RNinICU

How was I supposed to know she didn't know what she was giving if she didn't ask? Had she asked, I would have explained the difference. And as far as the patient not being harmed, he had to undergo an extra dialysis treatment to remove the excess potassium. A mistake like this could have been fatal. I don't believe in being harsh with new nurses, but just like any other profession, there are some people who do not belong there. I have had my hair ruined by a bad stylist, and my meals ruined by a waitress who did not know what she was doing. A mistake made by a healthcare provider can have devastating effects. Part of my responsibility is to be a patient advocate. If anyone thinks that covering up a mistake like this is OK, then I am afraid for our profession, and our patients. By the way, I would write up a physician, a respiratory therapist, or a housekeeper if they did something to endanger a patient. I have written up a physician in fact. I don't write people up frequently. In twenty years, I have probably not written more than 5 or 6 people up. Each time there was a blatant error that jeopardized a patient.

There is a huge difference between covering for a co-worker, and covering up for a co-worker. Helping and supporting our fellow staff increases patient safety, IMO. I would never let another nurse flounder, but I would also never let another nurse compromise patient safety. I don't mind calling labs that the previous shift forgot to call, or changing a dressing that was missed. But if something critical is missed, or a serious error is made, I will document the error. For instance, a few months ago I floated to another unit. A patient with renal failure and a high potassium was ordered Kayexalate. A new nurse took KCl out of another patient's drawer, and gave that instead. Had she come to me, I would have happily explained the difference between the two meds. Instead she gave a med she was unsure of, and jeapordized a patient. This is the kind of thing that cannot be overlooked, and I did write it up.

Couldn't have put it any better than this.

I would actually like to see our hospital go back to team nursing. I think that patient satisfaction was higher, and staff was happier with this method of care delivery. LPNs at our facility are now basically med nurses, and aides do most of the direct care. I think the LPNs felt more valued when they had more patient contact. And I am not putting down CNAs, but I believe that LPNs are more likely to see a developing problem and either intervene, or bring it to the RN's attention than an aide is. There were disadvantages, too. Some times a 12-15 patient workload could be overwhelming, especially if acuity was high. You could also get tied up with a patient that was having problems, and your other patients would be slighted. All in all, I liked doing team nursing. Hope this helped a little more.

We did a form of team nursing at our hospital years ago. An RN was in charge of each team, about 12-18 patients. RNs were responsible for assessments, signing off orders, patient teaching, physician rounds, calling docs, giving IV meds and generally managing patient care. There would be two or three LPNs on the team, each assigned 5 or 6 patients. LPNs did all direct patint care, including giving meds, dressing changes, bathing, and most of the documentation. There would usually be one aide split between two teams to help with care. We have not done this kind of team nursing for years though. You may have a difficult time finding resources. Hope this helped.

I was raised in a small town, and went to an all white school. I had very little contact with other ethnic groups until I started working. We have a few Blacks working in every department of our hospital, from Nursing to Dietary, and a few Hispanics, but most of the employees are white. I have never had a problem working with any of them, and never felt uncomfortable delegating to anyone, or accepting delegation from anyone either. This thread has reminded me of several incidents where race was a factor. Please forgive me if this gets too long. I do a lot of teaching, and frequently speak on health care issues for community groups. One of my coworkers asked me to speak about breast cancer to her Church group. On the day I was speaking, I walked into the Church, and discovered that I was the only white person there. I was completely surprised, as it had never occurred to me that this was an all black Church. After the presentation, my friend asked me if I had been uncomfortable when I had first entered the Church. I had to tell her that I was a little, but more because of the size of the crowd than their color. By the way, this was one of the best audiences I ever had. They were attentive and involved in the speech, and asked a lot of questions after wards. I have gone back to this church to speak several times since, and I am always just as wel received. Another time, my husband and I were in New York City, and were a little lost. We stopped in a McDonalds to eat, and were the only white people in the restaurant. Everyone there kind of stared at us, but they did not seem hostile, just curious. For the first time I knew what it felt like to be part of a minority. Right after my daughter graduated from high school, she went to Philadelphia to work, and lived there with her brother for a while. She would frequently come home for the weekend, and often brought a friend with her. One weekend she brought home a black girl. The two of them went to a neighborhood store to pick up a few things, and my daughter came home livid. She told me that she was so humiliated for her freind because the entire time they were in the store the clerk watched them, as if he was afraid they would steal something. Keep in mind that my daughter had often visited this store and was well known there. She left the clerk know what she thought of him, and he told her she should know better than to bring that ------ into the store. My daughter was actually more upset about it than her friend was. I guess the point I am trying to make is that we have come a long way, but still have a lot farther to go. Maybe someday when we make contact with beings from another planet we can stop hating each other because than we will have someone new to hate.

