ahhhh, crap; mixed news

[verushka70]

Well, the pathology report for my mom's "specimens" (i.e. the lower lobe of her R lung, all 20 lymph nodes and the section removed from the upper R lobe came back. We're told that the upper lobe nodule wasn't cancer, it was actually a fungal infection. That's the good news.

The bad news is that 3 of the lymph nodes were involved. 1 of them is in the mediastinum, near the heart/esophagus/trachea and in between the 2 lungs... which, we're told, isn't good. Also, there were multiple foci (3, to be exact) of cancer in the lower R lobe, not just the one that showed up on the CT, X-ray, and PET scan. So that's bad. No one will say exactly how bad; they're giving vague generalities. But lymph node involvement and multiple sites can't be good, when it comes to cancer.

I don't know if I'm just being a neurotic nursing student, but some stuff has happened while my mom's in the hospital that has made me think the nurses at this place, and the hospital in general, have become shitty over the last few years since they got taken over by Resurrection. For one thing, the nurse who put my mom's IV in preoperatively left a HUGE (like 2 inches long!) air bubble in the tubing, and as I watched it go into my mother's wrist through the IV site, I said to her, "Is that supposed to be there?!" and she said, "Oh, it's fine, it won't hurt her." Meanwhile, I'm thinking, if I had done that in school or in a clinical, my teachers would have failed me right then and there. wtf??

Then, after they transferred her from the ICU to the TCU (Transitional), the transport guys just left her in her room... and no one, not one health care worker, came to see her for over an hour. Again, I say... WTF?! When you get a new patient -- so I've been taught! -- you at LEAST go introduce yourself to them, even if you're busy with a complicated patient somewhere else. At least let them know that you know they are there! Not to mention someone should have come in to take her vital signs within at least the first hour, I would think.

Also, the unit doc told my mom yesterday that someone would ambulate her (walk with her) in the hallways and they'd also do stairs with her. Well, they didn't walk with her, the RN just told her to get up and walk. For someone on the amount of Vicodin and Tylenol w/codeine that my mom is, and the fact that she's older and totally unused to these drugs, that's not really safe. (Not to mention, if I'd ever done something like that in school during clinicals, I'd have been failed.) And no one ever did the stairs with her at all.

Lastly, and most frighteningly, when the surgeon came to take out my mom's chest tubes, he asked the RN there to get him a suture removal kit. The RN came back with two gauze pads and some tape! So the surgeon snapped, "I said a suture removal kit, dammit!" So again I'm going, WTF!? This clown doesn't even know what a suture removal kit is... should he be my mother's nurse? Even the surgeon was ticked off, which seemed ominous to me.

We thought she'd be coming home today (and my mom certainly WANTED TO), but it was not to be. Her oxygen saturation was down too low today, so the pulmonologist said No way to going home. My mom was terribly disappointed. She's bored, she hates being in the hospital, and she just wants to come home. So they put her back on oxygen today. She might not get to come home tomorrow, either; it depends on how the broncoscopy and suction they have scheduled tomorrow will go. If they go well, they'll send her home. If not, she's stuck in the hospital 'til Friday at least.

Sigh.

Comments

[grey853.livejournal.com]

Unfortunately, this isn't news to me. Luckily, the times my mom was in the hospital, we were able to have someone with her most of the time. It's really scary what might have happened if we hadn't been there.

Most of the time I think it's combination of understaffing, so too many nurses just don't do the quality they should.

Hope things get better soon.

[verushka70.livejournal.com]

Thanks. I think we resolved the issue. Well, I talked to the charge nurse... and my mother was discharged that day. The problem was really only on one shift, with one particular nurse. I could go into details but the point is, you're right, it's better to have someone there...

[purpig21.livejournal.com]

Oh dear. I'm so sorry you are having to go through this with your mom.

Since I am a CV nurse and deal with your mom's surgery every time I work I can say, I wish things were going better for you care wise.

First and foremost. Please understand. Nursing school and actual nursing are 2 totally different animals. Nursing school is the ideal. Yes you would fail if you did some of the things nurses do in real life, because they have to hold you to the ideal standard. Although this is an achievable standard the majority of the time, it is not the reality of the situation.

Real life nursing is a combination of short staffing, high acuities, time management, occasional unreasonably demanding patients or families, and the fact that nurses are human beings. (and I'm not implying you are being unreasonable, I mean I may have 2-6 patients and 4 good reasonable ones and 2 frantic, demanding, "fluff my pillow every 3 minutes," type of patients that occupy my time and keep me from having the time I need for everyone.)

