I just wanted to vent a little here. I was just assigned to a floor I don't usually work and I knew that I would be spending plenty of time locating the meds on the cart, reviewing the treatments so I could manage my time, blah, blah, blah. I ended up making about five different calls to the pharmacy to locate the medications that were not there. A couple of them were on their way, so I was reassured that they were being given. One, in particular, was a transcription error in the MAR, was not even the right medication that was written in the order in the chart. The pharmacy told me they hadn't filled the medication several WEEKS ago because the order was not the medication that they have faxed off the original DR order! The kicker is, nurses have been signing off as giving it and it has not been there! I placed the correction order with the pharmacy and changed it in the MAR so at least those nurses initialling the med can produce the med if anyone ever asked!
I'm a little neurotic, so a great deal of my nursing practice is run by, not only integrity in my own practice, but also a good dose of paranoia. What kind of response would I give a state auditor following me around for a med pass, not only unable to produce the medication, but also a confirmation from the pharmacy that it has never been sent with my initials all over the MAR?! Some of the treatments I was supposed to be giving were not available either, Triamcinolone, Lotrisome, etc.
A good friend and co-worker on my unit called me into a pt's room the other day to be witness to a pt actively dying, you could hear the fluid in the lungs from outside the door, non responsive, dropping BP. This was only two hours after shift report, in which the day shift nurse said, "so-and-so is fine" (her reports take about 10 seconds as she is walking out the door, by the way). The MAR had been initialled all day that this pt had been given meds. There is NO WAY this pt had been swallowing meds! All these situations are revolving around one particular nurse that I would not let take care of my sick tomato plant, let alone a family member. I no longer wonder why she looks rested and relaxed when I walk in, when the rest of us rarely get to sit down. It doesn't take long to sign the med book and call it a day ...
Oh, man, want a list? My favorite is one who, I swear, has probably NEVER given blood. The minute you see her name, you know that there's not going to be the first corpuscle passed. She told me in report one time that "the lab's having trouble getting the blood, the pt has a very rare blood type, weird blood factors" for a stat 2 PRBC/1FFP order on someone with a HGB of 6.9 and platelets in the toilet -- and idiot me believed her because she was so detailed about why the blood wasn't ready. I tell the US to call me the second the lab says the blood's ready, go get the tubing ready to go, assess the site to make sure it's in date and the vein's a big pipe, etc. Assess all my pts, give 2100 meds, keep checking with the desk every time I go by -- any word from the lab yet? Zip.
Finally at 2230, I call the lab to see what's up, and the lab says they called and said the blood was ready -- at 1400. There was nothing special about the woman's blood type or factors, they just had to do leukocyte reduced because she got a lot of transfusions, but that's nothing special. And they called and told the nurse who said they couldn't find the blood and TOLD her it was ready. She just couldn't be queen of the nurse's station and actually work, so she just skated the blood on someone dying from leukemia.
Very class act....and I've told my family that if something ever happened to me, she is absolutely NOT to come into my room as my nurse.
Okay, I just thought of another one, this chick drives me crazy, takes forever to give report...Room 222B is (first and last name) yeah, I know, they've been in that room for 4 months now! I really don't care how long their family was here last night, but I DO care how my liters of O2 she's on now...I don't care that it took a cup of hot chocolate to make her sleepy...or that her family was here and kept her up late.
Ugh! Anyway, this particular nurse is a very good nurse, but she has never done a catheter. EVER. And does not plan on starting now. So, she tells me one morning as I walk in the door "your going to hate me." She "couldn't find all of the supplies" (we don't have cath kits). Yeah right. She could only find a 5cc syringe and his balloon needed 30cc! OMG, what's a nurse to do? yeah, it's a PITA...but considering the guy pulled out his foley with that 30cc balloon intact and has prostate issues and now it's 4 hours later with no void except for a bit of blood, something tells me I'd better get this dying man's morphine out before I attempt to reinsert. I felt like I was torturing the poor man...
This morning she "forgot" to give a sup to a guy who hasn't had a BM in 4 days...I used to work nights, and these confused folks do best with things like supps. about 5am, before we need to get them up for the day. I couldn't convince the guy to lay back down, because he was already up for the day at 6am. *SIGH* so now we are up to 5 days without a BM.
She also forgot to offer sups. to 4 other pts. who are A&O, and give supps. to 3 other pts. Per our facility protocol, we offer milk of mag. after 48 hours, a suppository ofter 72 hours, and an enema after that if the suppository is not effective. We do MOM on day shift, and suppositories on NOC about 5am. She has worked for us for 6 months and has yet to give suppositories.
