The On The Night Shift

The result of this was detrimental to the patient. Once the nurse from my unit went in to assess the patient she observed that the patient had a severely infiltrated IV, leaving her arm swollen beyond belief. Her vitals also revealed that she was hypotensive, febrile and in respiratory distress unstable and rapidly becoming septic. Thankfully interventions were taken just in time and the patient ended up being transferred to the ICU where she received the care needed to save her life. Just imagine what the outcome could have potentially been for this patient. Clearly this patient’s life was put at risk due to others carelessness and inability to follow rules and guidelines. Talk about conflict!

When I arrive to the Trauma ICU 4800 unit, all of the nurses were already being followed by other students. The nurse in charge had me follow several different nurses, so I was able to observed several different patient cases. The first patient had received a triple bypass open-heart surgery. The patient had received a creatinine blood test. The patient had a dialysis machine next to them, which was used to function as the kidneys since the patient’s kidneys were not functioning correctly. Also, the patient’s body temperature was lowered from having a taken cool liquids so the nurses were keeping him warm with a bair hugger, which was a machine that helped regulate the patient's’ body temperatures.

On my first day on the ward it was decided that I should shadow one of the staff nurses to acustomise myself with the ward. During this induction we had to assist an elderly gentleman with sever diarrhoea the gentleman in question was quit large and almost completely immobile. On inspection of the

Not only did insufficient staffing contribute to the causes of this particular event, but human error also played a significant role. When Mr. B arrived at the ED, he was hyperventilating. His leg “appeared shortened.” He had edema in his calf, ecchymosis, limited ROM, and he rated his pain at a ten out of ten. Mr. B also had a history of prostate cancer, impaired glucose tolerance, elevated cholesterol and lipids, and chronic pain. He was admitted to the ED with a plan to relocate his hip. Dr. T ordered diazepam 5.0 mg to be administered through IVP and then just five minutes later ordered 2.0 mg hydromorphone to be administered because it appeared that the diazepam was not having the intended sedating effect. Again, just five minutes later, Dr. T was still not satisfied with the level of sedation and instructed the nurse to

Additionally, the care environment developed a hazard when the patient population increased both in number and acuity with the admission of the acute respiratory distress patient and increasing patient load in the lobby without note of available back up staff being called in. Examples of errors from the flow chart comparison might include failure to assess and monitor when Nurse J initiates blood pressure and SpO2 measurements, fails to initiate ECG with respiration monitoring, fails to administer supplemental O2, and leaves the room without apparently noting the baseline of the patient2. Furthermore, there appears to be an error in the lack of communication collaboration between the RN and LPN regarding Mr. B’s post procedure status and monitoring needs, and there is a failure to rescue when the LPN notes the low SpO2 value, fails to respond, and instead re-initiates another blood pressure reading without noting the results. As Mr. B’s condition deteriorates and a code is called, an ACLS error is observed in the timeline when the patient is noted first to have absent pulse and respirations and that a monitor is next applied and the patient and displays ventricular fibrillation. Chest compressions appear to not have been the first action in this scenario, nor is end tidal CO2 monitoring noted as initiated to monitor the quality of compressions. These are examples of hazards and errors in the care of Mr. B and in an actual RCA the level of detail would likely turn up

Q by taking vitals right away and report immediately, since the night shift reported elevated blood pressure at the end of their shift. This would help in determining the next step in delegating and treating Ms. Q. If her blood pressure remained elevated, the RN would delegate the LPN/LVN to proceed with the next step. After getting vitals for Ms. Q., the RN would ask the UAP to assist with Mrs. A, because she is scheduled for a Doppler flow study this morning and can help by bringing the machine to the room and by assisting the patient with morning care and ambulation prior to the study being done. The RN could have delegated Ms. Q vitals to the nursing student as well, but since the vitals were extremely high, the RN chose to have an experienced UAP report the vitals within a specific time frame. The RN has delegated these tasks because they are within the UAP’s scope of practice. They are trained to perform certain duties and tasks such as documenting and reporting information, and assisting patients with their activities of daily living. If the RN were to delegate the administration of medication they could possibly give it to the wrong patient and cause adverse reaction. The fluidity of the communication between the UAP and the RN team leader greatly impacts identifying what is expected from the UAP to communicate to the RN. Siegel and Young (2010) explain that the UAP needs clear guidelines and procedures,

We arrived at Clearview at 2231 Hrs. and took the patient to room 14. I went back outside and began to put our unit back together when Supervisor Carlock approached me and in a very agitated voice said: “WHY DID YOU PULL OFF?” Surprised, I said “What are you talking about?” He said loudly, “I TOLD YOU TO STOP AND YOU DIDN’T!” I replied, “Jeff was telling me not to stop because we had a pulse back.” He said “I DON’T CARE WHAT JEFF SAID, I’M YOUR SUPERVISOR AND I TOLD YOU TO STOP!” I said “Dennis, I think you’re talking to the wrong person, you need to be talking to Jeff, I was doing what he told me to do.” He replied “WHO’S YOUR SUPERVISOR, WHO’S YOUR SUPERVISOR, I AM, NOT JEFF, YOU DO WHAT I SAY!” I said ”yes, you are the supervisor, but at that moment I was doing what the Paramedic in charge of patient care was telling me to do, and what I felt was best for the Pt., since we had a 41 Y/O patient who had a pulse.” He said “I DON’T CARE, YOU DO WHAT I SAY!

