tmd76

I am not meeting with the doctor and director.....just the director. My director has already emailed me and told me not to worry, that I did nothing wrong. He just wants to discuss this with me (I think because I was really upset when I emailed him this morning) The patient was not diabetic, so I am not sure why he had ITP, but he told me during my initial assessment when I asked him about all his bruises, that he had ITP (chronic).

Thank you so much for that article. I just read over it, and realized that it says that you cannot give quinine to a patient with ITP. I do think it was the infection that caused this, but I wonder if that doctor is not confused. He is thinking quinolones (cipro) cannot be given, and he probably means quinine. I am going to print this out and take it to work when I go back. I think the Cipro was given because they were weighing risks and benefits and thought the benefits were greater than the risks, since he was septic. I forgot to mention his WBC count was 26. I am sure the sepsis is the culprit though.

Update: I emailed my director, he had already gotten all the info from the doctor and my charge nurse. He said I did nothing wrong but he still wants to talk to me about it face to face, so he asked that I come see him when I work again. He said he appreciated that I started the floor orders, though I didn't have to. Although, I do regret starting the floor orders, because then I would not have been the one to give the Cipro. Then the doctor would be blaming some other poor soul.

Yeah, this doctor is very well known for doing this. He does not like me anyways because we had a fallout because I didn't do something that he forgot to write orders for. He wrote orders on a patient 1 hr after they were discharged home from the ER. He was stupid enough to time his order accurately and put it in the already put away chart, then went all the way through administration to try to get me in trouble. He was told he was wron (of course) because how could I carry out orders that were never written. He also calls the ER and yells at the secretaries because he has to push too many buttons to get through to the ER. If the docs liked him, maybe he would have a direct line to them (haha). He is just a jerk, and does not play well with others. I see this as a way to try to get me in troube for real.

It is not so much the director wanting to discuss it, but that doctor called down to the ER 5 times yesterday after the patient ended up in ICU..just harrassing the charge nurse and saying "you guys better get on this". He wants me in trouble.

Thank you so much, I will give this reference to my director. Some of the other ER docs already told me that it is too far of a stretch to say that Cipro could be the cause. They said usually the Quinolones will cause a severe drop in BP, which did not happen. Otherwise, the reaction should have happened a lot sooner. I am going to keep researching though.

That is what I am trying to find out. I don't feel like this could be my fault. I am trying to research and see if there is any relationship between Cipro and ITP. I think this guy was a code waiting to happen. All the other nurses I work with agree with me, but the ER physician that was taking care of the patient was already gone for the night. I am anxious to see what his opinion will be. He is a very intelligent and trustworthy physician, I have full confidence in him. I also know he was aware the patient had ITP. Apparently the pulmonologist was somehow not aware. I just hope this is not some personal vendetta this doctor has with me....

I have been a nurse for going on 3 years now, I have in my 10th month of ER nursing. I have had a recent fall out with a pulmonologist at the hospital I am at, and tonight I had another issue with him. I had a patient come in today with history of ITP and ESRD (on dialysis), having trouble breathing. Patient was in tripod position when I entered the room. I immediately called RT, started IV, collected blood samples, etc..then the ER doctor came to see him. He ended up with diagnosis of Pneumonia, and I sent him to the PCU on a NRB at 15 LPM. Patient's vitals were stable. The doctor wrote Cipro on the admit orders, patient was allergic to Tequin (unknown reaction). I went ahead and gave the Cipro (IVPB over one hour) before I sent him to PCU. Patient went to PCU about 30 min after Cipro was finished. Patient was stable. I got a call about 3 hrs later that the patient had coded and they needed to know what family had been in the ER earlier. The pulmonologist later called and told my charge nurse "I saw the chart, I know who the nurse was. She gave the patient Cipro, and now he has ITP". One: the patient had no reaction in the ER, shouldn't he have had a reaction long before 2 1/2-3 hrs later, and Two: The patient already had history of ITP. I spoke to the CT tech and she said the patient crashed in CT during a CT of the chest with contrast. The patient's BUN and creatinine were through the roof. I think he should not have had contrast. She said she asked the attending and the radiologist and they both approved the contrast. Does anyone have any opinion or suggestions? I have to address this issue with my director tomorrow.

