other side of the coin. again.

Nurses General Nursing

Published

You are reading page 4 of other side of the coin. again.

@gemmi999

I talked to the charge nurse about issues but I am not going further with this. The last hospitalization was way worse, but they saved his life. I spoke with patient relations. They do nothing but send you a letter about how sorry they are.

Nothing is going to change. this is a large, very good teaching hospital with some of the best doctors ever. It is one of two hosp that have spec ped ED, which we could go to in another type of emergency, but our physician, who is wonderful, is here.

Just have to put up with it. I guess. 24 hours after being home, I feel like I have been hit by a truck.

As the thought that ALL ED's are short-staffed. I work short staffed but we manage to get things done. I think the systemic issue that new grads want ED or L&D. There are an abundance of newer nurses and I think they just don't know what to do in a non-urgent setting. The fact that the nurse was going to give SQ insulin IM is a little scary to me. that is a fundamental.

I recently had a different experience in my life where I was reminded of the phrase "Expect nothing for you shall never be disappointed" This was yet another reminder of that.

Thank you all for your support. Bottom line is that my child is alive. the rest is fluff.

I'm sorry you had to go through all of this mess. It will continue if you don't get your fight on. How can you even think of not trying to make things better?

I understand your weariness and your reluctance to possibly make enemies. But you are a nurse, so you could see potential errors and prevent them. What about other people who are not educated the way you are?

I realize you must look out for your own loved one, but maybe you could also help other people when you have recovered some from this trauma.

It's always awful being in the receiving end of care when you are used to giving it. Good look.

I know....Has anyone really ever suffered a stunning setback from being given a blanket?

Speaking as an ER nurse, as an new grad who went straight to ER, and as a person who has taken care of many "pt holds" in the ER that should be on floors, I have a couple things to say.

1) Absolutely right--insulin should never be given IM. On top of which, insulin should never be given without checking BG first. It's a POC test that all nurses can do w/out an MD order

2) Being an admitted pt. on an ER hold due to lack of beds is challenging for a number of reasons. I understand your frustration and a large part of your frustration is systemic, but a couple of things to keep in mind:

- ER nurses aren't floor nurses. We can do all the same tasks that floor nurses do, but our mindset is *very* different. A baby that's screaming their head off in pain? Hey, patent airway. Check. Pt's able to ask for food--well, if it's not your patient, you don't know the dietary orders/restrictions/what's available/what's been given. ER is such quick turnover that we try not to get food/drinks for pt's not our own. If I get a pt a glass of water and they're there for DKA? Maybe their orders are NPO, maybe they need Zofran first, maybe there is a fluid restriction.

- Additionally, in my ER, we have 4 hrs before we are to start *floor* orders. This is to prevent duplication of care/medication pass and to ensure that the pt's nurse is aware of everything that has happened. My ER has a completely different charting system then the floor and a lot of times when I try to be helpful and start floor orders--they just get re-done. I had a pt w/ a 1L NS bolus ordered yesterday due to lowish BP. I started it, got about 400mL in, and got a bed. It was still infusing when I got to the floor. The floor RN already had the bolus primed and ready to go, so she simply d/c the bolus i started and started her own. When I pointed out renal pt, CHF, fluid overload, she basically said it was her pt now and it was a floor order. I shouldn't have started it. I told the Charge RN and she said she would make sure pt only got 1L, not more, but not much else can be done.

- Blankets? Again, if it's not my pt I have to track down original RN and ask because a lot of times pt's don't have blankets due to fever at admission, etc. It seems like a simple request but it's actually a multi-step process. And in the middle of this is other pt's asking for things as well.

- Fluid? I don't give out water in the ER, period, unless it's my pt. I did it *once* to a pt that was WNL vitals, no pain, there for diarrhea. I was trying to be helpful. Pt. surgery ended up delayed by 4 hrs because I broke the NPO and pt had SBO.