I think this bears repeating.

Thanks for the suggestions. Our docs seldom use Angioseal. When they do, we have had very few problems with it. Almost all of our caths are on Integrilin or Reopro post procedure, and most of them get Plavix, too. Until now none of these meds has created a problem. One of our cardiologists always uses a Fem Stop, and he seldom has problems with bleeding, but the patients hate it. We always hold Lovenox twelve hours before caths too. ASA is a different story, it is usually only held 24 hours pre-cath. Our patients don't leave the cath lab till their ACT is 180 or less, and the cath is not pulled until it is less than 150. We have looked in to all of these things, and still found no connection. I don't think anyone thought to investigate the use of herbals or other homeopathic meds the patient might be using, but it's certianly something worth finding out about. We ask people about herbals when they are admitted, but in my experience, some people are embarrassed to admit they use them. I certianly don't mind if they start pulling sheaths in the cath lab. I hate being tied up for 20 minutes or more with my hand in someone's groin.

In our ICU, the patients usually come down from the cath lab with the sheath still in the groin, and the RNs pull them after a few hours. Until recently, we have not had too many problems with pulling them, a small hematoma on occasion, and a couple of pseudo aneurysms, but for the last two weeks, we have had some major complications. We have had five pseudos, two that required surgical intervention. We have also had two retroperitoneal bleeds, and one woman who bled so much she went into hypovolemic shock, arrested, and had to be intubated for two days. Thankfully, she survived. There have been no apparent commonalities between these cases. The caths were done by different cardiologists, and the sheaths pulled by different nurses. The cardiac docs are kind of blowing it off, saying it's just a cluster of complications, and that it's not significant that so many happened in a short time. Our Intensivist, who is also our medical director, wants all sheaths pulled in the cath lab with the doctor present. The cardiologists of course are against this. How do you handle arterial sheaths in your unit? Who pulls them, and has anyone else had these kinds of problems?

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You mean this isn't the most important thing?:roll

I will not post my location or the name of my facility on a public forum for obvious reasons. If you want to talk to me about anything that specific, you can PM me. I do work with several people who visit this board.

Most probably, this was a PEG feeding tube that was inserted through the abdominal wall for long term feedings. If it is accidentally pulled out, it can be reinserted through the opening left in the stomach wall. This is a common practice in nursing homes, but it must be reinserted carefully. Placement must be checked by aspirating stomach contents to make sure the tube is in the stomach. On occassion, the tube can pass between the abdominal wall and stomach, and instead be placed in the peritoneum. If tube feedings are given without checking for proper placement, they can be instilled into the peritoneum, causing peritonitis. In this case, it sounds as if the feedings were being instilled into the peritoneum for quite some time. I have seen this happen once before, and this lady also died. In a hospital setting, reinsertion of a PEG is usually done by EGD to prevent this kind of thing.

Last night I was scheduled to work 11-7, and was afraid I was going to end up with overwhelming responsibilities again. I called my unit to ask about acuity and staffing and was told I would be there with an LPN, two newer staff, and my orientee. Two other more experienced nurse had been called off for low census. Acuity was still high. I called the supervisor, and told her if she did not call in one of the experienced staff, I would be calling off sick. Amazingly, one of the older RNs was called in, and one of the newer people was given the night off instead. Last night went much better, and I actually got to do some teaching with my orientee. We all must start making patient safety a priority, and refuse to work with unsafe staffing levels.

Yes, we do put someone on call when they are called off for low census, but in this situation, the patient load did not increase, and we are staffed by "numbers." If we received an admission through the night, I would have been allowed to call another person in. At the beginning of the shift, I had expressed concern about the staffing, and was told by the supervisor that there was no way I was calling another person in. Our unit manager has been trying to get the staffing by numbers changed, but so far has had no success. She is frustrated herself, and is thinking of leaving her position, in part because of our staffing problems.