Mom's in the hospital... (it's a little long)

TypicalFish · Mar 17, 2006

...after having an ortho surgery. I visited her tonight and saw a few things from the nurse I'm a little concerned about. She was supposed to have clear liquid diet. When I got there at 6 she'd been asking for something to eat since 4. I told her to turn on her call light, and the PCT acted surprised she hadn't gotten a tray yet. I asked if they had a galley or something where I could go to get her some jello, juice etc. and the PCT came right back with stuff for her to eat. She hadn't been repositioned all day and c/o her bottom and back being numb/sore, so I helped her turn and got her comfy. Foley hadn't been emptied all day, the bag was about to pop. Ice packs for her incision were completely warm, and she said she'd had to wait 90 minutes to get pain pills she had to take on an empty stomach cause they still hadn't gotten her food.
I know in the grand scheme of things nothing related to my mom was a huge deal... What worried me is what I saw with her roomate receiving blood. She had the 1st unit of PRBCS hanging when I got in. The nurse hung the 2nd unit, put the BP cuff on her (and not a tele monitor cuff, just a dynamap) and hadn't been back in the room when I left an hour later. I know blood vitals vary from facility to facility, but seriously, an HOUR??????? Pt had a low grade fever when the nurse spiked the bag, 45 minutes later when the PCT did her 1900 vitals, her temp was up higher, she was really flushed and SBP was up by 40. She was resting comfortably, no distress. I'm not there in a RN role, know absolutely nothing about the pt or her history, so I didn't say anything. I think the nurse that hung it had already left, I passed a different one at the wallaroo on my way out.
So what it boils down to is that this is the first time I've been in the hospital as a visitor since I was little. Am I just being hyperaware of everything or should I have jumped in for the roomate? Maybe it's just because I come from advanced care with sicker patients and we have to be a lot more vigilant. Would you guys have spoken up? Should I have gone to that nurse or tried to find the charge?

First off-"I know in the grand scheme of things nothing related to my mom was a huge deal..." it is a big deal; your mom wasn't getting good care, and having the ice packs changed, nutrition and pain management taken care of would facilitate her having a positive outcome.

And then, well, it is easy to sit here and say "do this" or "do that" but if you had a concern about the roommate (and transfusion protocols and pretty much the same everywhere); you had an easy out "Excuse me, I'm a nursing student, and I noticed that (whatever) wasn't done; are the protocols for giving blood different here? In school they teach us XXXX." or something similar, as in "I'm just a curious nursing student, and I'm not saying that you are wrong, I'm just trying to learn"

And yes, you are hyper-aware; it is a career-hazard. But a good one-one day you'll walk into YOUR patient's room, and use that hyper-awareness to be a great nurse. Hope your mom gets better soon, and good luck.

nadjjaa · Mar 17, 2006

Hmmm...I don't think I'd say anything about the other pt because you may not have all of the facts, nor should you unless you are a nurse or student assigned to that pts care. I think it's good to learn, but there is a time and a place for it, and asking about another pt that is not under your care or a part of your clinical assignment is a confidentiality violation.

As for your mom, you have every right to find out what's going on with her care, and every right to question the staff if you don't think she's getting adequate care.

meownsmile, BSN, RN · Mar 17, 2006

I agree you had every right to make the situation with your mom known and make sure it was taken care of right away.

I think Tropicalfish's idea about inquiring about blood protocol is a great idea. It if nothing else reminds them that they havent followed protocol. That is their problem and im sure they may discuss what their policy is, but that doesnt mean you have to bring to their attention that THEY werent following what you know to be protocol. Just be the inquisitive student regarding their protocol. Im sure the minute you asked about it they would have almost run in there to do a set of vitals.

Keep up the good work, and yes you probly will have to be your mothers advocate while she is there.

LilRedRN1973 · Mar 17, 2006

Oh, how I can relate to this! In my 3rd semester of nursing school, my father-in-law was diagnosed with Acute Myelogenous Leukemia. It hit the family really hard because I married into an incredibly close family and my in-laws are VERY happily married (she calls him her "prince" and would be devastated without him). He entered the hospital just after Halloween and didn't get discharged until just before Christmas.

Every time I came to visit, I was shocked that nobody bothered to wash their hands before going in to see him (by this, I mean the nursing staff) and nobody bothered to put on isolation protection if they were going in for a short time (i.e. to drop off meds, etc) My kids were not allowed to even step foot in the room for the entire time he was there, yet the nursing staff would come out of one patient's room and head into my FIL's room without washing, donning gloves, or mask.

I remember being in the room with them and watching the nurse come in the room with a boatload of meds. She handed them over and looked expectedly at my FIL while waiting for him to take them. He politely asked what exactly all the pills were and she let out a big sigh. She told him briefly (and so fast that someone who had not been through Pharm would be completely dumbfounded). She did not tell him what they were for, etc. After she left, he leaned over and asked me to tell him why he was taking all these different medications.

I also watched her walk into the room one day while we were all washing and gowning, masking, and gloving up. I quickly asked her if she was going to put on isolation protection (my FIL was in a reverse isolation because he was neutropenic) and she became irritating, asking me "Oh, you must be the nursing student daughter-in-law" in a snide voice.

