Patient's Safety

[jaypee88]

Hi. I am an ER Nurse in Queens NY. I want an opinion from my fellow Nurses regarding this letter or mine to my Clinical Nurse Manager.

The letter goes like this;

October 22, 2008

The goal of my letter is to know if patient's safety was compromise and to enact future policies that would address future occurrence and also to enlighten the undersigned some policies regarding the assigning of patients to each areas in the ER.

Last Tuesday night during my night shift duty, I was assigned at Area 2 with my attending MD. After the shift change, I noticed that my attending was busy with a critical patient's transfer to another hospital. This was concurred by Charge Nurse who told the undersigned that MD spent about 4 hours just to send the patient to another hospital. During that period the following was my patients and a little story about what is happening to them;

1.Patient A - patient came around 7:30pm brought by ambulance, EMS gave the following meds, epinephrine x 1, solumedrol IM 125mg, and albuterol + atrovent x3. EMS failed to get a line form the patient. A report was given to attending and ordered MG Sulfate 2grams and Solumedrol 125mg IVP. Line was made and meds given IVP. After 1 hour there was little improvement and nebulizations were given x 8. During this period there was little improvement on the patient. Luckily patient was never intubated , was given to admitting for admission around 5am. Patient was sent to room around 7:20am at the end of my shift.

2.Patient B- 83 old female admitted to MICU for respiratory failure on bi-pap at 60%. Patient was transferred to MICU around 2AM.

3.Patient C - female admitted to telemetry with a diagnosis of CHF exacerbation.

4.Patient D- 38 year old patient admitted to telemetry with diagnosis of hepatic encelopathy, with troponin of 0.63 and was put on cardiac monitor.

5.Patient E- patient with uncontrolled HTN came with systolic pressure of more than 200. Patient was eventually d/c around 4am after BP stabilized at 140 systolic.

6.Patient F - female patient with complaint increased BP and headache d/c around 4am after negative CT of the head.

7.Patient G- a patient with c/o of severe abdominal pain RUQ, medicated with morphine 4mg who was d/c around 4am.

8.Patient H- patient came around 11pm c/o of R leg pain with redness and itching. Patient eventually admitted with diagnosis of R leg cellulitis after waiting for 4 hours to be seen.

9.Patient I - Mentally challenged patient with c/o of runny nose, fever. Patient was seen after 3 to 4 hours. ABT zosyn given. Bp dropped and was given 1 Liter of NS. For reevaluation

10.Patient J - Male patient came with c/o of right

groin pain. Sonogram done in the am, sent home around 6 am with Augmentin 875mg BID and with diagnosis Right Epididymis.

11.Patient K- Female patient with complaint of asthma attack. Nebulization given with albuterol and atrovent x 3 sent home with MDI pump.

12.Patient J - patient came ETOH with back pain, refused treatment but otherwise stayed in the ER and went home after 7am.

13.Patient K- patient came around 5am with c/o of increased BP medicated with clonidine 0.2 and procardia XL 30 MG.

14.Patient L- Male patient arrived around 4 am, c/o of abdominal pain. Labs sent and was seen two hours after patient came.

During that period of shift the question is was there a time that patient's safety was in danger considering the following;

A.All the admission, including the MICU and two telemetry was being monitored by the nurse in charge of the area.

B.The attending MD was busy with a critical patients transfer to another hospital.

C.The attending MD appeared to be very tired of the work, was seen by other MD's and also this writer to be falling asleep during writing of orders and deciding who is to be d/c and to be admitted.

D.The d/c of where done after this writer informed the nursing supervisor that there was backup of so many patients to be seen and re-evaluated and an intervention was made.

E.The help from other nurses what limited to blood draw and faxing of nurse to nurse report.

The charge nurse at that time was the finest among the four charge nurses in the Emergency Room. Unfortunately, she was the only one present that shift and the other senior nurses who should have behave professionally and resolved the problem did not do anything to alleviate the problem and was contended in helping blood draw which an elementary skill for nurses.

I hope and pray that my letter would be addressed and I am willing to sit with anyone to plan and implement a corrective action that would improve the assigning of patients based on patient's acuity.

:argue:

[canoehead, BSN, RN]

Rip it up. You are complaining about conditions that are normal, though dangerous, and admin won't like having someone point it out. You will have a target on your back because you dared to speak up.

[northshore08]

You need to talk with the charge nurse that was working with you during that shift. If you decide to go on with this, you and the charge nurse must go in together. This letter will be taken more seriously with your charge nurse's participation.

I agree with canoehead about it not being good for you to do this alone. You need to debrief with other nurses; you may also need to drop some of the accusatory "nobody helps me" language and go for pt safety. The other nurses may be feeling the same.

JMHO. Good luck to you!

[Hilinenursegrl]

I'm not sure about your facility but where I work there is a chain of command and we don't just go straight to admin before going though the other channels first. Look up your policies and procedure your chain of command should be in there. Oh, and all docs are tired at work, our main ER doc starts at 8am Mon and is done, if he is lucky 5pm on Thurs. We do, as most all do, have an on call room for him to stay in. These are just conditions of the medical profession. And honestly I don't see anything too blatently neglegent or dangerous in the letter you have provided.

[Larry77, RN]

While I could see similar problems with the patients and the doc happening in my department I could not see similar problems with the staff...we work as a team, we play as a team, and we will sink as a team...if I were you I would be looking at other places of employment.