When the Nurse Becomes the Patient | The Nurse Keith Show | EPS 117

On July 7th, 2017, I was minding my own business at the gym when a freak accident occurred. It resulted in a shattered fibula, a fractured tibia, two severed tendons, a severed peroneal nerve, and a whole lot of suffering. A blog post tells the whole story in gory detail, and my desire for that post and this podcast episode is to remind us nurses that vigilance is needed in terms of our advocacy for patients — and for ourselves.

Nurse Keith becomes a patientThe Story of Friday, Bloody Friday

As told in the aforementioned blog post, here’s the story:

On a recent Friday afternoon, I was doing my usual workout at a local gym where I can be found pretty much every other day most weeks of the year. Cardio, weightlifting, various machines, balance exercises, and resistance training all figure in my personalized routine. 
Early in my workout, I was using thick rubber tubes for resistance training. These bungee-like tubes have handles at one end and are anchored into a sheet metal base on the wall. I use three in each hand in order to maximize resistance, and I was deep into my usual process when I heard a sound and then instantaneously felt a searing pain in my left ankle as I fell to the floor. 
Apparently, the metal anchor for the bungee cords had torn from the wall as I did my usual exercise, and this 18-inch piece of molded sheet metal flew at me with all of the pent up force of those six tensed rubber tubes. It guillotined the lateral aspect of my left lower leg just above the lateral malleolous.

Blood was spurting everywhere, and although I couldn’t fully visualize the gaping 7-inch long wound, I could see bone and knew I was in trouble. No one else was in the large exdercise room with me, but my screams brought another gym rat to my rescue, and he valiantly applied massive pressure to the wound with blood-soaked towels for the 15 minutes it took the ambulance to arrive. 

Through the pain, I had the wherewithal to tell the gym owner where to find my keys and wallet, and gave her instructions to call my wife and ask her to fish my laptop out of the trunk of the car. I also noted that several gym members chose to do their usual routine on the rowing machines not six feet from my head, even though I was writhing in pain, yelling, and pounding the floor with my fists. Not even human suffering could get in the way of their fitness (they obviously weren’t nurses). 

Keith's surgical wound

Pain and Neglect

Other than being in a great deal of pain, my hospital stay was pleasant enough. My wife was by my side, friends came and went frequently, and I was on the road to recovery.

However, even in my slightly obtunded narcotic haze, I noticed some very striking deficiencies in my nursing care. To wit:

  • I had surgery on Friday night and was not offered an incentive spirometer until Sunday
  • Not a single nurse assessed my lungs or respiratory status on Friday or Saturday
  • Although I was on oxycodone and Dilaudid, my bowel status was not assessed until I demanded that it be addressed on Sunday. Not a single dose of the ordered stool softener was offered to be until I asked
  • My pedal pulses were not assessed on Friday night or Saturday. The surgical NP was the first person to check my pulses, and this occurred on Sunday.
  • I was never offered a basin, warm water, and soap until I begged for it, and no one offered to help me do a bed bath when the supplies were delivered.
  • My room never disinfected, mopped, or otherwise cared for (with the exception of the trash being emptied)
  • The surgeon attempted to force me to be discharged on Sunday at 5pm, despite ongoing pain, dizziness, nausea, and a home completely unprepared for a disabled patient (our bedroom is on the second floor up a spiral staircase)
  • The case manager didn’t know what a transfer bench was, so I had to Google it and show her what to order

A Teaching/Learning Moment

What I most want to take away from this experience is that, even as an educated healthcare professional, things can still slip through the cracks when I’m the patient and not the nurse. For whatever reason they did so, the nurses failed to perform basic assessments on a post-op patient, and these omissions of care could have proved, if not fatal, at least problematic. I could have easily developed pneumonia, a bowel obstruction, and all sorts of sequelae from not being assessed appropriately.

Were these nurses carrying overly large patient loads? Were they overworked? Were they cutting corners because they simply had to? I’m not sure, but I know that if they made time to frequently chat with me (which they did, knowing that I was a nurse), they could have also made time to listen to my lungs and bowels, assess me for narcotic-induced constipation, checked my pedal pulses, and otherwise made certain that all their physiological bases were covered.

Imagine if I was a less educated patient without healthcare experience, would I have known to ask for a stool softener and an assessment of my lungs? Would I have known that checking pedal pulses was paramount? If I had asked for such things, would my request have been scoffed at or heeded?

The Upshot

Christus St.Vincent Hospital here in Santa Fe is locally known as “St. Victims”, and I now understand why. Although they indeed saved my wife’s life when she had a severe lung infection some years ago, stories still abound of neglect, poor medical practice, and less than stellar nursing, not to mention questionable labor practices.

There’s no doubt that nurses are frequently overworked, underpaid, and pushed to care for more patients that is prudent or safe. We are under duress, individually and collectively. Having said that, there is no excuse for the loss of basic nursing skills and assessments, especially in acute care settings where things can go south faster than you can say “tib-fib”.

How can we advocate for ourselves, as well as lean in when we see other nurses cutting dangerous corners of patient care. Now, when one nurses misses one lung assessment on a particular shift, that’s not necessarily a catastrophe. But when every nurse on every shift fails to do a lung assessment on a mostly supine post-op patient, the door is open for disaster.

These lessons are crucial, and we must protect ourselves, our patients, our licenses, and our profession by doing our due diligence and practicing safely and prudently every moment of every shift.

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Be well, dig deep, and keep in touch!

Keith Carlson, RN, BSN, NC-BCKeith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known blog, Digital Doorway.

Keith is co-host of RNFMRadio.com, a wildly popular nursing podcast; he also hosts The Nurse Keith Show, his own podcast focused on career advice and inspiration for nurses. Keith was previously the resident nursing career expert at Nurse.com.

A widely published nurse writer, Keith is the author of “Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century.”

He has also contributed chapters to a number of books related to the nursing profession, and has written for Nurse.org, Nurse.com, MultiViews News Service, LPNtoBSNOnline, StaffGarden, Working Nurse Magazine, and other online platforms.

Mr. Carlson brings a plethora of experience as a nurse thought leader, online nurse personality, holistic career coach, writer, and well-known successful nurse entrepreneur.

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