I had my first two night shift this week on Sunday 9/13 and Wednesday 9/16. I am on 7 West at Sharp Memorial Hospital and the unit is PCU unit with tele monitoring. The unit had a high census this week, but proper staffing and no codes lead to the nights being relatively calm. I was working with Laura who is not my regular preceptor. She stepped in to work with me for this week while Elle, my regular preceptor, was on vacation. I had a wide variety of patients on my two shifts. The first shift I had a patient that was suffering from an exacerbation of COPD with a history of CHF and a patient that had polycystic kidney disease, which had progressed to end stage renal failure. The second shift I had four patients; one patient had been admitted to the hospital multiple times in the past month for GI bleeds, another patient with a history of diabetes and hypertension was admitted for fever and chills and was later diagnosed with sepsis, the next patient had a history of schizophrenia and was found on the ground in her home and was expected to have been there for over 24 hours resulting in deep tissue injury, and my final patient was suspected to have a history of alcoholism and presented to the hospital with shortness of breath and an oxygen saturation of 89%. The first clinical shift I was shadowing my nurse for a majority of the shift. I was being orientated to the unit and learning where to find supplies on the unit. The second shift I took a

In healthcare today, when hospitals are judged upon patient safety standards, it is critical to prevent errors involving medication administration. Distractions while preparing and administering medications, has been report as one of the leading causes of medication errors. Distractions while nurses are administering medications can lead to poor patient outcomes and even sentinel events. Nurses and nurse managers are responsible for maintaining a unit with minimal distractions. When distractions are minimized throughout medication administration process, a decrease in medication errors will occur and lead to increased patient outcomes.

First off I wanted to say I enjoyed reading your post and, in my opinion all of your ideas listed in this weeks post regarding, the growing number of homeless people in the downtown business district, were excellent. Almost all of us this week agree that a survey needs to be established to help identify why this is a growing problem. That being said, I particularly liked your idea of having a night shift survey at different times of the night to see how many homeless are sleeping within what areas, and also having a day shift to survey the areas to see how many are panhandling. This idea is not only useful for gathering information, but also to help with public safety.

wrong patient. LVN had to stop the infusion and notify RN. RN had hung wrong medication for

The main dilemma I am presented with in this case vignette is my co-worker is acting negligently, unprofessional, and violating hospital policies and procedures (Masters, 2015). The best response for this situation would be to insist he double-checks my dosage calculations and pump programming or have another co-worker double-check and offer him peer feedback on his performance (Nursing: Scope and Standards of Practice, 2015). During the peer feedback, I would educate him that this kind of negligence leads to malpractice. I would also tell him when he is the second person verifying a high alert drug he needs to be compliant and actually verify the calculations and pump programming. Double verification is a safeguard that increases patient

The nurse who was looking after that patient was not aware of the request for transfusion until

Usually in the medical surgical floor, nurses must take care of 4 or 5 patients. That’s where Delegation and prioritization comes handy and becomes their best option. During my clinical rotation, I was assigned two patients each week to care for. Before caring for any patient, we must get a report from previous nurses in the patient’s room. For that reason, I decided to get said report from my buddy nurse to get my shift started. After receiving reports on my two patients, I immediately knew both patients were stable. I then decided to do a two minute assessment on both patients on their vital signs. After my assessment, I realized that one of my patient was in severe pain on a pain scale 8/10, on his neck radiating to lower back, on the scale

I was working night shift in a level 3 Neonatal Intensive Care Unit facility and my 10 days orientation was over. It was my first day working without my preceptor. Since I was a new staff, the charge nurse allocated two stable babies for me. One was Baby Zahra, a 33 weeks preemie, on room air, with nasogastric tube, with peripheral intravenous line to keep the vein open and feeding with expressed breast milk every 3 hours. I started my shift with a bit of nervousness knowing that I am on my own and wondering if I can remember everything that my preceptor had taught me during our orientation. I started my assessment and observed Baby Zahra to be pale, her skin was slightly mottled. I checked her vital signs. The cardiac monitor showed that she