Most nurses know that the worst family members of patients are doctors, lawyers, and other nurses! We know what to look for. We know what is standard operating procedure. We know what is correct technique. We know what the alarms and numbers mean. We know how things are supposed to be done…and we don’t want crap care for our families. When my dad had surgery recently, I saw some things that I wasn’t happy about- but not close enough to see what was going on at the time, or had taken a break to go take care of my dog, so not there at all. I’d hear when I got back to the hospital.
Dad returned from surgery to spend 24 hours in ICU for observation since the surgery was on his neck, with a lot of real estate in there that needed to be closely monitored. One of his blood vessels had to be cut in order to remove a mass, and then sutured shut, and it was critical that he be monitored for any signs of that vessel leaking. It could be fatal- or life-altering- if it ‘blew’. I had to wait until he got settled until I could see him in ICU- very understandable that they had to get him hooked up and an initial assessment done. Seems his nurse forgot about his family and close friend in the waiting room for nearly an hour and a half. I finally asked if it was OK to see him, only to see his nurse sitting at the desk at the end of the hall. She said , “Oh, yeah, come on back”, as if we had just shown up. We’d been in the hall when he was brought into the unit, and told they’d come and get us. That nurse was there.
I initially stayed in the ICU room for only a few minutes, since dad was still sleeping most of the time, and the numbers on the monitor were stable. I stepped out into the waiting room again with his friend, and we talked. I needed to run home and give my dog her medicine, and then came back up to the hospital. When I got there, dad’s IV fluids had been turned off. He hadn’t peed yet, and wasn’t taking enough fluids to compensate. When he got some IV nausea meds (preventing vomiting was very important to protect that sutured blood vessel), he said it hurt. There was no saline flush first- just straight to the nausea meds. He was told that meds sometimes hurt (which is true- BUT, the site and patency of the site must be checked). Basically, he was blown off. Then, after the medication, the saline flush was the bare minimum to maybe clear the extension tubing (5-6 inch tubing that makes it easier to reconnect IV antibiotics and give IV meds). The nurses were ALL very nice. That wasn’t an issue. But youth and the inexperience that goes with it (simply because there isn’t the time yet to gain the experience) aren’t always useful. It’s not always because someone is ‘still out of it’ from anesthesia. They still feel pain in IVs- and dad was plenty aware when the meds were given. More than one nurse did this. When he got to a room (more on that later) the first thing the ‘old timer’ RN did was assess the IV site when he flinched a bit, and said that isn’t right; she changed the site, and dad had no more problems with the nausea meds or the antibiotics that had been leaking into his hand.
When dad was transferred to a room, I was again taking care of the dog’s meds (took me about an hour in the afternoon/early evening to do this) during the actual transfer. I knew he was going to a room, and was fine with that- he was ready. He had been up in the chair and done well, and walked one time to the end of the ICU hall (about 6 rooms) and back. When I got back, and found his new room, I was told that the nurse loaded up his stuff to carry, his friend had carried some stuff, and dad was left to walk with no support (or WHEELCHAIR) to a room on another part of the same floor. It was a considerable distance away from his ICU bed. It was the second time he walked at all, and a few hours after he’d even been out of bed at all. His friend told him to hold on to her arm, at which time the nurse offered her arm- but if he had started to lose his balance, nobody (the NURSE) would have had any sort of grip on him. His elderly friend certainly wasn’t responsible for his safety. I was mad when I heard that. He could walk when he got to the other room- NOT as a means to transfer him there. That is incredibly stupid from a safety standpoint.
Dad had eaten a bowl of soup a while before ‘tranferring’ himself to the new room. That was the first food in 36 hours besides sips of diet soda. Since his IV fluids had been axed before he was taking adequate fluids, he was ‘low’ on fluids. His heart rate was OK, and his blood pressure was actually a bit up for him (the dinging and gongs in ICU drove him nuts- he is VERY sensitive to auditory stim….gum chewers in the same area will actually drive his BP up to stroke level)…so I guess from looking at the numbers alone (and not the actual patient), he may have looked hemodynamically stable….but people still need fluids !! Orthostatic changes don’t always happen in the first minute; he could have easily dropped his pressure en route to the new room from being ‘dry’.
The nurses on the regular ‘floor’ were outstanding. Both of the ones he had were personable and very attentive to the things that may not seem ‘worth’ the time of an ICU nurse- but can make a huge difference in how care is perceived. I’ve been an RN for nearly 28 years. Granted, I’ve been on disability for 8.5 years- but during that time I’ve been IN the hospital a LOT. I still know the routine procedures and when an IV needs to be assessed more closely. IV meds aren’t given without a saline flush (and assessment of the IV itself) first. I’ve spent time around monitors and floated to several types of ICU (including NICU). That’s only part of the picture. Someone can have great ‘numbers’ but still have things wrong!
Nurses must listen to the patient, and if a patient is complaining about an IV site hurting when anything is pushed into them, they need to be changed (or at least addressed in some way besides some lame ‘oh, some meds do that’ comment- without looking at it). Sure- meds can be pushed through just about anything…doesn’t mean the vein and IV are intact. Many of the patients in that ICU were on vents and not communicative- maybe the nurses just got used to dealing with overt, objective issues. Maybe the transferring of someone who could walk seemed OK since most of their patients don’t walk at all. That goes back to inexperience (and some lack of common sense of youth- and known policies re: transfers).
An elderly patient one day after major surgery with no supportive fluids, or consistent food intake is not a candidate for walking throughout the hospital to a new room, or ignored when they say the IV site hurts.
There are many good young nurses- but ALL nurses (no matter how many decades they have worked) must always be open to learning. The young ones need mentors during their first several years- especially in a critical care setting. IV fluids need to run until the patient is taking in enough oral fluids to equal the rate of the IV, and at LEAST until they pee (providing there aren’t any issues with fluid overload or kidney function; my dad had neither of those). As a patient myself, I saw why it’s no wonder these younger nurses aren’t doing the basics. As students, they weren’t allowed to do anything but follow an experienced (sometimes still relatively new) nurse during clinicals. When I graduated, if we didn’t DO the skills, we didn’t graduate (never got to take boards). Period. There is a huge gap between book knowledge and practical knowledge that is only getting worse.
All of the nurses dad had were so very kind and sweet. That wasn’t a problem at all… but some of the decision making reminded me of my very first semester of nursing school, with trying to get the basic skills learned. Press Ganey will hear about this. But this hospital’s ER satisfaction is a ratty %83 per the hospital’s own information anyway. That’s up from the %65 from a few years ago. The floor and ICU numbers were better, but in ICU I wonder if it’s because their patients often can’t reply or respond to satisfaction surveys and their family members don’t know what is responsible care in specific situations. ? With healthcare becoming a concierge (hotel-like) industry with these stupid surveys, the nurses focus on the sweet and kind, and less on the technical prowess needed with the sicker patients. Dad was relatively easy for ICU standards- but he could communicate with them. And they didn’t listen.