Nurses that kill

Nurses General Nursing

Published

This happened in a hospital in the late 90's opposite a Big Ben/parliament buildings, one of the most prestigious in the UK.

I'm working my 2nd ever weekend in A&E caring for majors - that's like the middle area - they generally have 3 areas, minors, majors and resus.

Anyway, I have the left hand wall, and 4 patients, most of them look like they're going to be fine. It's a friday night, and just getting heaving, when suddenly I hear 'help me' drift across the room. But no one reacts. I begin to wonder if I imagined it, but then I hear it again, 'help me'.

I track it down, and it's a patient on the opposite side from mine, and I walk into the room to see someone who looked like he should be dead. It was a pale, african man, soaked in sweat, the whites of his eyes huge, starting out me in desperation. I automatically put my hand on his wrist, feeling for a pulse. I feel putting hands on your patient is a great way to assess things while talking to them.

I can't really feel a pulse, and he's cold and clammy to touch. Whatever is going on, it's not good.

'What are you doing?' I turned to the sound of the charge nurse, an unhappy look on her face. 'Shouldn't you be looking after you own patients?' she asked.

'Um, he called out for help, and no one else seemed to hear him'

'It's just Mr Smith, he does that all the time' she said, as if this explained everything.

'But, but..' I stammered, 'he looks really sick.'

'He's a regular, he always looks like this, so please leave.'

I reluctantly left, but 5 minutes later I heard it again, 'help me.'

I couldn't ignore him, and this time grabbed the ECG machine as I went in and quickly wired him up.

'I thought I told you to take care of your own patients' this time the charge nurse didn't hide the anger in her voice, but I ignored her as the ECG printed out.

I took one look at the ECG and ran to the nearest doctor. He took one look and asked me who this belonged to and we ran to Mr Smith's room, grabbed his bed and rushed him through to resus.

I stayed briefly, until the resus nurse took over, and I headed back to my own patients.

The doctor came round later to thank me, while the charge nurse never spoke to me again. The doctor said he couldn't believe Mr Smith was still alive. His potassium was 1.5 and the doc reckoned he did not think it possible for life at this low level.

I never found out the bigger clinical picture of why it was so low. But I'll never forget that charge nurse.

The crazy thing is, nothing happened to her. I was an agency nurse with no history and no one would believe my version of events. You see, the scary thing about agency/temp nursing is that often you fill in when a place is short or very busy, and sometimes the care you can manage is to simply fill in the gaps and not much more due to the huge workload. Another weakness (which may not be true in the USA) but in NZ and UK emergency rooms, the documentation is often pretty rushed and weak. The result is that if you go stirring things up with complaints, they will find a way to get back at you.

I would think familiarity and complacency can lead to potential tragic results. This could lead to a discussion on how making assumptions about frequent flyer patients can lead to missing critical signs & symptoms resulting in increased morbidity and mortality. Agency nurses are not exclusive to witnessing these scenarios, nurses that float to different departments can experience the same.

Your story had potential for a grand discussion as nurses' instinct or gut reaction has saved many lives

I agree that this could be a grand discussion as noted.

Maybe re-title the thread? The Intuition of Nurses. Or something.

(As an aside - Nurses THAT kill grates on my ears of course - Nurse WHO kill is easier on the ears).

Specializes in critical care.
Here's a reference to a pt with K+ of 1.2 Profound Hypokalemia.

"Our patient presented with significant dehydration and electrolyte abnormalities after several days of emesis. Most alarming of these findings was a serum potassium level of 1.2 mEq/L. The electrocardiogram showed changes consistent with hypokalemia that rapidly degraded into pulseless ventricular tachycardia. Potassium chloride of 140 mEq was hand-pushed during the resuscitation with return of spontaneous rhythm. The patient was discharge 11 days later in his prearrest state."

Hand pushed.... How much did that have to get diluted? I guess they had a central line? Wow!

Eta: bummer - followed the link and the abstract says no more. Gonna see if I can find more.

