Sunday, January 1, 2017

Are you a REAL nurse? Or are you just someone who was able to pass NCLEX?

As Ralph and I travel across the country, I have the opportunity to work with some of the best healthcare workers in the world. Their level of skill and compassion is second to none. Unfortunately I have to opportunity to work with some of the biggest slackers in the world as well.
One might ask what is the difference, or how can you tell. The most recent example we will illustrate below:
Scenario 1: 30 minutes before staff shift change we are called to the ER because EMS is inbound with a possible stroke. In preparation for their arrival, I ask lab to come to the ER and Xray to warm up the CT scanner. I tell the ER RN that if the patient is stable on arrival they will go straight to the scanner (which they will pass by on the way from the ambulance to the ER) and then to the ER. The reply from the "RN" was "they need to come to the ER first so I can triage them and get their history in the computer". Needless to say at this point Ralph woke up!
I met the EMS crew at the door, did a rapid assessment and to the scanner we went. When we exited the scanner and arrived in the ER the "RN" was nowhere to be found. The patient was in the ER with 3 members of the BLS EMS crew, a CNA and Ralph and I. Over the next few minutes an appropriate history was obtained, NIH Stroke Scale of 6 documented twice, a 12 lead EKG was obtained,  I started 2 large bore IVs, hI had reviewed the head CT and identified a subdural hematoma, and was talking to the tertiary hospital neurologist on the phone when the "RN" wandered back into the room. Her first words were "why didn't you come get me, I was just having a cup of coffee". I asked her to call the on call RN to assist us because we were going to fly the patient to a neurosurgeon. Her response was "night shift will be here in a few minutes, I don't want to bother the on call RN".
Well at this point it was all I could do to keep Ralph from "splainin" the facts of life to this supposed "RN". But, professionalism prevailed and I was able to keep him muzzled.
The night shift staff arrived and the day shift "RN" informed us that ******* is here I am outa here.
Scenario 2: A few weeks later, Ralph and I were called to the ER for a chest pain patient that had walked in. The ER nurse for the day was the night shift RN from the previous case. When I walked into the ER about 6 minutes after I was called I was handed a 12 lead EKG, the patient had 1 large bore IV and a second was being started, the patient had been given 325 mg aspirin that he chewed, and labs were drawn and in process. This patient eventually also flown to the above mentioned tertiary hospital with a diagnosis of Non STEMI MI, had been started on thrombolitics in our ER and, by EKG and symptoms, his infarct was resolving. The evolution of this case also overlapped shift change, and the oncoming night shift "RN" was, you guessed it, the day shift "RN" from the previous case. The day shift RN did not leave the ER until almost 3 hours after her shift had ended and she had seen the patient roll out the ER door with the flight crew, because this was HER patient.
Now the difference between the 2 scenarios, in mine and Ralph's opinion, is one of the above is a Registered Nurse, and one is someone who was able to pass NCLEX.
Ralph and I will let you debate which is which, and even more importantly, which you choose to be like.
Happy New Year!

3 comments:

  1. Glad you were there. Sounds like an apathetic lazy nurse.

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