Thought you all might enjoy reading this...

[milkyway]

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Hey... I do a lot of reading on here but hardly ever post... I am a nurse, once thought about med school but changed my mind... I love most of my coworkers and fellow nurses but I have met many who I can see why you get so frustrated with them, and here's an example...

I thought you might enjoy reading this and the subsequent dressing-down the original poster received...

http://allnurses.com/general-nursing-discussion/over-riding-resident-499879.html

 

[mig26x]

sad story. hopefully nothing happened to the patient and it was all pain related to the surgery but that nurse should have known better not to play with chest pain and only because her shift ended?

 

[Taurus]

This is foolish on the nurse's part (and the senior's too).

1. She didn't want to do it stat because it was almost her time to go. So it was inconvenient for her.
2. So she got the senior to modify the order. But did the senior actually see the pt to determine if the order should be modified or did the senior take the nurse's word for it over the phone? I'm guessing the latter.

If the pt was indeed having an emergency and it was later determined that treatment was delayed due to the nurse not executing the stat orders because she felt inconvenienced by it, the nurse will be disciplined (and hopefully fired). Likewise, if it is later discovered that the senior didn't see the pt before modifying the orders, then that senior will get in trouble. The intern who wrote the stat orders is free of fault.

 

[Gastrapathy]

Senior residents take note. If a nurse backdoors your intern, talk to the intern before you countermand their orders (unless its patently dangerous, in which case, talk to them after). The senior got played and when the post-CABG graft failure -->v fib arrest gets reviewed, it won't be the nurse tap dancing on the coals. There won't be any mention of shift change, etc, just that you ordered a routine evaluation.

 

[gschl1234]

I think this whole scenario was quite unfortunate; however, instead of blaming individuals (as most do in the culture of medicine), why not look at the institution? Why isn't there someone to carry out EKG's/blood draws etc...around the time of shift change? It would be best to have 24/7 coverage but if that is impossible, it would be reasonable to extend the coverage by a few hours on each end so that the time around shift change is covered. It's very annoying to me that most people in medicine have no "systems" prospective and go straight for individual scapegoats. After the offending individuals are properly reprimanded, it's back to the usual. Nothing has changed and no one has seriously looked into what environmental factors brought about the incident in the first place. And don't you find your hospital incredibly inefficient? Think of all the man-hours potentially saved if only hospitals ran more efficiently, like a Toyota line.

 

[Stitch]

And don't you find your hospital incredibly inefficient? Think of all the man-hours potentially saved if only hospitals ran more efficiently, like a Toyota line.

Talk to jcaho about improving efficiency and let me know how it goes.

Honestly I'm impressed that all the replies at allnurses pretty much told the OP she was lazy and dangerous for not taking the guy's pain seriously. 👍

 

[McGillGrad]

Why isn't there someone to carry out EKG's/blood draws etc...around the time of shift change? It would be best to have 24/7 coverage but if that is impossible, it would be reasonable to extend the coverage by a few hours on each end so that the time around shift change is covered.

You mean the nurses? These are normal duties for staff nurses.

 

[Stitch]

You mean the nurses? These are normal duties for staff nurses.

It depends on the hospital. RTs do our EKGs on the floor and techs do them in the ED. Don't know why. Blood draws are sometimes done by phlebotomists or by tech. In fact, when I was a med student in New York City, med students and residents were responsible for most blood draws and IVs, not nurses. Nonetheless, I agree: the nurse ought to have been able to do these things, and from the sound of it, was just lazy.

 

[lowbudget]

I don't enjoy reading this at all. The central issue in this case is: who is closer to the actual truth? The intern's interpretation of stat? Or the nurse's interpretation of stat?

I mean, let's be honest, sometimes we write stupid orders or give orders based on convenience/efficiency. So, there is a role for safeguarding. That said, in this case, where you have a disagreement in clinical impression, you need to break the tie somehow with better information. I don't think the intern was unreasonable.

Anyways, kudos to the responding nurses to hold their own up to their professional standard. Certainly dispells a myth I have that nurses are united & will defend each other without regard.

