Tuesday, June 7, 2011

Silly ER nurse!

Sunday Night at work was wonderful. I started with 3 walkie talkie patients....which NEVER happens. So I was in my glory. I knew I was open to get a 4th patient since I had such easy patients. No problem. I've got plenty of time to admit someone and my new admit was also an easy patient. So I just knew Monday night would not go as well. Never is it possible to have 2 great nights in a row.

Monday night I got 3 of my patients back. Great, I think. The charge nurse gives me an admission while at the same time one of my patients is getting discharge orders. Wonderful! @@. I take report from the ER nurse. It had to be one of the worst reports ever given. I'm hoping he's a new nurse, otherwise....he doesn't belong in nursing. The patient's name sounded very familiar to me, yet I couldn't place her face. I'm told she overdosed on morphine tablets....but didn't mean to. She took 10 times the dose she was supposed to. Ummm, that doesn't sound like an accident to me. Apparently she was just trying to get rid of the pain. At least that's what she told them when she was still conscious. Fastforward approx 2 hours later and I'm told they gave her 2 doses of Narcan & she's still unresponsive, but has lots of secretions that they are suctioning. Ummm, ok??? He goes on to tell me she has normal saline running at 100 ml/hr through a #24 IV in her thumb. And that they bolused her with 1,000 ml's. I asked how was her urine output. He sounded surprised & answered honestly....he didn't know. I asked does she have a foley cath or a diaper on...since she's unresponsive & obviously not getting up to pee. The ER nurse doesn't know. He's reading through the orders when I ask if she has any oxygen on. He replies 2 to 4 liters. Ummmm, which is it? He isn't sure. And he proceeds to tell me he cannot get an O2 sat on her. Then how do you know this drug overdosed unresponsive patient is getting enough oxygen? He doesn't know.

Now I'm starting to wonder if our ER has any doctors...because this is making no sense. I ask what her rhythm is. He says sinus tachy at about 120 or so. No one is concerned about that rate. Guess they're just happy she has a heartbeat. He proceeds to tell me she is a Baker Act & requires a sitter. I thought this was a little silly as she was unresponsive, but she obviously was a threat to herself, but ok. Only there is no sitter available. WTF? This is a joke, right? I hang up with ER cause now anything I ask, I get the generic response of "I just got this patient.". I go to my charge nurse & tell her I do not think this obviously unstable, critical patient belongs on PCU. Since no sitter is available, she calls the supervisor & refuses to accept the patient. Later I hear that she is in ICU, still unresponsive, on a Narcan drip with a blood pressure in the 80's and a temp of 103 and on the verge of being intubated. I want to know who the heck made the decision that she belonged on a PCU unit. Ridiculous!!

I did end up getting an admission. Luckily, it was after I discharged my other patient...who by the way was so happy to go home, that she surprised me by giving me a hug and a kiss on the cheek. I don't usually like strangers getting that close to me....unless we're talking about someome like say Tim McGraw or Luke Bryan. :). It was sweet though, so I didn't flip out.

I'm off now for 8 days...yay! Celebrating my mom's birthday tomorrow, then the Katy Perry concert on Thursday & a nice lobster dinner on Saturday night! Yum!


LivingDeadNurse said...

ok...trying to look at this positively. Since I work in the ER I know what its like to get a dumped patient. That's what I call them. In my Er every 4 hours you can be moved from your rooms to triage or split flow and then back to your rooms. So our "shift" change is whenever. Plus when you switch you might be lucky to get a 5 min speel on your patient. Unlike some of the floor ones where its a little longer. I have gotten a patient right before they were going up and I haven't even seen them. Sucks. So you rely on someone elses charting. Which if they are lazy might suck. Especially if they don't chart their O2 or even their foley. I usually have to try to patch the chart. I hate half assed people. I usually end up telling the ICU nurse let me give report at the bedside. Not saying this ER nurse wasn't an wrong. Because you can at any point get off your ass and look at the patient. Why the hell they didn't place this patient in ICU in the first place is crap. So there is my 2 cents...glad you had a decent day. Those are hard to come by anymore.

Jen said...

I'm not bashing ER nurses....quite a few are excellent, but this one...he was clueless. As far as "just getting this patient"...he had her for over 90 minutes, yet knew nothing. Being that she was critical, I figured he'd know something...but other than suctioning her, it was like he knew nothing.

The thing with our hospital...if a patient is admitted to ICU, they have a rule that a doctor must come in within 4 hours to assess the patient, BUT if they admit the patient to PCU & we call a rapid response & THEN the patient gets transferred to ICU...a doctor doesn't have to come in within 4 hours....because Rapid Response has assessed the patient. So they commonly dump on us at night as they don't dare try to make a doctor come in after 8 pm.

It's a stupid rule. Obviously an ICU trained nurse can convey to an MD what the patient needs or at least the signs/symptoms & orders should be able to be given over the phone. I guess it's one of those rules that sounds good on paper, but in reality, it's ridiculous.

Jen said...

Her MD came in around midnight & I saw the history & physical. It went something like "Pt admitted to PCU, but at the last minute, ER doctor conveyed to me the necessity of pt being admitted to ICU due to critical condition. Uhhhh, it was THIS pcu nurse refusing the patient. Guess they can't document that...lol.

LivingDeadNurse said...

Gotcha...I knew u weren't bashing..I was just hoping that was the issue. Don't get me wrong there are plenty out there to bash. I work with a couple I would like to chock to death. You shouldn't get dumped with a patient. Yea and our dr check out the patients in ed and the the hospilist sees them once they get upstairs...whenever that is.

LivingDeadNurse said...

Dr admit they r wrong? Lol...ok that looks like I am bashing all docs

newnurseinthehood said...

Freaking fail. Um, I couldn't get an O2 sat? Really?
Uh, yeah, I don't know, they said something in report about them being pulseless and asystolic but I had to go downstairs to the machine to get a red bull but she hasn't called on the call light complaining of pain or anything.
I guarantee you this is the kind of jackass who I work on a team with and end up taking care of their patients in addition to mine because they are always gone on 45 minute smoke breaks and it's unethical for me to let their people die.
I'd like to apologize on behalf of all ER nurses. Lesson number one, make sure your patient is not in distress, covered in their own waste, or dead before you call report. It isn't that difficult.