Thursday, January 15, 2009


In any job there is an element of inconsistency. There are many ways to do things that result in the same (or similar) outcomes. As nurses, we all work under the same "don't let the doctors/residents/interns kill the patients" thought, but in the background we all have the "don't let one of my colleagues fuck up and kill my patient either." This is the real world and I'm not going to bullshit this.... we all know that some nurses are just better at their jobs than others. I know that I'm nowhere near the best, but I try to give 110% to all of them (except maybe the drunken assholes.... they get about 85% :) ) .

What do we as nurses consider our rules when dealing with peers?

  • Don't kill anyone (duh)
  • Don't leave pee, poop, vomit or other goodies for the next shift to clean up (unless they say its ok and MEAN it!)
  • Don't leave the rooms trashed
  • If you say you did something.... you better have done it
  • If someone is screaming for help, or if their patient is tanking, you help them
  • Don't do anything unsafe, or leave a patient in an unsafe condition for the next nurse

I picked up 4 patients in the green mile last night from a traditionally shitty nurse to follow behind. His rooms are ALWAYS a mess and I don't think he understands how to prioritize. One patient had the flu and was getting IV fluids, another was a psych guy with random belly pain. The other 2 patients were sick... really really sick.

The first was a 39 year old with a fever (103) low bp (70-80 systolic) and a heart rate in the 140-150 range. Yeah... sick girl (hello is the word SEPSIS going off in anyone's mind?) She had been there for hours, was not on the monitor, not even changed from her clothes... potassium was being run straight in. Grrrr.....labs sent (no blood cultures) and vitals had not been documented in hours. It took a long time to get her straightened out...

The other patient had something similar to Steven's-Johnsons Syndrome. They were calling it something else. She was in her 70's and her skin had been sloughing off like a burn for a day. She had popped blisters all over and was soaked from them. Her temp on arrival was 94.4 and very little had been done to warm her. She had no IV, and the IV fluids, labs and antibiotics had not been given. This poor soul was in really bad shape.... especially after waiting 9 hours before I even showed up. The attending, Dr B, had no idea she didn't have a line until my relief had gone. She quickly got an IJ, labs, fluids, IV pain meds (!) and cleaned, warmed, wound care and big warming blanket. I gave her fluids a little on the gentle side since she was old AND had a recent MI. Despite all of this, she was awake and alert, smiling through everything and thankful for her care. When I called burn (she went there for the wound care) I explained the whole situation, apologized profusely and took her to the unit myself.

I had already contacted my supervisor and made copies of the charts this morning when Burn called me back. My patient tanked her pressure after getting to burn, was placed on Levophed and then coded and died this morning. I was soooo angry that I could hardly think straight. Yes, she had lots of medical issues and may have been on her way out the door, but as my very good friend said later, "she may have been going out the door, but we didn't have to throw rocks at her while she left!"

I anticipate some phone calls over this one. To what extent would you hold the previous nurse accountable?

GRRR... I am SO very sorry. I'm sorry for my patient and her family. I hope that she is somewhere warm and dry and that the events of her last day aren't even a memory. I'm just so sorry (and mad) that this happened.


Blogger KELmomRN2b said...

I'm mad for you. And for the poor dear patient and her family. UGH.

11:01 PM  
Blogger NTICUNurse said...

I am sorry for the horrible situation your coworker left you in.
I always judge my day based on what condition the room and patient were left in.
That poor patient, at least you gave her so much tlc while she was in your care!

12:39 AM  
Blogger GingerJar said...

There will always be "bad" nurses...and uncaring nurses...and plain old burned-out nurses. I'm glad you're on of those "give a damn" nurses. Sometimes even when you give kick-ass care the patient doesn't make it. She may have had a better chance if the shift before you would have asked somebody for some help starting an IV or doing *whatever* was needed. Did you ever notice that some of those careless nurses are the one's who are LEAST likely to ask for help, because they don't want to admit they cannot do everything. The least they could do for their patient, is to at least start an IV and get fluids running....

6:50 AM  
Blogger mojitogirl said...

I'm sorry your name was on the chart!

7:19 PM  
Blogger NUS said...

This is a really upsetting story! I'm a nursing student and they're teaching us that we have avenues to deal with bad nursing by co-workers (as well as an obligation to do so)either by speaking to the co-worker directly or reporting it to your superior. Does this not hold true in the real world?

7:43 PM  

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