I have been a nurse for going on 3 years now, I have in my 10th month of ER nursing. I have had a recent fall out with a pulmonologist at the hospital I am at, and tonight I had another issue with him. I had a patient come in today with history of ITP and ESRD (on dialysis), having trouble breathing. Patient was in tripod position when I entered the room. I immediately called RT, started IV, collected blood samples, etc..then the ER doctor came to see him. He ended up with diagnosis of Pneumonia, and I sent him to the PCU on a NRB at 15 LPM. Patient's vitals were stable. The doctor wrote Cipro on the admit orders, patient was allergic to Tequin (unknown reaction). I went ahead and gave the Cipro (IVPB over one hour) before I sent him to PCU. Patient went to PCU about 30 min after Cipro was finished. Patient was stable. I got a call about 3 hrs later that the patient had coded and they needed to know what family had been in the ER earlier. The pulmonologist later called and told my charge nurse "I saw the chart, I know who the nurse was. She gave the patient Cipro, and now he has ITP". One: the patient had no reaction in the ER, shouldn't he have had a reaction long before 2 1/2-3 hrs later, and Two: The patient already had history of ITP. I spoke to the CT tech and she said the patient crashed in CT during a CT of the chest with contrast. The patient's BUN and creatinine were through the roof. I think he should not have had contrast. She said she asked the attending and the radiologist and they both approved the contrast. Does anyone have any opinion or suggestions? I have to address this issue with my director tomorrow.

I lived in a small town (Lockhart) about 30-45 minute drive, more than I would want to commute anymore. Traffic wasn't too bad because I left so early in the morning, and then got home so late (I worked 7am-7pm), it was just a long drive. The cost of living in the towns around Austin is much cheaper than living in Austin. Buda is a nice little town with good schools and it would only be about a 20 min drive, depending on which way you go of course. Quite a few people I worked with lived in Leander, and they only took about 15-20 min to get to work, and that is a nice little town. Cost of living is more though. Some good things about Seton network though: They have profit sharing, you make your own schedule, the benefits are excellent, they have a great internship program for new nurses, they are very nurse friendly, and because they are Magnet the nurses have an enormous amount of say in the policies, procedures, and equipment used.

accidental post

I recently moved from Austin area, I worked in Austin, but commuted from a small town south of there. I worked at Brackenridge Hospital (the Regional trauma center), it is part of the Seton Network. The hospital was GREAT, I would never have left, but moved to be closer to family. I am now in Fort Worth. I like the hospital I am at, but would trade for Brack any day. Brackenridge is a Magnet hospital, the benefits are great, the people are great, and we had some great trauma doctors.

That reminds me of an MD I used to work for...he was a real tight-wad when it came to supplies, he would take is gloves off nicely and reuse them. I was working as a medical assistant for him, and he walked in and saw me throwing my gloves away. He pulled me out of the room and advised me that those are not cheap, and if I am going to throw them away then I can buy my own. I told him that reusing them defeats the purpose of wearing them and that I would not do that. I continued to use gloves and throw them away, then we ran out of my size and he didn't buy more. So, I started using his size which was too big. He then discovered it was a losing battle and bought me more. He reused other things too, such as the ear covers for the otoscope, he would buy boxes of each size, then rewash them...they said disposable on the box. He would stack them and put them back. After myself and the receptionist really giving him a hard time about it, he quit doing that. But he still reused lots of other stuff. Then he wondered why I wouldn't bring my kids to him.He asked me why one day, and I finally told him that his practice was unsanitary and that he could lose his license. I think he finally got it, and he quit doing it, but he was not happy about it. He would snarl every time he threw his gloves away. Sorry such a long post, just letting you know it goes on everywhere, unfortunately. But, it makes you a wiser patient.

I am a nursing student, and I will tell you right now...the CNA's are our best friends...they know where things are, they help us when we ask, and they are not rude to us. In return, we help them out as much as we can...at least I do. There are usually about 2 of them per floor where we do clinicals. That adds up to about 15 or more patients each, and hospital policy is to have all patients bathed with fresh linens by 11am...yeah right. So, I have learned to treat the CNA's with respect, because if stuff is not done...it will still come back to the RN in charge of them.

Have you tried actually calling a nurse recruiter at a hospital and explaining the situation. (I am just a nursing student, so I may be way off). Maybe they can look at your application, hear your side of the story, and then get you with a supervisor/floor that may be more open and understanding. After all, their job is to recruit, but alot of times I think they just send the applications over to the appropriate dept., without really going over them in detail, so they may not know you are getting passed up for an interview over something like this. Just my opinion, maybe it'll work. Good luck. I graduate in April...so I hope I do not have to go through something like this.