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Thread: Nurse firing

  1. #1

    Nurse firing

    So here is the story: Patient with recent throat surgery presents to ER with copious bleeding from throat. No ENT coverage for hospital. Stable H&H and vital signs. Hospital transfer arranged for ENT at hospital approx 45 minutes away. ER physician verbally ordered one unit PRBC's to accompany patient. Paramedics are not permitted to transfuse blood products. Temp outside 90+ degrees. Nurse disagrees with physician order: 1. What nurse in their right mind would transfuse blood sent from another hospital 2. blood would be out of refrig for at least 45 minutes. Physician still ordered blood to accompany patient. Inform supervisor of physician's order and nurse's reluctance to send blood, supervisor stated to do what physican wants. Inform lab of physician's directions and reasons that blood should not accompany patient, lab released blood even with stating they did not have cooler to send blood. Paramedics accepted blood even with nurse's explaination of why they should not accept blood product with transfer. Events occurred on weekend. Monday, nurse calls ER manager and reports incident and nurse's reluctance to follow order and the reasons why. Evaluation given approx 1 month later with good review. Nurse manager stated she told administration that physician insisted blood accompany patient. Risk management comes to ER to discuss incident with said physician. Physician sits in nurses station and discusses event with other nurses. Other nurses soothe phyisican and told physician that he didn't do anything wrong and "they didn't want to use blood, they could throw it away". This nurse listened to encounter totally blown away that no one seemed to have an issue with the safety and ethical issues with event. 2 weeks later, nurse is fired for event. What am I missing with this scenerio??????

  2. #2
    Super Moderator cougarnurse's Avatar
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    Soothe the doctor, what else?! We seem expendable.

    Did you get stuff in writing?

  3. #3
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    You're missing nothing. The lot of them are idiots. Tell the fired nurse to come work for us because I'd have her on my team in a second. Incidentally, was there any reason why this very controversial unit of blood couldn't have been administered before the patient was transferred?

    Just wondering,

    R

  4. #4
    Physician stated that intubating would be a nightmare, " bleeding, don't know what's in there that's bleeding and fat neck". Dr was in a rush to get patient out of ER and blood ready just as paramedics arrived. Thanks Ricu.

  5. #5
    Super Moderator cougarnurse's Avatar
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    I am reading GOMER (Get Out Of My ER) and do whatever you are going to do elsewhere.

    Gypsy, I hope the said nurse who got let go finds a MUCH better place to work.

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    A unit of blood can go in 5 minutes if the patient is that unstable. From what you say, this patient was not stable prior to transfer. We are talking about an ED, right? This sounds like a classic EMTALA violation and the hospital can be sued. My guess is that the patient was going to be better off with the paramedic anyway which takes us back to the fact that the doctor is an idiot. Any idea how she made out?

  7. #7
    Patient had a patent airway, stable vital signs and H&H at the time of transfer. However, the bleeding was quite copious and @ least 1 1/2 - 2 full suction canisters. Was amazed that maintaining patency was not the primary concern for the physician. Honestly, I was the nurse and thought that maintaining airway patency was the first priority and not blood transfusion even though that might needed to be addressed after airway if bleeding continued. And I would have rapidly infused PRBCs if given opportunity, but my main concern was airway. DR FSL was more concerned that he would be forced to attempt intubation if bleeding worsen. I agree that patient would probably fare better with Paramedic. I spoke in the 3rd person because I wanted to get honest feedback and insight to how I should have handled incident. Thanks RICU and Cougarnurse for your honesty. Patient was handed off to me just minutes before Paramedic arrived BTW.

  8. #8
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    Gypsy, my hat is off to you.
    You stated stable AT THAT MOMENT but then indicated, a lot of blood in canisters and rapidly swelling neck. This would certainly suggest a deteriorating situation and I agree, airway was a primary concern. This patient was in an emergency department under the care of a physician who was not operating in her best interest. She needed that airway and probably the blood. If the medic didn't have to do it, you know it was going to happen upon arrival in the next facility. I'm sure they had a lot to say about the condition of the patient. I'm surprised the medic didn't request the intubation or do it him/herself under the optimal circumstances of having a well lit and immobile ED stretcher instead of the back of an ambulance. How far away was the receiving hospital?

    You raised an important point that we talk about where I work; the situation of hand off care and communication. This patient had been in your care for a very short period of time and it sounds like you didn't have a good sense of her situation or all that had been done. Your keen assessment skills triggered red flags that were being ignored. Had the nurse on before you been as concerned about how the patient was handled? I'm sorry you were so badly treated but as painful as it was, it sounds like you're well rid of a sorry working environment. What are you doing now?

  9. #9
    Looking at my options. Found this area to be one of the least nurse friendly places, left a very good job to move back here. Oops, big mistake...... Just bought a house here. Maybe, going back to travel nursing.

  10. #10
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    Yikes to the house. I hope something turns up soon. Hang in there.

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