- Urinal's on the floor. That one is tough. Normally I leave at least 1 urinal, filled, at bedside in case MD orders urine labs after admission/after initial order set. Again, you don't want to be the RN that discarded urine because you were being helpful and then the MD orders a Culture and Sensitivity on urine due to pt meeting "SIRS criteria" and it being protocol.

I'm not trying to make excuses for your bad night. I've been there, as a daughter caring for her mother. But there are a *lot* of different things going on in the ER that can make even simple tasks be more complicated then pt/pt family realize. And minor requests are just that, minor. The RN might have another pt that she's helping intubate, one with hypotension that is on a vasoactive drip to monitor and chart q15 minute vitals on.

And sometimes it's just a nurse that is overwhelmed/tired/not necessarily all there at the time. And it sucks when it happens to you and your family member. So definitely complain, just understand that there is a reason behind a lot of behaviors that you might not know.

A lot of what you point out from the ER nurse perspective is interesting and helpful. But couldn't you check to see if the patient has certain orders? Like NPO? Or needs a C&S - but would you take that from the urinal? And a blanket - give me a break. How about at least a sheet for a little modesty?

couldn't you just tell the pt/family you need to check the orders and/or get their nurse because you are tied up with a critically ill situation. Communication is key.

Floor nurse who threw out your bolus sounds nutty.

and

I'm sorry you went through that. I hope your son is okay!

-- 1 ) I wouldn't have given food, either, sorry not sorry. Not until I got a verbal order from ER doc or admitting MD. I keep all pt's NPO if possible surgery candidates. If your son needed emergent surgery and I didn't know it yet, I'd rather not risk it. I would have checked his sugar, got him some D50 or fluid w/ dextrose in it depending on his BG level.

-- 2) If no MD orders pain medications, the RN can't give it. And it doesn't matter how much the RN want's to give your son more pain medicine, wanting doesn't correlate to an order. Maybe the MD was worried about respiratory depression, maybe he or she thought the dilaudid would have taken the edge off and left it at that. Maybe it was the ER policy due to constant drug seekers not to give more then 1 dose of narcotic prior to admission, which sucks, but a lot of ERs are going narcotic free due to current drug seeking climate.

--3) A lot of "simple" broken bones don't get labs ordered until after x-ray's are done/etc. It's a matter of resources and beds available. For an x-ray, your son could be made a lower acuity level and get x-ray's done immediately. If he needed bloodwork too, then that means the acuity level went up and if there weren't enough RNs or beds for that acuity level, he would have had to wait longer for everything, including pain medicine and the initial x-ray.

--4) Units don't stock as much food as they should. 1/2 a turkey sandwich might have been all that literally available. If the food isn't there and cafeteria is closed there isn't much the RN can do. They can call other units and see what they have available, but given time of night, etc, that might have been just as fruitless.

Again, not trying to make excuses. It's just--ER has different priorities. Airway, breathing and circulation. A pt being hungry isn't necessarily part of that list. Low BG should have been, but it sounds like that was addressed (or at least the RN tried w/ juice).

How about getting the doctor to actually look at the suffering patient so he/she might think on his own and actually order adequate pain Rx?

How about getting the House Sup to round up some food? That person does have keys to the kitchen or could get Security to get into the kitchen.

Unless someone else was critically ill/traumatized, no real excuse.

Of course, it's been quite a long time since I worked the ER and I'm sure it's pretty much a hell hole unless you are royalty.

Of course we understand these things. But as a floor nurse who is floated to the ER, it is very disheartening to see nurses sitting at the desk on their cellphones while passing off unstable individuals as med/surg patients while necessary medications are simply collecting dust on a computer screen.

What you must understand is that these were our actual experiences. For me, it was experiences as a patient in the ER for only 4.5 hours, and as an employee in the ER for enough shifts to know that these were not isolated incidents. Working beside these 'nurses' replicated the care that I received during my one-time visit on the other side of the tracks.