 

[gschl1234]

You mean the nurses? These are normal duties for staff nurses.

If you recall the original post, the nurse in question implied there are other staff to carry out those duties after 7AM. But you and just about everyone else missed my point about looking at the bigger picture. It's easy to blame an individual and leave it at that but many times environmental factors play a part.

 

[dpmd]

I can't imagine it would have taken much more time than the multiple paging/phone calls the nurse did while trying to avoid the work. Although if there wasn't a clerk around to put the orders in/call radiology for the CXR/call RT for the EKG that would add to the time. Also if the nurse would have to do the EKG personally (especially if the machine isn't close by). At the very least he/she could have not argued about the order and instead done what was possible, and ask the charge nurse for help if needed (which is why it is nice for there to be a charge nurse with no patients-or minimal).

 

[Ronin2258]

I have been in at least a dozen hospitals from the Eastern Seaboard to Honolulu and places in between during my training.

I have been respectful to my nurses throughout the entire time.

I have NEVER seen nurses downplay chest pain in ANYONE. I have had EKGs done on healthy 15-year olds with costochondritis due chest pain protocols. If I was paged for chest pain on call, they would run the EKG out of knee-jerk response, knowing that is the first thing I am going to want after I evaluate the patient.

I realized shift changes, and I have been fortunate enough to work with dedicated nurses who will stay late to finish something, signing out to their relief as they can. I definitely thanked them for staying late. And I have been forced to work nurses like dogs when **** hits the fan.

Delaying labs and studies, even in a sternal incision patient, due to SHIFT CHANGE?! Every nurse I had the privilege of working with would answer in unison: Oh, HELL NO!!!

 

[maceo]

I think this whole scenario was quite unfortunate; however, instead of blaming individuals (as most do in the culture of medicine), why not look at the institution? Why isn't there someone to carry out EKG's/blood draws etc...around the time of shift change? It would be best to have 24/7 coverage but if that is impossible, it would be reasonable to extend the coverage by a few hours on each end so that the time around shift change is covered. It's very annoying to me that most people in medicine have no "systems" prospective and go straight for individual scapegoats. After the offending individuals are properly reprimanded, it's back to the usual. Nothing has changed and no one has seriously looked into what environmental factors brought about the incident in the first place. And don't you find your hospital incredibly inefficient? Think of all the man-hours potentially saved if only hospitals ran more efficiently, like a Toyota line.

patients need what they need regardless of time of day, how many patients you have, how over worked you are how many system failures there are. period. you do what you have to do. you as a resident should be the first person to understand that. The nurse was over stepping her boundaries, delayed the patient getting evaluated and really should be reprimanded for questioning the interns orders. full report of this should go into her/his file.. the senior resident got played

 

[Stitch]

If you recall the original post, the nurse in question implied there are other staff to carry out those duties after 7AM. But you and just about everyone else missed my point about looking at the bigger picture. It's easy to blame an individual and leave it at that but many times environmental factors play a part.

Didn't miss your point, simply disagree completely. This case comes down to a single person who didn't want to do her job and carry out her responsibility. Period. In fact she probably spent more time and energy arguing and paging people than she would have just by carrying out the order, and in doing so, possibly endangered a patient. The nurses on that board agree, as do most of us here.

Yes, many errors are systemic errors, no doubt. But you need to take (or give) a little individual responsibility and not cover it up by saying 'well it takes a village.' That's administration double speak.

 

[chimichanga]

...Certainly dispells a myth I have that nurses are united & will defend each other without regard.

I agree w/ it being a myth, but one story dispelled a myth for you?

I take it that you've only heard that nurses behave one way, all the time?


Anyway, the nurse is a tool (I mean she laid it out for us, she admits to downplaying the symptoms)...

Behaviors like hers only fuel myths and hurt patients...

She deceived the senior and threw the pt under the bus...

She actually had the nerve to think the context of the time of shift matters...

And do (moreover, should) senior residents have time to physically check in w/ every little thing?

I've never been a resident, but my point is there should be some trust there between nursing and medicine...

The RN's behavior in this story just undermines that trust, and the resident will likely get in just as much (or more) trouble...