Please assess your patient well!

ADN 2002 · Apr 26, 2006

Good grief! I've had stuff left for me (not nearly as critical as yours) and it really bugs me. The IV thing would have totally freaked me out..

meownsmile, BSN, RN · Apr 26, 2006

This isnt a case of the previous nurse leaving things for the next shift. Its a case of the previous nurse just not doing the job, plain and simple. She needs to be given a written warning and put back on orientation for a few weeks. I dont care how long shes been there.

4 hours on a new patient and no orders? That smacks of in your face neglect. Sure on a 12 hour shift a head to toe assessment is only required once, but i have always said it wasnt enough. If she did one assessment at all. A lot can change with an acutely ill patient in 12 hours so its not a matter of doing the assessment and then finding a corner to hide in. GEEZZZ

The pain control thing i have run into numerous times. Irks me to no end to come in in the morning and find out people havent had any pain medication since they "tucked" them in at 10pm.

That also tells me, noone has bothered to turn them, to check for continence, to see if they were in fact even breathing.

PLEASE people offer and in fact,, just give pain meds through the night. It takes to long for these folks to get control in the morning so its almost midday before we can even do anything with them. Looks real good for physical therapy to hit the floor at 9am and everyone is in so much pain they cant even do their job because they havent had any pain pills since 10pm the night before..:angryfire

GooeyRN, ADN, BSN, CNA, LPN, RN · Apr 26, 2006

Its not only a night shift thing where pts dont get medicated. We have a few nurses on evening shift that will get an admission at 2000 and the pt is in pain, and they don't bother to call to get orders for some pain meds. In report they say pt has no c/o pain. Of course the pt tells me they have been suffering since they got there. They push it off on nights b/c the pt is should be going to sleep soon anyway. Gee, thank a lot. Now its 2330 when I do rounds and find this out. Dr. just love to be called for that stuff real late when it could have easily been taken care of earlier. Because remember, pts always sleep at night. :trout:

squeakykitty · Apr 26, 2006

The other one, the hyperventilation one was on report as "too anxious, too jumpy". By the time I got there..heck yes, but not for psych reasons....she was more distended than I have ever seen anyone, and her liver was going bad! Her IV actually blew out of its site by pure BP...I watched it!!!!!! It scared the death out of me...and she was so hypertensive and pulse nearing 200 that there was no way we were getting another in...I tried, another nurse tried..a ER nurse tried...all as we waited for the MD and the infusion nurse to show up.
She wound up in the ICU quick, and immediate surgery to deal with the amount of blood seeping into her abdomen! I caught it...but took time to get all in order before anything went forward! Needless to say the family and patient were furious, and not at me after I kept them in communication on what I was doing at all times to help! Man what a mess!!!!!
Then there was one more...admit came in at 0400, it was 0800 by the time I got to her and she had NO orders no nothing...because the other nurse didn't do anything or even assess the patient!!! I was playing catch up for three very ill and painful patients in total utter fast mode to the point I wanted to cry!
Oh yeah did I mention..one nurse short, no cna's!
If that nurse before me had done a good job, not only would I had been aware of this...but I may not have gotten all those pts in one assignment, but in good fashion between nurses! I know I did my best...but that was more than I should have ever had to deal with or be assigned! The nurse before me should have assessed and implemented things and at least gotten that full admit something written for me to know what was going on!
By the end of the day..which happened fast, I had two in the ICU only because the nurse before me didn't catch the probelms that occured on her shift, or told me what was going on...or my charge nurse!
A good report and assessment not only helps the PATIENT, but the nurse that comes after you......
Sorry for the vent here really, but wow...this was absolutely avoidable...and a good reminder of what can happen when you leave too much for the next nurse....

I'm a first year nursing student, but it seems to me that these problems should have been caught, and reported, and the new admit should have been assessed, not left for the next shift for four hours. The patient could have had something seriously wrong that needed attention right away.:nono:Also, no one should have to wait all night for hours in pain because no one gave them their pain medication.

Antikigirl, ASN, RN · Apr 26, 2006

The previous nurse was indeed written up, and we had the Nursing Management Staff come up to interview me about how my day had gone. I was so exausted I was getting dizzy...so they got some additional help for me (Thank GOD!) and by end of shift things were a little more saine!

In all of this...I got all that admit paperwork done, got two people transfered to ICU, took care of my patients ADL's and got one bed made at least, took vs, charted, and got their pain issues under control, and did a transfer in the last 15 minutes of my shift and wrote down a report for the next nurse.

Wow...I am still tired! LOL (actually I started getting a sore throat after this...I am home ill now. I was proably getting sick, but yesterday stressed me too much and I finally got it full blown! UHGGGGGGG!!!!!! I hate sore throats and not being able to swallow without pain..grrrrrrr!). But don't ya worry...taking it easy with lots of warm fluids and rest! :) Should be better in no time!

SmilingBluEyes · Apr 26, 2006

what a lot of horrible things happening there......you are right, we all would do well to take a wee bit more time to assess our patients more thoroughly....for the reasons you already have stated. It's not specific to any shift; we all could improve in some way.

UM Review RN, ASN, RN · Apr 26, 2006

Wow, Triage, I've never seen an IV do that before! Must've given you the willies!

So sorry you had a bad shift.

I've had problems like that before as well, but at least I know that the entire crew before me does bust butt despite having a lot of things working against them.

Hope it's better tomorrow. Maybe you need to have a chat with that nurse.

GooeyRN, ADN, BSN, CNA, LPN, RN · Apr 26, 2006

what a lot of horrible things happening there......you are right, we all would do well to take a wee bit more time to assess our patients more thoroughly....for the reasons you already have stated. It's not specific to any shift; we all could improve in some way.

Very well said, that we all can improve in some way. :blushkiss

Beary-nice · Apr 26, 2006

Triage,

You can tend to me anytime! Holy Cow! If anything you have stamped a reminder on my brain to assess, assess and reassess! :bow:

I can relate to situations with post op pts not being medicated for pain. I hate when I walk in and when I ask them about pain...they say "I'm okay as long as I don't move." Problem is, they should be able to move, turn, cough, deep breathe etc, etc, etc. Very disappointing when the nurse before me says "They slept and didn't ask for anything." :banghead: Okay can we all say post op pneumonia??????

Thanks for the eye-opener! Sorry your shift was so bad...I would be finding the other party and educating that person. :uhoh3:

mellomom · Apr 26, 2006

Well, I'm (sort of) glad to know the same crap happens someplace other than my facility.... The pain thing makes me crazy, we have alot of orthos and I can't count the times I have started the shift with a furious, painful patient and phone calls from (equally upset) family members. It's a good thing the nurse who had the pt previously is gone by then!

I'm glad you vented and I hope it helped! It sounds like you did awesome with lots stacked against you!

KellieNurse06 · Jan 10, 2007

wow...thats awful!!!! Obviously nobody is checking or they chose to ignore the patients complaints.......another thing that gets me as well is when there is a non verbal patient and people think just because they can't talk it means they are not in any pain......:trout: ...I can't blame you for being mad......and I am glad that nurse was written up because there is no excuse for someone being left in pain........That's why I always think of it as if it were my loved one ..that's what I did on clinical rotations at school..I always thought of how I would want my loved one treated and acted accordingly.....that kind of helped me put things in perspective.

I bet if that was that nurses loved one boy the nurse that was caring for that patient probably would of gotten reamed out from her...I'll bet ya anything.... :madface:

I am so glad we have nurses that are diligent & truly care like you obviously do......keep up the fantastic work!!!