Med/Surg and the Bad, Horrible, Terrible, No-Good Day

GingerSue · Mar 26, 2005

yes, it does take time to teach a patient about self-admin of insulin and related teaching. Would referral to home visiting nursing have been a possibility?

jnette, ASN, EMT-I · Mar 26, 2005

That's a da** shame, Marla. Goes to show once again just how little these docs understand about what nurses really do on the floor.. about all the many hats we wear and situations we juggle minute to minute. It's like they have no concept of all we are involved with , nor do they give a crap.

... it's just major passing the buck, wiping one's hands of the matter and go on their jolly way. :stone

"It's really no big deal" he said... well then why didn't HE offer to come back up there and educate this patient so YOU could go about caring for your others? Just what do they think? DO they even think..give ANY thought to what's involved in teaching a patient on this, and the time it consumes? Evidently not.

I don't understand why the nursing supervisor didn't step in and help you out with that one, either. Seems to me she should have been your resource.

Stuff like that just really goes all over me.

webblarsk · Mar 26, 2005

That really is a shame. But good for you, being a patient advocate, standing up for your patient. I unfortunatley know some nurses who would have sent the patient on their way! Its a shame how little doctors really understand about our job as a nurse.

~Kitty~ · Mar 26, 2005

:icon_hug:

(((Hugs)))

lee1 · Mar 26, 2005

That's a da** shame, Marla. Goes to show once again just how little these docs understand about what nurses really do on the floor.. about all the many hats we wear and situations we juggle minute to minute. It's like they have no concept of all we are involved with , nor do they give a crap.
... it's just major passing the buck, wiping one's hands of the matter and go on their jolly way. :stone
"It's really no big deal" he said... well then why didn't HE offer to come back up there and educate this patient so YOU could go about caring for your others? Just what do they think? DO they even think..give ANY thought to what's involved in teaching a patient on this, and the time it consumes? Evidently not.
I don't understand why the nursing supervisor didn't step in and help you out with that one, either. Seems to me she should have been your resource.
Stuff like that just really goes all over me.

Agree totally with the comment about the supervisor-----who obviously did NOT do her job properly, nor intervene with the MD as she should have. Good thing you made up an incident report. Hopefully all turns out well for you. Let us know. Very tough position to be in when patient's get discharged on a weekend without having proper resources in place. Personally, would not have allowed the discharge until patient knowledge acceptable and that is just where the supervisor should have stepped in.

