, but I think it may be the only way to get some nurses to realize that omitting a dose of insulin should be looked at the same as missing an antibiotic or B/P med.

Nurses are not perfect, and we should not think that all criticism of nurses is invalid.

I once wrote a column in the newspaper about EMT/Paramedics that was syndicated across the united states in response to a patients family member who was nitpicking an incident that occured with their family member and the services provided by our local Emergency Response team.

In that column, I wrote about the education and defensive driving classes, the Advanced Cardiac Life Support training, Intubation techniques and the general caring attitudes that our men and women projected and utilized in their day to day training.

I have tremendous respect for the training that these wonderful men and women recieve. Not often do I have to deal with extremely dangerous situations, fires, car wrecks, falling debris, etc that they deal with on a day to day basis.

I also think it wonderful when anyone furthers their education.

That being said, I have no negative or critical comments to make to Keith. However, i do have advice based on years of managment experience.

Utilize two departments. Your nursing service department and the Risk Managment department. Both, if the situations you presented were indeed true, need to be "in the know".

They will need specific time, date and person information.

While i hate to say there are incompentent nurses or doctors or lawyers, etc. out there in the world, the fact remains....

There are those who are incompentent for various reason. Lack of education may be one, lack of caring may be another. Lack of access of education may be a third.

I, too, in my nursing tenure have seen things that make me cringe. My goal is always to strengthen my own education and those of my co workers. When you do this the right way, all benefit.

Being critical in our profession is the equivelent of destroying our own self worth. I am highly education, but when a co worker of mine offers advice, you can bet your last dollar I listen, even to a new first year nurse.

I have always said, the day i stop listening, learning or crying over my profession, will be the day I leave it.

I am still here after seventeen years, and still love it as much as the day I entered nursing school ( back in the dark ages).

I have a wonderful telemetry tech that i work with, when he calls, my hiney jumps. Its about trust and a professional working relationship that you develop that is paramount to life saving.

Isnt that what we became a nurse for?

Respectfully to all my fellow medical personnel.

rsharpe