Blitzed Again…
I worked Ick-U last night with THE NURSE. It was going smoothly because we had 3 patients, 2 vented and one DKA. I had 2 nurses…one who is willing to mentor; and then THE NURSE. I had all my work done by 9pm and still stayed very busy helping my Nurse’s with their patients.
THE NURSE has a problem with the fact that I have insatiable curiosity and ask a lot of questions. She often misconstrues my questions to promote my own learning and progression as me being insubordinate, rahter than me merely being motivated to learn as much as I can. Well, I am a Master at the basics, however, because we clash I always defer to THE NURSE. Last night I just couldn’t keep my mouth shut…we were bathing, turning, and positioning a woman who was intubated via an EndoTracheal Tube. She was on 90% O2 and only saturating in the low 90%. She had rhonci and rales in all four lobes. Well, THE NURSE (who has been a Nurse for 40+ years) was nearest to the vent. This position placed her nearest the tubes and the thingamajigs that hold the vent tubes at an appropriate angle from the machine to the patient. I told her she needed to give me slack and disconnect the tubing from the holders (she knows better than to leave the tubes attached…she’s been a Nurse for four decades)…well, she opted not to do as I suggested and take the tubes out of their holders; and, she opted NOT to give me slack…so, sure enough…the T-tube popped off, as did the connection between the ET tube that was in the patients mouth and the inline suction devices. Anyway, the patient started emitting thick yellow-brown mucous (or is it sputum when it is expired…I forget the proper language…but I am hoping you, the reader, is getting a visual)…she also started having spittle and air bubbles emerge from her nose; AND, she was gagging on more spit, phlegm, and mucous that was pooled inside her cheeks. She started to choke and gag, and I was almost certain she had aspirated. Anyway, THE NURSE got mad at me for not holding the patient correctly! I had her turned using the soaker pad and using the recovery position as the patient was a heavy set woman. My hold was fine, THE NURSE just wanted me as her personal punching bag because she was in a hurry and didn’t follow common sense or prudent care with the tubes.
All ended up being well with the patient because THANK THE LORD our Respiratory Therapist was in the room with all of this going on and quickly and efficiently suctioned the patient with both in-line suction and yaunker suctioning, flushed the in-line with saline to clear the sludge that was getting clogged in the line, suctioned a little more to clear the airway, and put both the T-tube and the ET tube back together. We were really lucky the RT was there helping us or we well could have extubated the patient (note to self…if I ever become “seasoned” still take time to listen to my support staff, they may be observing something I am missing that ensures the patients well being).
Well, THE NURSE being older and a little on the lazy side had another line mishap — the patients Miller-Frederick tube came out. The patient was in 2 point restraints per our vent protocol but was still agitated and restless. Perhaps when the patient turned her cheek on the pillow she rubbed her face hard enough into the pillow to pull it out? I am thinking this is the only plausible reason the MF feeding tube was pulled because it was intact after the fiasco I just wrote about, and I was in another room…
I was in a room getting some basic education about our vents and learning the importance of inspiratory vs. expiratory breaths, basics about Tidal Volume, PEEP, and the modes used on the ventilator to help a patient eliminate CO2. The RT that was taking the time to teach me some RT basics felt it would be another way for me to help my Nurse’s — as well as, give me an idea of what I should expect RT school to be like. We started our conversation with me taking notes at about 0330 and finished at 0400. Prior to having this experience, I made sure all of my work was completed and also that the 5 ECG mons were being watched and were stable.
Well, THE NURSE, flustered and frustrated about the MF tube pretty much pointed the blame at me for not being at the Tele station to advise the patient had gotten the tube out. She said that it wasn’t appropriate for me to advance my education while on the job and that I didn’t need to know any respiratory information as an Aide/Tele Tech. I was stunned! I was upset as well…I am entitled to a 30 minute lunch break although I NEVER take one, my educational moment was the length of a break…I also wouldn’t have participated in this learning process had I felt that any of my Tele’s were not monitored or if the Nurse’s needed my help. They both indicated that they were caught up. Furthermore, if one can’t progress and gain knowledge or ask questions so he or she may apply what is being learned what is the point of entry level positions in the Hospital setting?
I am floored that THE NURSE is so old school she is unwilling to mentor, to take responsibility for her mistakes, and for using me as a punching bag. I definitely feel blitzed again.
January 3,2009 at 18:34
It’s like the old saying, “Nurses eat their young.” This doesn’t always apply to young, new grad nurses, so I’ve discovered in my job as a CNA thus far. While some “seasoned” nurses are excellent when it comes to answering questions and taking advice from their co-workers, some of them think everyone is beneath them because they have been doing it for X number of years, and that is sad. In my humble opinion, you never stop learning, and just because you feel that you have a routine down that has been working for a number of years doesn’t mean that someone else does not know a more efficient method. I always grew up hearing that “There is more than one way to skin a cat,” and healthcare is no exception to this adage.
I’ve been fortunate in my short span as a nurse’s aide that I’ve worked with several nurses who know that turning people, bathing, emptying catheters, doing accuchecks, etc. is something we do on a daily basis and very often; and usually ask me the best way to do something. However, there have been a few that believe I am truly beneath them and know virtually nothing, and my time spent working with those nurses include many stories like the one you told above, usually with a similar outcome.
It’s sorry that you had to take the blame for all of that, but I guess you just have to remember that it wasn’t your fault. It’s hard to be blamed for something you didn’t do, but that is something that happens all too often where I work. If I knew how to fix it, I would. Until then, I guess we just have to stand up for ourselves and do what we know is right.
January 5,2009 at 18:34
Your thoughts and advice are well put. I have thought a lot about that night; and, I don’t think I should have held back my request to THE NURSE to give me slack. She put the blame on me regarding the MF tube because I, the lowly aide, had been right about the tubing and everything came apart; and, she was caught being irresponsible by the RT (who never said anything about it to the Nurse, but talked with me in the morning — reassuring me I did everything right). Anyway, when I work with this Nurse, I am determined from this point forth to always be on the side that the vent tubes are directed…that way, if slack is needed then I can take care of the problem. Also, when I work with this Nurse I am going to ensure that at least yaunker suction is on and within easy reach. So…all in all, I am now able to find some positives over that bad experience…AND, I will be more cautious when I work with her about the kinds of questions I ask and to whom I ask it.
January 26,2009 at 18:34
Not to be flip, but it sounds like she’s just a toxic, burned-out old hag. Don’t let her get to you…you did everything right, and she sounds like one of those people who will always be “right” even if she’s clearly wrong. Usually I avoid people like that, and if I absolutely can’t avoid them, I minimize any interaction with them.
Anyway. You did everything right, and I’m glad the night RT is helping you learn. Having the initiative to ask questions and learn means you’ll be an awesome, successful student.