I was tempted to call this story the 'no name story' so as to avoid being accused of misleading or creating 'click-bait.' But this time, I actually think what I'm about to tell you, has to be your worst nightmare. I also hope to give plenty of detail, so you get a clear picture.
It happened to a good friend, in the same A&E department, in a poor part of east London.
The hospital was in a poor neighborhood, and 2/3 of the patients first language was anything but English, many people were on government support, and the neighborhood was not the safest in daylight, let alone night time.
Regardless, myself and many fellow kiwis and aussies worked there as agency/temp nurses, especially night shifts, due to the regular work, as well as the large number of fellow antipodeans. On any given shift, half the staff were agency.
I'd spent 6 months working there, with a good friend Amber (not her real name) who was a very skilled, hard working nurse. She was manning the acute assessment unit - this unit ordered bloods/ecg's etc, so by the time a patient got to the doctor, they had something to work with.
So a 50yr old African man walks in with chest pain, and is sent to Amber. The pain is only on movement, no SOB, good colour, not cold/clammy/sweaty, in fact looks well. His ECG is normal, and he is in no pain when lying on the bed. The pain is left and right sided, and only returns when he moves ie got up from the bed.
It turns out he'd begun a weight training program the day before, and he'd been doing bench presses. His CK was a little elevated, but his tropinin normal (I can't remember which specific one, and I know they've got more accurate testing these days) but as the pain had begun the morning after the workout, and it was now evening, everything seemed ok.
The patient was a non-smoker, and had no previous medical hx of note.
Amber felt it unlikely to be cardiac, but of course ran the results and history past the doctor. The doctor signed the ECG to say he'd reviewed it, put a time and date, and said he could be a category 3 (which meant about a 2hr wait).
Anyway, the patient and his wife don't feel like waiting, especially as all the tests seem fine, and they ask Amber if he's okay to leave. She tell them they still need to see the doctor, as it's not her call to make.
The family wait 2hrs, only for the department to be swamped with some nasty traumas, and the doctor wouldn't be seeing them anytime soon. Amber kept checking on him, and he'd had no further pain (unless he stretched or moved a lot) and felt fine, and they decided to leave. They didn't sign a self-discharge form.
The next night, Amber and I are in resus when an ambulance blue lights in a patient, and Amber finds herself doing compressions on the man from the previous night.
'You said it wasn't his heart' screamed his wife at Amber, (which she hadn't, but you can understand the grief) while Amber had tears streaming down her face.
The man dies.
As an agency nurse, Amber didn't get support from management, so we discussed what to do. She decided to photocopy her notes, as well the ECG from the previous night.
She's called into a meeting with management the following day, and I go as her support person, and we're sitting in an office, and we hear the head doctor approaching with a bunch of big-wigs from the hospital, and we clearly hear him say 'she's done for, she messed up.'
Amber confronts him on this, and he doesn't have a reply, but they accuse her of not doing her job, and say the man did not get an ECG. We all go through the notes together and the ECG is missing. She tells them she did do one, and the doctor signed it, and gave his name, but they don't believe her.
'Well it's just as well I have a copy then don't I' she says, producing the copy of the ECG.
This action saved her. Saved her career, and saved her from a witch hunt.
She eventually was cleared of any wrong doing, although management were never confronted about the missing ECG, which would have helped them find someone to blame.
Anyway, that's one of the agency experiences that has taught me not to trust anyone.
nursingaround1
247 Posts
Wow, I'm quite impressed, I'm no longer a nurse.
Actually, lots of hospitals I've worked in have lots of different protocols for chest pain. Some had special chest pain units, where any chest pain, no matter how unlikely, is monitored and ECG etc. Others keep them in a acute assessment unit, sometimes with monitoring, but often without, while some hospitals do ECG's on everyone over the age of 30 as part of the baseline obs (that's if they're admitted to the moderately ill area, often called 'majors' in the UK).
I'm not sure how to show I'm a nurse, I could talk about working in the UK when the introduced the 4hr limit, where any patient presenting to A&E had to be seen and either discharged or referred/admitted within 4hrs - if the hospital managed to get a certain % (it might have been 90%) within this time, they got funding, I think like 100,000 GBP per month for every month they met the target. This has been a disaster as it created the messiest holding wards with patients being referred there with nothing done ie still waiting x-ray, labs etc.
What else can I say - oh, I ended up for a 3 month stint in Lydia clinic in St Thomas' in central London, a walk in STD clinic, where we had to swab and then do the microscopy straight away - and yes, I only swabbed the men, while the female nurses swabbed the men and the women. I'm not sure what you make of that; maybe you disapprove, but then how can you disapprove when it's the way another society feels is right for them.
I could talk about my first arrest, and yes it happened on the toilet, and I remember trying to rush the patient on the shower chair back to his bed while holding him upright while he turned blue, and knocking over the bottle of raspberry concentrate, which looked like fresh arterial blood, and seeing the shock on the arrest team's faces when they got there wondering where all the blood had come from.
I could talk about my first suppository in the gynae ward, with too much lubricant, and it going in the wrong whole, and looking at my preceptor for help (who was holding her buttocks apart) as she rolled her eyes then made a 'hooking' motion with her finger, and having to go and fish it out.
I'm sorry you don't believe I'm a nurse, and I'm sorry you don't believe any of my stories. I really have seen a bit of the world, and worked in almost every department imaginable at some stage. Sometimes I knew what I was doing, but not always.
Strangely, I feel I've become more humble and less prideful in my practice, although I'm guessing you're not getting that feeling from my posts. I really don't have all the answers, and am happy to admit I don't often have a clue.