tjusnjon · Mar 26, 2005

It all started so innocently: put on standby from 11A-3P, then called back in at 1115 because one nurse wanted to go home. I came in, happy because call-back means time-and-a-half for those first four hours. It all went downhill from there.
First thing, I get a discharge and two admits (one of which is from the doctor's office, so they have no IV or orders). The other admit has a K+ level of 2.3, so she's got to have mag sulfate plus K-riders---six of them, given over six hours---while she is to be monitored on telemetry AND closely observed for any adverse reaction. In the meantime, I have a tube-feeder who gets meds every hour or two and is having frequent diarrhea due to C.diff, two incontinent female patients who pee about every 15 minutes, and a family of 20+ people milling around the room of another patient who's expecting to be discharged.
At 4PM the doctor for this latter patient called and gave me a T.O. to D/C her with her current home meds, plus insulin, and have her follow-up with him on Monday as he was on his way out of town for Easter weekend. I took the orders, then realized something: the patient had never even been ON insulin before this hospitalization, and since she'd been admitted with altered LOC I thought she was probably NOT the best candidate for learning how to administer insulin. Not only that, I literally had no time to teach her or her family this task, you can't get hold of a diabetic educator at 1600 on the Friday of a holiday weekend, and everyone else was as busy as I was.......so I called this MD back, told him what the deal was, and his reply was "Oh, it shouldn't take more than 3 minutes to teach her how to give herself insulin. I'll see her in my office on Monday anyway". ~Click~
OK, so how does that get the patient through the weekend? I've taught insulin administration before, and it always took me an hour at bare minimum to explain the equipment and the rationales, the proper technique for drawing up the insulin and injecting it, and have the learner do a few return demonstrations, first on an orange, then on themselves and/or their family member. This patient had some mild dementia due to chronic hypoxia and her family didn't know the first thing about how to do this.......so since I didn't have time to do the proper instruction (and thought it would be irresponsible to let her go home without it) I turfed it to the next shift after unsuccessfully trying to enlist assistance from pharmacy, the nursing supervisor, and several other nurses.
Of course, by now the patient and family were becoming upset (for which I don't blame them), the MD on call was no help whatsoever ("What's the big deal? Just show her how to take the insulin and send her home") and I was getting frustrated because I'd been late with all my other patients' meds while trying to get this patient the teaching she needed. The night-shift nurse and I got the night supervisor involved since we weren't getting anywhere with the MD, and it turned out that the patient ended up staying another night after the VP of nursing threatened the doc with being reported to the Internal Med board if he didn't give us an order to hold the discharge until diabetic teaching could be done.
So then I had to write a page full of progress notes, along with an incident report, and I ended up staying an hour and a half past the end of my shift :stone The thing that bugs me, though, is that BOTH of these doctors seemed to think this was no big deal.......they didn't really care if the patient/family knew what they were doing or not, and they sure as hell didn't care that a floor nurse with five very busy patients didn't have the time to teach this task properly. The patient's doctor was too busy getting out of town, and the on-call MD couldn't have cared less. :angryfire
Now, of course, the fecal matter is on target and headed straight toward the oscillatory ventilation system, because I did write an incident report which I know is going to make the doctors look bad---and frankly, I think we ALL look bad here, myself included, because I couldn't take the time to do this teaching AND manage my other patients. You know how a hamster looks when he's running and running on that little wheel, only to fall off over and over again? That's how I felt yesterday......man, it was ugly out there, and it may get uglier before it's over with.
Did I say I love my job? OK, now I'm going to breathe deeply and say to myself: IlovemyjobIlovemyjobIlovemyjobIlovemyjob...... :stone

Hey, dont be so hard on yourself...remember..we aren't super nurses that can do EVERYTHING.

Tweety, BSN, RN · Mar 26, 2005

I feel you pain sistergirl! I feel your pain.

cannoli · Mar 26, 2005

Now you know why that other nurse wanted to go home! LOL!

steelcityrn, RN · Mar 26, 2005

I think the answer here would have been to consulted a homecare company. Because of the patients diagnosis, that would have been appropriate. Then instead of wasting all that time with documentation and phone calling, you could have been on to the next problem...Im glad someone out there still wants to work in a hospital :)

Long Term Care Columnist / Guide · Mar 26, 2005

I think the answer here would have been to consulted a homecare company. Because of the patients diagnosis, that would have been appropriate. Then instead of wasting all that time with documentation and phone calling, you could have been on to the next problem...Im glad someone out there still wants to work in a hospital :)

I agree. However, I work in a small city where they roll up the sidewalks at 5 o'clock, and that includes social services. Home health wouldn't even have seen this patient until Monday, which is when she's supposed to go back to see her physician (hope his golf game is lousy :devil: ). It was the weekend itself that was my concern........I wish docs wouldn't wait until 4 PM on Friday afternoons to discharge patients.......~sigh~

GingerSue · Mar 27, 2005

I agree. However, I work in a small city where they roll up the sidewalks at 5 o'clock, and that includes social services. Home health wouldn't even have seen this patient until Monday, which is when she's supposed to go back to see her physician (hope his golf game is lousy ). It was the weekend itself that was my concern........I wish docs wouldn't wait until 4 PM on Friday afternoons to discharge patients.......~sigh~

I guess each community differs - when I worked in community nursing, it was usual on a Friday afternoon (finish at 4:30) to expect referrals to keep coming in, sometimes some of us would be at the office until 6 p.m., just waiting for the information. And this was a 7-day a week service, with staff scheduled for weekends (and with staff on call especially for the weekend if needed). But - I guess each community differs. And my co-workers, the community nurses, were beautiful people who would have helped.