If this does not apply to you, that is absolutely wonderful. But it does apply to many nurses. And from what I have seen, if some of these patients had been medicated, they might have been able to go home instead of spending the night waiting for a bed because they were not getting any better.

Of course they weren't getting better! How could they when the medications to make them better simply were not given to them? One nurse even told me, when I asked about why a Lovenox wasn't given to the patient with clots, that she would give it. Ten minutes later, she called back and asked why couldn't I give it. "Hello!!! You have the patient there with you"!! The medication could have been given in less than the time it took for her to call me back to ask that stupid question!!

One patient came into our ER with chest pain. Our policy, as with most places, include the initiation of MONA. Well the ER nurse decided to call report, found her error in that she had not given the (A)spirin, and said she would before bringing the patient over. Instead, what she did was to chart it as not given. No explanation; no reason. She just did not give it. I called the pharmacy to have him reinstate it so that I could pull and give it.

Another ER nurse handed a patient to me whose K+ level was 2.9 when she took over 5 hours prior. I specifically asked what was done about that and when is the repeat level due. She blatantly lied to my face about things that had been done. Nothing had been done, nor had a repeat test been ordered. In fact, when I called the doctor, he was livid when I informed him that nothing had been done since before 1845. And this nurse did not have all those issues going on because she was working with me on this unit. I took over her patient (Thank God!) because she was being pulled to the triage room. Her critical thinking was on vacation, apparently. Who knows what would have happened had she kept that patient for the remaining 7 hours of the shift.

The last straw was a malignant hypertensive crisis patient, whom the ER nurse wanted to pass off. I asked if he had treated the blood pressure and he said no. I asked that he get the pressure under control before bringing the patient to me. (He, too, lied about the patient not having PRNs on board for the blood pressure. He did not count on me looking through the patient's file as he gave report. But, things are so unreliable coming from that department that we've learned to not immediately take report when they call. We get to a place where we can sit down and open the file to verify what is being told because the outright lies flow like dysentery).

The ER nurse brought the patient to me anyway, medicated the patient on my unit, then clocked out and went home. That's not stabilizing a patient. (Had he medicated that patient 3 hours prior when the order was entered, he would have been able to follow-up, check the effectiveness of the treatment and notify the physician accordingly. But he chose not to).

Once he did that, it gave me a patient who I had to medicate and recheck every 10 minutes, along with another who I was bolusing and checking every few minutes, while trying to reach the attending residents, as these patients were not stable. Sometimes the run-of-the-mill sick person ends up in similar conditions as what you described because the ER nurse feels that they are stable enough that medicating them can wait, when in actuality, waiting is what expedites the decline after arrival to the ER.

If you wait to treat, then your relief waits, then they are handed over to whomever without having been treated for their condition, who is at fault when the patient tanks? Who dropped the ball? The first person who delayed treatment? The second? Or all of the above?

It does not matter whatever else was going on in the ER. These patients warranted and had a right to remain in the ER just as the others did until they were stabilized; not be transferred inappropriately because a nurse was going home, or because no one else wanted to do triage.

Again, these are actual accounts that were witnessed, complained about, reported, and still left unaddressed. There is no justification for what I saw.

As for the treatment that I received, I simply chose not to return there if ever I'm in need of care, nor do I recommend them to anyone who would ask. Do I bad-mouth them publicly? Absolutely not! I choose not to waste any of my time discussing this facility on my day off. I feel there are some wonderful people who work there. But there are also those employees who simply have watched entirely too much TV, and prefer to look the part instead of actually working the part.

You have to inform your boss and the ER nurses' boss about these incidents. The nurse who didn't treat the malignant hypertension is dangerous and needs teaching so he never dares to ever again not treat seriously high BP.

