The situations you described wouldn't have happened in the tele unit or the CCU I worked in. I worked nights, and we didn't hesitate to call a doctor at 3 am if the pt's condition warranted it.
Nursing is like any other profession, and there are exceptional nurses just as there are incompetent nurses (and most of the rest fall under the bell shaped curve.) I've been exposed to both--as a pt and as a nurse.
Sometimes what I might see as incompetence, might be a nurse who has too many pts to manage, or a nurse who sets priorities differently than I would.
As a diabetes educator, I regularly encounter nurses who make incorrect decisions about insulin administration or don't see a late or missed insulin injection as a medication error. We are working to educate the nurses and the MD's so that our pts with DM will have better outcomes.
I worked extremely hard last week to get a pts BG controlled. I had to talk to the MD and convince him that "regular insulin according to a mild sliding scale" was not appropriate for a pt whose BG was over 500 on admission. I convinced him to order basal/bolus insulin. The next day the pts FBG was much improved, but BG ac lunch was still high. I spoke to the MD again and we revised the doses.
The pt was transferred from CCU to a tele floor late that afternoon. I returned to the office from a conference at 10 pm. I decided to check on the pt. No one could tell me what the pts' last BG was or when he last received insulin. The pt told me that the insulin I gave him at lunch was the last injection he had received. He was, however, given food in the unit before transfer. His BG was checked when he arrived to the tele floor (I had to check all the glucose meters on the floor to get this info because it wasn't documented anywhere). He was given dinner, but no insulin. (I reminded him to wait for insulin before eating, and to keep calling for the nurse until he gets the insulin).
When I checked his BG, it was again back up to the mid 300's. I don't know if the nurse omitted the insulin accidentally, or decided not to give it because his BG was 75 (not a reason to hold mealtime insulin). The nurse who was taking care of this pt had no clue what his last BG was ("I didn't get that in report.") and she had her hands full trying to complete the paperwork on a new admission.
I wrote a medication variance incident report. This is the first time I've resorted to filing such a report, but I think it may be the only way to get some nurses to realize that omitting a dose of insulin should be looked at the same as missing an antibiotic or B/P med.
Nurses are not perfect, and we should not think that all criticism of nurses is invalid.