This is not a new nurse--she's been a nurse for over 30 years.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
this morning she "forgot" to give a sup to a guy who hasn't had a bm in 4 days...i used to work nights, and these confused folks do best with things like supps. about 5am, before we need to get them up for the day. i couldn't convince the guy to lay back down, because he was already up for the day at 6am. *sigh* so now we are up to 5 days without a bm.
she also forgot to offer sups. to 4 other pts. who are a&o, and give supps. to 3 other pts. per our facility protocol, we offer milk of mag. after 48 hours, a suppository ofter 72 hours, and an enema after that if the suppository is not effective. we do mom on day shift, and suppositories on noc about 5am. she has worked for us for 6 months and has yet to give suppositories.
this is not a new nurse--she's been a nurse for over 30 years.
i used to work with a nurse who was notorious for giving suppositories to all of his patients -- even if they'd been npo for the past three days. even if they'd had an enormous formed stool earlier that day. even if they had c diff, for heaven's sake! if there was a suppository order on the chart, he gave it. just before change of shift. then never went back in the room. oh, i used to hate to follow him!
i used to work with a nurse who was notorious for giving suppositories to all of his patients -- even if they'd been npo for the past three days. even if they'd had an enormous formed stool earlier that day. even if they had c diff, for heaven's sake! if there was a suppository order on the chart, he gave it. just before change of shift. then never went back in the room. oh, i used to hate to follow him!
i would have demanded that they institute a code brown team! :roll
i've followed my share of sloppy/lazy/disorganized nurses. there were just some nurses that you knew left a mess for you to clean up. while giving report, the outgoing nurse would remember things she forgot to do and pass them off to me. meds would be uncharted, meds would be late (antibiotics), the rooms were a mess, and my lines were almost always a tangled mess.
my biggest peeve in the icu is when i'd have arterial lines that were zeroed with the mattress, thus showing that the patient had a wonderful arterial blood pressure. i'd re-zero the line and spend the night chasing the blood pressure with fluid boluses or blood.
i know we all have 'off' days, and even i do sometimes, but a pattern of laziness/sloppiness is not acceptable.
Oh come on, she probably wasn't actually dead when whoever it was was feeding her.
I am not trying to vindicate the stuff that is discussed here, I have seen most of it, or a similar version myself.
A lot of you nurses are going to be like me, you won't last, whereas these you are complaining about will be home sucking up on a nice retirement someday.
A large part of the problem, the way I see it, is the belief that the modern health care system can cure anything, even death.
A LOT of patients, or their families, should take a realistic look at their conditions and make themselves DNR, (and yes I know that does not mean 'don't treat'), and when the time to go on to whatever comes next is coming , there should be some way to address that in a humane manner.
After all, even a dying animal has enough instinctual 'smarts' to stop eating.
In the LTC you have to go through the motions, even if it against all good sense.
The patient was probably fed by some CNA who tried to do what they were told they must do in order to get their paycheck.
The 'savy' CNA would have done what the 'savy' nurses who are sitting at the desk or out smoking are doing.
Let nature take it's course, and hang in there so they can make a couple of bucks to support themselves and their families.
Just playing Devils Advocate, but say the truth, sometimes preforming, or not preforming nursing care is just another way of saying 'look at me, I work so much harder than so and so".
If no one had fed this patient then the battle cry would have been, she was lethargic and no one even fed her so she got so weak she died.
Oh, I absolutely agree with you 110%. They should not be fed or maybe it's not appropriate to give the meds. Most of these nurses would rather just not have the responsibility of simply calling the doc to ask for comfort measures and call the family. Shoot, the family would probably be real happy to sit there for hours for you. Usually, they don't want to be interrupted much and there's not a TON of paperwork. I'd rather do that and write a brief note in the chart detailing what was happening than the paperwork involved in a fall! Gawd, or an admission. But I get that done.
I don't know, maybe it's not as obvious to others that someone is dying, or maybe have their own issues with it. Who knows?
Specializes in Neuroscience/Neuro-surgery/Med-Surgical/.
When our facility first introduced 'bedside nursing report' ...no one was a happy camper. Now, I am grateful we have such a policy, as NO one can stand there and lie about a patient's condition since we are both looking at the patient. It is OBVIOUS what has and has not been done. With those co-workers that are notoriously lazy, I like to start asking all kinds of questions in front of that patient/family about what the patient might need, if such and such as has been done today, would they like to be repositioned, go to the bathroom, etc... At least then I know that lazy ass RN has done something.
Many a times there have been corrections made while giving bedside report, not to mention fewer falls, because we are both there to reposition a patient, change the diaper/do peri care or get them up to the bathroom or re-applying forgotten restraints....
Specializes in Case Mgmt, Anesthesia, ICU, ER, Dialysis.
To those of you in situations where you've reported dangerous things: get a small notebook, keep it in your purse and document. No names, maybe just room numbers, but dates, times, ppl spoken with, etc. Cover your butts.
Because if someone decides to sue, it WILL come back on you as to why you didn't report it...at that point, management's memory will become very sketchy.
Don't get into charting wars, and "pointing fingers" via chart - it's unprofessional, and will come back to bite you in the butt in the long run. It's OK to say "Medication noted as being given on previous shifts, but Bob Jones, R.Ph states has not been filled in X weeks. Discrepancy report done, and So-and-So, RN, Unit Manager notified". Tell the truth, but don't look like you're pointing the finger. You are there to protect YOUR license, and nobody else's. I guarantee you they won't protect yours if push came to shove. They - coworkers and management - will hang your a$$ out to dry and offer you up as a sacrifical lamb with a side of A-1 sauce!
Find a way to maintain your own, independent, HIPPA-friendly documentation of events - it may be the only thing to save you in the long run.
SunnyAndrsn
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