Of course, I was much aware of what was going on than most because of nursing school and by that time, I had been working in the ICU at my facility for almost a year. But I was taken aback by some of the attitudes of the nursing staff there and how they seemed to resent questions. I love it when my patients ask questions (which doesn't happen very often because most are vented...but I do get asked questions by family and are happy to do some teaching. I like to see patients taking control of their hospital visit and questioning the MD when he doesn't put on isolation gear and they know they are in isolation for MRSA. Or they ask the MD to please wash his hands. Those are the ones who usually don't end up hospitalized forever with infection after infection.

My FIL was in the hospital for so long because he did end up getting a multitude of infections and was on gentamycin, vancomycin, cipro, flagyl, zosyn, fluconazole, etc. (not all at the same time, mind you). They way they handled his situation was wrong, in my opinion and my mother-in-law was taken aback by how some of the nurses were really rude when she would inquire about some of his treatment.

I'm sorry that your mother did not have the best experience; I realize that sometimes, we do the best we can with what we have (i.e. working short staffed) but sometimes, there is just no excuse for some things.

Melanie =)

UM Review RN, ASN, RN · Mar 17, 2006

...after having an ortho surgery. I visited her tonight and saw a few things from the nurse I'm a little concerned about. She was supposed to have clear liquid diet. When I got there at 6 she'd been asking for something to eat since 4. I told her to turn on her call light, and the PCT acted surprised she hadn't gotten a tray yet. I asked if they had a galley or something where I could go to get her some jello, juice etc. and the PCT came right back with stuff for her to eat. She hadn't been repositioned all day and c/o her bottom and back being numb/sore, so I helped her turn and got her comfy. Foley hadn't been emptied all day, the bag was about to pop. Ice packs for her incision were completely warm, and she said she'd had to wait 90 minutes to get pain pills she had to take on an empty stomach cause they still hadn't gotten her food.
I know in the grand scheme of things nothing related to my mom was a huge deal... What worried me is what I saw with her roomate receiving blood. She had the 1st unit of PRBCS hanging when I got in. The nurse hung the 2nd unit, put the BP cuff on her (and not a tele monitor cuff, just a dynamap) and hadn't been back in the room when I left an hour later. I know blood vitals vary from facility to facility, but seriously, an HOUR??????? Pt had a low grade fever when the nurse spiked the bag, 45 minutes later when the PCT did her 1900 vitals, her temp was up higher, she was really flushed and SBP was up by 40. She was resting comfortably, no distress. I'm not there in a RN role, know absolutely nothing about the pt or her history, so I didn't say anything. I think the nurse that hung it had already left, I passed a different one at the wallaroo on my way out.
So what it boils down to is that this is the first time I've been in the hospital as a visitor since I was little. Am I just being hyperaware of everything or should I have jumped in for the roomate? Maybe it's just because I come from advanced care with sicker patients and we have to be a lot more vigilant. Would you guys have spoken up? Should I have gone to that nurse or tried to find the charge?

This is where "customer service" can get turned right on its ear. What you need to do now is complain to Admin that staffing levels are low enough to compromise patient care.

Why?

Because believe me, no nurse in her right mind, with a manageable assignment, would WILLINGLY leave someone like that.

This is where the fight for safer staffing levels needs to begin--with the public, with the patient and the families of patients.

Unfortunately, it takes the critical thinking of a professional nurse to spot the symptoms of short-staffing.

Please make your concerns known to management immediately. Please make it clear that scapegoating the individual nurse is not the problem, nor does it address the solution.

nursejohio, ASN, RN · Mar 17, 2006

Thanks for all the replys, I came home last night kicking myself for not speaking up then. Tomorrow will be my 1 year anniversary for graduation, so I'm still kinda new. I'm getting much better at being assertive and advocating for my pts at work, and I'm perfectly ok with stepping up for family, but I didn't know what my role is regarding moms roomate. You guys are reinforcing what I was thinking, so I'm gonna drop by consumer relations or something today.

What bugs me most is she knew I was a nurse! It got passed on in report. On my unit, knowledgable patient/family equates into do everything in that room exactly by protocol. Even if they're not your patient, you can be sure they're watching everything that happens on the other side of the curtain.

nursejohio, ASN, RN · Mar 17, 2006

First off-"I know in the grand scheme of things nothing related to my mom was a huge deal..." it is a big deal; your mom wasn't getting good care, and having the ice packs changed, nutrition and pain management taken care of would facilitate her having a positive outcome.
Oh, I'm perfectly aware of that. That's why I offered to go to the galley to get her food, find the freezer for her ice packs, go to the linen room to get pillowcases so I could help her turn. An unspoken sort of "since you guys haven't done this, where can I get what I need to?" It all got done within 10minutes of me being there.
Coming from a critical care floor though, I understand that sometimes there are more important things to do. I have been tied up with someone who was trying really hard to buy themselves an ICU bed and a vent. While I'm sorry my trauma pt is in pain, the one I'm with now is actively circling the drain if I don't get something done, so pain is not my priority right now.... That's all I meant by the "grand scheme" Sometimes other things are more important that whatever's going on with my mom, oh...like her roomie getting blood.