I received a call from my little sister (brand new mom) regarding my nephew. He is 7 months old and has been hospitalized three times since birth for various reasons. She wanted me to stop by and check in on him.
I am two weeks away from starting nursing school. The decision to go back to school at 32 stemmed from both losing a job that I hated and being lucky enough to have a fiance’ that encouraged me to pursue what I have always wanted to do–become a Nurse. My sister values my opinion; not as a nursing student but more because I am the mother of 3 children, lol.
I stopped by her house to take a look at “Lil G”. He was fussy, running a low-grade temperature, and not eating well. Other than that, he had no signs or symptoms of anything being seriously wrong. I told her to watch him closely and try to encourage him to drink. A few hours later his fever was up to 101.8F and he was showing signs of dehydration. We decided to go ahead and take him to the ER (it was late Saturday afternoon).
Next, the decision as to where to take him ensued. She has worked as an EMT so she and I compared notes regarding area hospitals. She really wanted to take him to a hospital that was a 45 minute drive from our home. I volunteered trying a more local hospital. The only one we agreed upon was about 20 minutes away. She only agreed because she knew the ER staff on the floor that night.
Luckily, the Charge Nurse for the night was an acquaintance of hers and we were able to bypass hours in the ER waiting room (helps to NETWORK, NETWORK, NETWORK). Upon arrival his temperature was 103.4F. The Triage Nurse was friendly and appeared to know what she was doing. We were in a private ER room within 15 minutes of arrival.
Then the fun began…
We sat in our room attempting to pacify a fussy, feverish 7 month old for almost an hour. My sister is not the most patient of people. Finally, she sent a text to her friend the “Charge Nurse”. A few minutes later, she personally paid us a visit. She promptly apologized for our wait and explained that our “Assigned Nurse” was very busy and behind. While she was in our room, she assessed my nephew. He was clearly dehydrated and needed a bolus of fluids quickly. She said she would go inform our assigned nurse and stepped out of the room.
About 10 minutes later, our elusive assigned nurse made her first appearance. She boisterously introduced herself as “the one in charge”. She then proceeded to assess the baby SANS GLOVES. The rest of her assessment included kissing on his forehead and feet while announcing her previous history as Pediatric Charge Nurse along with the fact that she knew all things baby… Her exiting act including calling my nephew her future “Pimp Daddy”. Needless to say, my jaw hit the floor.
And the wait continued…
After another 30 minutes, my sister again sends a text to her Charge Nurse friend (like “what is going on???”). Within a few minutes, the Charge Nurse re-enters the room with all necessary items to give Lil G the IV he needed. She was gentle, exact and started his IV on the first stick. Knowing how easily children pull IV’s out–she taped the tubing and all things that could be tugged down securely. By this time, she was noticeably frustrated with our assigned nurse’s absence–yet she did not make a single comment to us about it. She left and within a few minutes who should appear??? That’s right–assigned nurse! This time she had a new nurse following her for teaching purposes. She did not speak directly to us but rather spoke to the new nurse as she prepared to hang my nephew’s fluids. She makes comments as to the “crappy tubing” the hospital uses and proceeds to illustrate how to get the air out of the tubing for the new nurse. All the while—STILL NO GLOVES!!! As she continues her illustration, she kneels on the floor with the tubing “to allow gravity to push the bubbles out” then removes the cap from the tubing WITH HER MOUTH. To top it all off–she then releases the port-end of the tubing and allows it to roll all over the ER room floor before picking it up with her bare hand. That’s right folks–no sanitary measures followed WHATSOEVER!!! In the milliseconds before attaching the tube to my nephew’s IV port my sister asks if the tubing should be sterile before insertion. Assigned nurse glares at my sister with obvious contempt and responds “no because the cap was on until insertion”. To add insult to injury, upon exiting our room she does an “about-face”, takes a look at G’s IV and announces “I’m going to fix this shoddy tape job (insert charge nurse’s real name here) did… She has her ways and I have mine”. She roughly rearranged the tape securing his IV and leaves.
Weeeehell, knowing my sister as I do–this was not going to fly. I knew every detail of our encounter would be discussed with Charge Nurse. My sister recounted the gory tale to her as I watched the kind nurse’s face get pale. She was frustrated, embarrassed, and apologetic for the care we had received.
The Dr working ER was also an acquaintance of my sister’s. She did a very thorough assessment, reviewed labs, ordered another IV bolus and decided he should be admitted. She also explained that due to the lack of an obvious cause for G’s fever, loa, lethargy, and fussiness–a lumbar puncture would need to be performed. This was precautionary, of course–to rule out sepsis. My sister knew she couldn’t handle being in the room during the procedure.
At this time, assigned nurse comes to our room with a syringe of Children’s Tylenol and a second syringe of Motrin. Take note: we arrived 2.5 hours earlier and this was the first antipyretic medication he was administered. Once again WITHOUT GLOVES she administers both medications simultaneously. No instruction or reason for this administration was ever provided. When she turned to leave our room she informed us she will be holding the baby during the lumbar puncture. My sister looked at me and said, “DO NOT leave this room for one second while that woman is in here with my baby!” That was definitely not happening…
This point was obviously both my sister’s and the Charge Nurse’s limit.
Within minutes Charge Nurse enters our room and announces she is moving us. When my sister asked if this will upset our assigned nurse she responded, “this is my decision”. We relocated to Room 8–under a different nurse (duh). Luckily our new nurse was 6’6″ and almost capable of restraining my nephew (the strongest 7 month old I have ever seen). Within 15 minutes, the LP was complete. The Dr explained she “nicked” a blood vessel when the baby squirmed and some blood was in the CSF sample. So, she couldn’t absolutely say the CSF was clear at that time. The sample was sent to lab for culture and Lil’ G was admitted to begin his precautionary meningitis treatment.
About 5:15 a.m. G was admitted to a Pedi room. I decided it was time to call it a night.
The walk to my car seemed to be in slow motion. My mind was swirling with the events I just witnessed. Yes, I know the “real world” outside of nursing school is harsh and unpredictable. I know because people are different-nurses are different. My insatiable thirst for nursing knowledge exposed me to the study of ethics, sterile procedures, privacy laws, microbiological warfare, patient advocacy, continuity of care, teamwork, delegation of responsibility and much, much more. I have read nursing articles regarding strife among healthcare team members–it all seemed so juvenile in print. The reality of repercussions due to failure of any kind on the part of a nurse was not lost on me. … For about a millisecond I wondered if I made the right choice to become a nurse…
Then I thought of Charge Nurse. I recalled her precision, her patience, her attention to detail, her maturity, and above all her prioritization of her patient’s needs above all else. I thought of the Dr. and her high regard for the Charge Nurse. The Dr. recognized quality nursing: knowledgeable, personable, dependable, intelligent, selfless and caring.
Complete care takes a team. I see now there really IS a shortage of competent, qualified RN’s.
Yes, there may be thousands of nurses out there just like “Assigned Nurse” who is in nursing for the wrong reasons. And, unfortunately as a student or newbie, I may be working with a few myself.
I decided that night…err early morning it is my responsibility to be a quality nurse. It is my responsibility to learn my role correctly and to perform it properly. This will include dealing with other nurses who take short cuts, do not treat their patients with the respect they deserve and refusing to behave in the same manner. Above all, my role is to promote health and benefit others in such a way as to validate the honor in being a Registered Nurse.