Specializes in Psych, Addictions, SOL (Student of Life).
I'm not trying to direct the discussion. I put an experience out there, and see where it goes. Agency nursing, especially in London, is quite an interesting experience, and I could share some posts about that. But while I have seen dangerous or bad charge nurses, this one was so blatant, that I had to take action - not because I felt I was saving someone's life (which I might have done) but because there was a sick man who looked sick, cried out for help, and people did nothing.

I'm also surprised no one showed surprise that someone still had a beating heart with a Potassium of 1.5 Not even the experienced doctors on that night had ever seen one that low, and did not think it compatible with life.

I thought there was quite a lot of interesting angles in this story, such as regular patients who can be taken for granted, but are really sick, or knowing when something is wrong, but not knowing what, except that your gut tells you something ain't right. But I guess others don't see the opportunity for dissection of this topic.

I think what turned people off was the title to you post. I read your post thinking "What's he trying to imply?" That the patient was calling for help and not getting attention. I work in an LTC and have a number of patients who will call for help - when no help is required. Still I respond to each accordingly. Then I though maybe he's implying that the Charge nurse in question was actually trying to kill the patient and was angry because he (OP) kept interfering? A more appropriate title might have been Bad charge nurses - or nurses that don't seem to care etc.......

Hppy

Specializes in Hospice.
Here's a reference to a pt with K+ of 1.2 Profound Hypokalemia.

"Our patient presented with significant dehydration and electrolyte abnormalities after several days of emesis. Most alarming of these findings was a serum potassium level of 1.2 mEq/L. The electrocardiogram showed changes consistent with hypokalemia that rapidly degraded into pulseless ventricular tachycardia. Potassium chloride of 140 mEq was hand-pushed during the resuscitation with return of spontaneous rhythm. The patient was discharge 11 days later in his prearrest state."

Before I had my gallbladder out (10-12 years ago), when they did labs in the ER my K+ was somewhere around 2.1. I had K+ riders up the wazoo, and oral supplements for awhile after I went home. I was completely asymptomatic.

Here's a reference to a pt with K+ of 1.2 Profound Hypokalemia.

"Our patient presented with significant dehydration and electrolyte abnormalities after several days of emesis. Most alarming of these findings was a serum potassium level of 1.2 mEq/L. The electrocardiogram showed changes consistent with hypokalemia that rapidly degraded into pulseless ventricular tachycardia. Potassium chloride of 140 mEq was hand-pushed during the resuscitation with return of spontaneous rhythm. The patient was discharge 11 days later in his prearrest state."

Now that's impressive. Was the patient particularly old or young?

Specializes in tele, ICU, CVICU.
I think what turned people off was the title to you post. I read your post thinking "What's he trying to imply?" That the patient was calling for help and not getting attention. I work in an LTC and have a number of patients who will call for help - when no help is required. Still I respond to each accordingly. Then I though maybe he's implying that the Charge nurse in question was actually trying to kill the patient and was angry because he (OP) kept interfering? A more appropriate title might have been Bad charge nurses - or nurses that don't seem to care etc.......

Hppy

I imagine (my initial thoughts when seeing post title & upon reading) OP simply meant, nurses that don't intentionally inflict harm but whose lack of actions/judgments/giving attention when it's clearly necessary cause significant harm... same as docs etc.

Potassium of 1.5???? I actually said quite a few naughty words out loud after reading and re-reading and then RE RE-reading....

Specializes in critical care.
Now that's impressive. Was the patient particularly old or young?

12 years old.

Specializes in critical care.
Before I had my gallbladder out (10-12 years ago), when they did labs in the ER my K+ was somewhere around 2.1. I had K+ riders up the wazoo, and oral supplements for awhile after I went home. I was completely asymptomatic.

That's wild. A few weeks ago I have a stomach bug that I know made my electrolytes nutty. I spent a couple of days going back and forth between trigeminy and quadreminy and had a mess of seizure activity (I'm epileptic, so not unexpected). I just took care of it at home, but I am curious about how off it was to have me be symptomatic. Then again, I am assuming. Viruses can cause the same all by themselves.

Specializes in Pediatric.

I think we've all experienced a nurse either missing something crucial (either due to being overwhelmed, new grad given too much too soon, etc,) and there are those nurses who are flat out dangerous. I had a situation recently where something was passed off to the next shift and it should have been evaluated sooner.

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