I could explain each and every one of your complaints. All are justified in one POV, but they happen.
The air bubble in the IV line? It really wouldn't hurt her that small amount as long as it was a peripheral vein. the fluid/blood combine in the blood stream and the bubble ends up not being big at all once inside the body. If it were a central line, that would have been different.

The leaving your mom alone for an hour? Nope wouldn't happen on my watch..but not all nurses are me. But I have had patients arrive under the radar. Messages do not get relayed. The wrong person is told, the right person is told, you aren't around to recieve the message and when they do see you again they have been in 3 other rooms, answered 4 phone calls, dealt with a cranky doctor, and oops it slipped their mind. Not an excuse, human nature.

Ambulation....sucha wonderful idea, and a great practice too. I never let a patient ambulate alone the first time. I see how they do first. But not all nurses are that conscientious or cautious. once again human nature.

As for the suture removal kit? That nurse could have not been listening close, or the doc could have mumbled his request, or it could have been a sorry nurse. Yep we have em just like every other profession. Once again human nature.
We put a suture removal kit in the room when we set the room up to recieve the patient cuz we know eventually we will need the it.

It's not only that the hospital was taken over by some corporation, but you are dealing with humans. Even if they did pass boards they are still human with good and bad days and we have our good and bad nurses. I got report last night from a nurse I despise because she half way does everything.

But first and foremost understand this.....nursing clinicals and real life are not the same thing and do not resemble each other in any way. That is the first lesson you learn after you graduate and get into the real world. I was fortunate that I had some realistic instructors who were willing to pull us aside and whisper that to us beforehand. Plus working as a PCT before I actually began clinicals was very helpful in every way.

I'm not discouraging you from trying to maintain the high standard. Hell I struggle for it every shift. But also accept that clinicals and nursing school can't show you every situation.

But also as Grey853 says, having a family member or friend close by is a safe thing to do and always has been. From the beginning of health care not just the last few years.

[verushka70.livejournal.com]

Yeah, I realize that they're teaching us best practice and that's not going to happen all the time in the Real World, and that some of these things were minor. But the unattended handoff/transfer, the ambulating by herself, the not knowing what a suture removal kit is... it was always the same nurse on the same shift, an unfortunate pattern. Turns out he hasn't been here in the US that long. Uses different terminology (and that's what he's used to). There's a bit of a language barrier, too. And cultural (and perhaps culture-related care) differences. At any rate, one of my sisters was the "bad cop" earlier in the week, so I was the "good cop" and just very calmly and diplomatically discussed things with the charge nurse. I don't know if it will make a lot of difference, but I felt better. I mean, I know I've already screwed up in clinicals -- left the bed in a high position with side rail down once, failed to put the call light within reach of the patient another time. I'm not unsympathetic to the fact that we are all human; I just had a patient tell me I was too negative last week and that I should smile more -- "smile more" for her, while I'm going through this about my mother. Needless to say, since her care was not supposed to be about me, and she wasn't pulling it out of her ass, I'm sure my worry/fear/anxiety/depression were coming through somehow, I didn't bother explaining anything or making excuses to the patient... just tried to smile through gritted teeth and yank my mind away from my mother and back to the patients in my care that day.

But it was the pattern of screwups in my mother's care that bothered me, and the fact that the things were happening at times when none of us were there or could be there. I dunno what kind of training or orientation they gave this nurse, but either he doesn't have the English skills for it to work, or maybe he's worked too long in other systems that don't do things the way we do here, or he has cultural expectations of patients and health care that are quite different than ours, or some combination of all three.

Anyway, she's home now, doing better, still on O2 and I'm giving her the nebulizers but she's gotten to a point where she mixes the meds herself and does it herself. She's doing the deep breathing, coughing, and incentive spirometry without much nagging on my part, so I don't have to worry so much.

[purpig21.livejournal.com]

I'm so glad your mom is doing better, and making a good recovery.

So it comes across that the majority of the problems were this one nurse?

I totally agree that you should have spoken to the charge nurse, or better still the nurse manager for that unit. Sometimes as I mentioned you get a bad nurse that everyone else sees as a bad nurse, but they are hard to get rid of. Also as you said he coud be having difficulties with the cultural differences. I do know they do alot of things differently in other countries.

As for that patient telling you that you were negative? Heh I've had that happen, and yep it is hard to put your own life aside and focus only on them. I went through my own mother's cancer ordeal and went into work and dealt with cranky, crazy neuro patients. It's not easy. All I can say is there are good days and bad days. That's why we have LJ and LJ buddies. :)

Keep it up, you are gonna do well.