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Are You Scared Yet?... (Part 2)

posted 10/28/2007 6:30:37 PM |
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A short time later, I am called upon by a co-worker to go see a patient in the intermediate care unit. She is busy in the ER and is concerned that the IMC patient needs to be seen before she will have time to get there. So, being a good little therapist and co-woker, off I go to see the patient. The IMC on this particular occasion is staffed by two nurses whom I shall refer to as Nurses Dumb and Dumber. Let’s just suffice it to say that there is a whole lot of bad history with there dealing with those 2 particular nurses-- not just me, but with a multitude of the other therapists as well as quite a few doctors and physcian’s assistants. I am in the room of Mr. G (for goofy, only because he is a little psychiatrically impaired, but nice none the less)

Nurse Dumber appears at the door. Can you come into the next room? She has a very frantic look on her face. The apnea alarm is sounding on her monitor! Mr. G. seems to be doing okay for the minute so I remove my gloves, use some alcohol gel on my hands, go to the other room and don a new pair of gloves. I’m standing there, and yes, sure enough, the patient’s monitor is showing that there are no respirations. Of course the patient is sleeping comfortably, quite pink, and her chest is visibly rising. The monitor also shows a nice regular heart rythym of about 84 and 100% oxygenation. Nurse Dumber is about to call a code Blue and is thrusting an ambu bag/mask at me. Yeah, I can be mean… I yelled at her. Had to stop her and get her attention somehow.

Me (to Nurse Dumber): Maybe you should replace your monitor leads?

Nurse Dumber: What you mean?

Me: Well I don’t know this patient, but she is obviously breathing and appears to be doing fine to me.

Nurse Dumber: But.. But.. The apnea alarm is sounding. Say she not breathing!

Me: Look at her! You can obviously tell she is breathing. You need to fix YOUR monitor. There is nothing wrong with your patient.

Nurse Dumber: How do I fix monitor? Do I replace that thing on her forehead?

The thing on the patients forehead is the SPO2 probe, the one which shows that the patient is fully oxygenated. Haha.

Me: You know, I don’t know, because it’s YOUR monitor, but somewhere on your patient’s chest should be a lead which measures her rate of breathing. Whichever lead does that, you need to replace it.

Nurse Dumber, giggles and says “Oh, the patient IS breathing” and runs off to fetch her partner, Nurse Dumb, to find out what lead she needs to replace. The whole scenario explaining that the monitor lead needs replacing is repeated with Nurse Dumb, who eventually has a eureka moment and tells Nurse Dumber what she needs to do to fix her monitor. Score +1 for the patient who was left quietly sleeping, and not subjected to about a dozen people rushing into her room ready to intubate her and place her on life support. Score -5 for Nurse Dumber, who looked only at one parameter on the monitor and failed to even take a look at her patient to determine if they were actually breathing. Why such a negative? Well she didn’t even know how the monitor and leads worked or their function. Yes, she is an RN. Are you scared yet?

Then I hear the rapid response team being paged overhead. A rapid response isn’t a Code Blue, but often it’s the few moments before a patient has a cardiopulmonary arrest. Here we go.. Lets go see what’s happening. I’m one of the first to arrive and am met by one of the doctors.

Dr. C. (for cool): Can you draw an ABG for me?

Me: Sure, no problem… so what’s going on with this patient?

Dr. C.: Oh, the patient’s only real problem is that the nurse is trying to kill them.

Yikes.. Now I can assure you that the nurse wasn’t actively trying to kill the patient. But when a nurse is actively screwing up so bad in administering meds etc., due to incompetence, that it puts the patient in a crisis? well that’s just what we call it. I draw the ABG and run the sample off to the lab while Dr. C. gets the patient restabilized and proceeds to rip the nurse a new one. Score 1 for the patient who was lucky enough to have Dr. C show up at the rapid responce. Score 1 for Dr. C for realizing what the problem was. Score -2 for incompetence in healthcare.

Was this incompetence reported? Honestly? It probably wasn’t. I couldn’t report it because I am not qualified to determine the exact incompetence which occurred as I’m not a nurse or a doc. Did the doc report it? Probably not, he was off running to the next emergent situation. Did the nurse report it? Hell, she probably didn’t even “get” the fact that it was her actions which put the patient in a crisis in the first place.

Are you scared yet?

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post a comment!


Oct 28 @ 6:42PM  
got a word for you...nosocomial

Yeah, you really don't want to be in the hospital unless you can't help it. Fortunately, health care providers like the ones you mention aren't the norm. Sure, mistakes are made but there are checks and balances to (hopefully!) prevent these sorts of situations.

Oct 28 @ 7:05PM  
From a medical record I once typed up for a physician in a hospital which will both be unnamed:

The patient presents with extreme edema of the scrotal area.

The patient was a 34 year old female who had hit her head on a rock... the swelling was nowhere near her .. heh.. scrotum.. he was in the waiting room.

Oct 28 @ 7:18PM  
Looking... are you absolutely sure that these incidences are 'not common'? I would never be convinced of that. Now I'm not saying all nurses are incompetent, although it might appear that this is my viewpoint. There are, in fact some very very good nurses out there. However, with the severe shortage of all kinds of providers, not just nursing, well let's just say the standards are getting quite low. Nothing wrong with foreigners either, but hospitals do use alot of foreign nurses to fill all those empty positions, which brings a whole new set of problems like cultural and language barriers.. on top of the other stuff.

Oct 28 @ 7:39PM  
The rest of us make a mistake we start over or erase it. In health care when you make a mistake the patient gets buried a lot of the time.

Oct 28 @ 8:28PM  
Oy Vey

I'll have trouble sleeping tonight.

A loooong time ago I went to the hospital with a pain in my side. I'd been drinking the night before...a lot. I didn't know why I had this pain but it felt like it was in my rib area. To make a long story short, I had two complete sets of chest x-rays, two doctors telling me that I had liver damage...radiation tests.

Finally I got a competent doctor to write an order for a rib x-ray. I had a fractured rib.

Oct 28 @ 8:32PM  
I am biting my tongue to keep from saying
Keep Up the Good Work!

How about:
Thank God a few people like you are still there.
And thanks for writing this and putting it on the site.
Tonite is not the nite for my story,
of a friend who was hospitalized last week,
but while you are at it,
don't forget the incompetent PAs (physician assistants)
& PCAs (patient care assistant).
Don't get me started. And thanks again.


Oct 29 @ 10:20AM  
Jeez if I ever have to come to that hospital I hope I am lucky enough to get you as my nurse.

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Are You Scared Yet?... (Part 2)