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I've found something worse than acopic rehab nurses; it is acopic ED nurses.
Yep, you wouldn't believe it but they do exist. Tonight in ED, it was a particularly bad night, even by MMC standards. At the end of the night shift there were 30 patients waiting to be seen, some hitting 4 hours already. At one point in the night, I counted 15 patients arriving in one hour; terrific.
This shift was made worse by this one nurse I had to work with. Now, to be fair, he is in the less acute area of ED which is probably not as well staffed as the rest of the department but when there are so many patients waiting, you just put patients wherever you can find a bed right? I saw a lady with end stage metastatic non-small cell lung cancer. She had come in with APO because someone thought it was a smart idea to stop all her regular medications in preparation for end of life care but did not put a plan in place for when she would inevitably go into rapid AF and APO. Whatever. The true problem is when I saw her, she did not look well. Imagine peri-arrest. Gurgling in the upper airways, breathing at 40 per minute, heart rate of 190 and BP 200/140. Saturating well on 10L at least but that was her only saving grace.
When I walked in, the first thing this acopic nurse asked was: "Can you document her NFR? Because she's palliative, we don't want to do CPR on her if she arrests here." My first reaction, "Hang on. She might be end stage cancer but surely we won't let her just die from hypoxia and respiratory distress right? I'll talk to the family and patient and get it documented but I want to see her first OK?" It took all my effort to stop rolling my eyes as he walked out of the cubicle. I ended up putting in a cannula, taking bloods and writing up some frusemide, antibiotics and IV magnesium. When I went out to find the nurse, I was met with the same request, "Can you document her NFR?" Now, I wanted to lose my temper at this...there's a sick patient in your cubicle who needs some treatment and all you can think about is what NOT to do if she deteriorates? Who the hell are you???
I gave my orders and walked away to talk to the consultant about CPAP for my patient. After I came back, guess what? None of the medications given, not even the frusemide. Partially because the patient wanted to go to the toilet so he had gotten a pan for her but surely somewhere along the line he could have had the medications drawn up. I went in and asked him to give the medications and get some morphine for her respiratory distress. You know the reply? "I can't do it" and he walked out of the cubicle. Excuse me? What do you mean you can't do it? If you can't then who can? Luckily my patient was transferred to resus soon after to get her CPAP so I didn't have to strangle this nurse personally.
Later on in the night, I was walking past another one of his patients who was half sliding out of bed. I managed to stop the patient from falling and got her back into bed, saying I will go find her nurse to get a pan for her. Once again, he was standing at the desk (sort of around handover time I think) and I said, "Hey, I just stopped your patient in A6 from falling out of bed. Want to get her a pan or something?" and he replies, "Yeah, she's too big so I can't get her onto the pan. I'm looking for someone to help." I had no sympathy so I told him, "Well, do it now before she starts climbing out and has a fall. I've already saved her once, not going to do it again." He looked sort of not impressed and simply said to me, "Well, she shouldn't have been put in the cubicle anyway, she's too unwell for that cubicle." Now, A6 is supposed to be a psych cubicle but putting medical patients in there is a frequent occurrence. Either way, I didn't care much for the excuse that this lazy fat-ass was giving me so I just said to him, "Sorry, I don't care. If you have a problem, take it up with the nurse in charge who put her in there. Otherwise, get it sorted before she falls."
Unbelievable. Never thought there was such a thing as acopic ED nurses but apparently they do exist. I haven't met this nurse before; hopefully he's agency/bank and I'll never see him again.
Yep, you wouldn't believe it but they do exist. Tonight in ED, it was a particularly bad night, even by MMC standards. At the end of the night shift there were 30 patients waiting to be seen, some hitting 4 hours already. At one point in the night, I counted 15 patients arriving in one hour; terrific.
This shift was made worse by this one nurse I had to work with. Now, to be fair, he is in the less acute area of ED which is probably not as well staffed as the rest of the department but when there are so many patients waiting, you just put patients wherever you can find a bed right? I saw a lady with end stage metastatic non-small cell lung cancer. She had come in with APO because someone thought it was a smart idea to stop all her regular medications in preparation for end of life care but did not put a plan in place for when she would inevitably go into rapid AF and APO. Whatever. The true problem is when I saw her, she did not look well. Imagine peri-arrest. Gurgling in the upper airways, breathing at 40 per minute, heart rate of 190 and BP 200/140. Saturating well on 10L at least but that was her only saving grace.
When I walked in, the first thing this acopic nurse asked was: "Can you document her NFR? Because she's palliative, we don't want to do CPR on her if she arrests here." My first reaction, "Hang on. She might be end stage cancer but surely we won't let her just die from hypoxia and respiratory distress right? I'll talk to the family and patient and get it documented but I want to see her first OK?" It took all my effort to stop rolling my eyes as he walked out of the cubicle. I ended up putting in a cannula, taking bloods and writing up some frusemide, antibiotics and IV magnesium. When I went out to find the nurse, I was met with the same request, "Can you document her NFR?" Now, I wanted to lose my temper at this...there's a sick patient in your cubicle who needs some treatment and all you can think about is what NOT to do if she deteriorates? Who the hell are you???
I gave my orders and walked away to talk to the consultant about CPAP for my patient. After I came back, guess what? None of the medications given, not even the frusemide. Partially because the patient wanted to go to the toilet so he had gotten a pan for her but surely somewhere along the line he could have had the medications drawn up. I went in and asked him to give the medications and get some morphine for her respiratory distress. You know the reply? "I can't do it" and he walked out of the cubicle. Excuse me? What do you mean you can't do it? If you can't then who can? Luckily my patient was transferred to resus soon after to get her CPAP so I didn't have to strangle this nurse personally.
Later on in the night, I was walking past another one of his patients who was half sliding out of bed. I managed to stop the patient from falling and got her back into bed, saying I will go find her nurse to get a pan for her. Once again, he was standing at the desk (sort of around handover time I think) and I said, "Hey, I just stopped your patient in A6 from falling out of bed. Want to get her a pan or something?" and he replies, "Yeah, she's too big so I can't get her onto the pan. I'm looking for someone to help." I had no sympathy so I told him, "Well, do it now before she starts climbing out and has a fall. I've already saved her once, not going to do it again." He looked sort of not impressed and simply said to me, "Well, she shouldn't have been put in the cubicle anyway, she's too unwell for that cubicle." Now, A6 is supposed to be a psych cubicle but putting medical patients in there is a frequent occurrence. Either way, I didn't care much for the excuse that this lazy fat-ass was giving me so I just said to him, "Sorry, I don't care. If you have a problem, take it up with the nurse in charge who put her in there. Otherwise, get it sorted before she falls."
Unbelievable. Never thought there was such a thing as acopic ED nurses but apparently they do exist. I haven't met this nurse before; hopefully he's agency/bank and I'll never see him again.
Risk man him :D Isn't that what nurses like doing?
I will not bring myself down to their level. I'm sure the nurse in charge will realise if he's not coping
haha, the term acopia.
that's some terrible attitude. not professional at all. giving lame excuses and pushing his responsibilities away