And you are at fault for not speaking up. No it isn't pleasant or easy, but you need to do more than just not go to that ER if you need care. What good does that do? What if you go to an ER where the nurses are just as inexperienced, lazy, whatever?

nursej22, MSN, RN

3,496 Posts

Specializes in Public Health, TB.
and

I'm sorry you went through that. I hope your son is okay!

-- 1 ) I wouldn't have given food, either, sorry not sorry. Not until I got a verbal order from ER doc or admitting MD. I keep all pt's NPO if possible surgery candidates. If your son needed emergent surgery and I didn't know it yet, I'd rather not risk it. I would have checked his sugar, got him some D50 or fluid w/ dextrose in it depending on his BG level.

-- 2) If no MD orders pain medications, the RN can't give it. And it doesn't matter how much the RN want's to give your son more pain medicine, wanting doesn't correlate to an order. Maybe the MD was worried about respiratory depression, maybe he or she thought the dilaudid would have taken the edge off and left it at that. Maybe it was the ER policy due to constant drug seekers not to give more then 1 dose of narcotic prior to admission, which sucks, but a lot of ERs are going narcotic free due to current drug seeking climate.

--3) A lot of "simple" broken bones don't get labs ordered until after x-ray's are done/etc. It's a matter of resources and beds available. For an x-ray, your son could be made a lower acuity level and get x-ray's done immediately. If he needed bloodwork too, then that means the acuity level went up and if there weren't enough RNs or beds for that acuity level, he would have had to wait longer for everything, including pain medicine and the initial x-ray.

--4) Units don't stock as much food as they should. 1/2 a turkey sandwich might have been all that literally available. If the food isn't there and cafeteria is closed there isn't much the RN can do. They can call other units and see what they have available, but given time of night, etc, that might have been just as fruitless.

Again, not trying to make excuses. It's just--ER has different priorities. Airway, breathing and circulation. A pt being hungry isn't necessarily part of that list. Low BG should have been, but it sounds like that was addressed (or at least the RN tried w/ juice).

Thank you for your reply. My son spent 4 days as an inpatient, and several weeks healing. My fear is that he will hesitate to seek emergency care in the future because he does not trust that his glucose levels will be taken seriously. Many type 1s fear severe hypoglycemia, seizing and dying,and I can't say that I blame them.

caliotter3

38,333 Posts

Have encountered similar treatment for self regarding food, pain medication, just plain attending to. Now avoid at all costs. I can ignore myself at home with far better outcomes. So sorry your son was treated this way.

NuGuyNurse2b

927 Posts

I tell all my family to avoid hospitals if possible. The system is broken. If management even sees me sitting to catch a break, I am surely getting an admission. It's chronic short staff followed by cynical management who think they can squeeze more out of a nurse.

The BON/ That is a little over the top. Telling the hospital new grad does not know how to give Insulin would suffice...

Horseshoe, BSN, RN

5,879 Posts

That is quite the list of things you don't do and, wow, you will not give a patient you do not know a BLANKET? Even with your endless rationales of thinking you have covered all your bases with adding patient may have a fever this one boggles the mind. I have worked as an ER float and your attitude is not unique though. I would never have switched to working primarily as an ER nurse not because of the patients but due to the callous and arrogant attitudes I witnessed in there among staff; that *special* ego stuff was just so non-endearing.

I don't go to ERs, either even if it would be in my best interest; was in a single vehicle MVA 2016, slid on the ice & hit a tree, both airbags deployed, rib fx, bruised lung & brutal pain. Told my husband I can breathe and ERs don't treat pain so not going to ER; my PMD got me in next day. The unfortunate experience OP had with her son in an ER along with your statements only confirm for me I made the correct decision.

Just reread your post and actually nearly laughed over the rationale for not giving a blanket' 'multi-step process'? Really? You are right on one thing, I don't understand the reason for a lot of your behaviors and pity the unfortunate ER patient who is not *your* patient ands asks for something...

Who is the "you" that you keep addressing? If you will use the quote button when you want to reply to a particular post, your meaning will be more clear.

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