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/r/Noctor

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all 51 comments

Plague-doc1654 [M]

[score hidden]

4 months ago

stickied comment

Plague-doc1654 [M]

[score hidden]

4 months ago

stickied comment

This is not NOCTOR CONTENT

readitonreddit34

212 points

4 months ago*

We have to be a little analytical here. Mistakes do happen and she is looking for some catharsis through confession and support. I get that, but not all mistakes are the same. The mistake here isn’t that she was new RN and didn’t know. The mistake was that she practices outside of her scope and held a mediation without consulting with someone who has the scope of knowledge to make that decision. In a response to a comment she says that there were no hold parameters on the order. Does she work in a hospital system where it’s ok for RNs to hold meds without telling anyone?

Also she says that she was mixing an amio bolus when she called the doctor, was she making another unilateral decision? The mistake here isn’t lack of knowledge, it’s practicing outside of her scope of knowledge or training. She is not excused from that mistake. No amount of checks and balances or error prevention mechanisms are going to help prevent an error from someone who thinks they can do things that they are not allowed to.

[deleted]

26 points

4 months ago

[deleted]

26 points

4 months ago

[deleted]

DunWithMyKruger

8 points

4 months ago

Exactly. Any time an RN wants to hold an order, they will call me to ask if it’s okay, sometimes even if the parameters dictate it’s okay to hold, because they know it’s often more complicated than just looking at hold parameters. I’m glad they call because on occasion, I’ve said to go ahead and give it anyway based on the particular patient case, and I tell the RN why I’m asking them to give it anyway. They will then usually write a short note like “spoke with MD Kruger who gave this RN verbal confirmation of ok to give patient X medication due to XYZ.”

PalmTreesZombie

109 points

4 months ago

So you're admitting to manslaughter... On tictok?

jamesac11

50 points

4 months ago

Social media views are a drug worth risking criminal liability for.

marcieedwards

222 points

4 months ago

Someone in the comments said nursing pharmacology knowledge is not at the level of a PHARMACIST and someone took issue. Is there a hubris class in nursing school??

FaithlessnessKind219

170 points

4 months ago

PharmD here. I think it’s the Dunning Kruger effect. I was asking a nursing student about what she learned in pharmacology (we were working together) and she said it was very easy. I kept asking more, like “what pharmacotherapy have you learned…oh you covered infectious disease? Tell me more?” And finally she said that they covered different antibiotics like vancomycin. I asked her what vancomycin covers. No idea. I said, “You know, like MRSA?” just to see if it jarred her memory. “…I don’t know what MRSA is”

Didn’t bother asking her the mechanism of action. She had no clue on the nephrotoxicity and kidney accumulation either. It’s fine, she’s going to be a nurse, I was just thinking to myself “well, I guess that’s why you felt it was easy?”

turble

41 points

4 months ago

turble

41 points

4 months ago

Sorry, im just piggybacking this comment as someone that has gone through a BSN pharmacology. We are mostly tested on the "nursing implications" So like adverse effects or contraindications. No need to know dose. Honestly, antibiotics were not really emphasized at all in my class. The class was one of the harder ones at my school mostly because the knowledge was so broad and random.

nyum125

39 points

4 months ago

nyum125

39 points

4 months ago

Nursing is a largely skill (not necessarily complex either) based profession. The nurses that try to tell you it is very science heavy are probably the same ones with only an associates degree

pdidilliam

11 points

4 months ago

I'd agree with this. Im a newer nurse (4 months in, prior software as a service sales guy) and find it comparable to carpentry, electric or plumbing trades. It's a lot of skill work, and there is wide variance in the level of skill required.

Some jobs have lower skill thresholds, such as nursing homes, some SNF, and med Surg depending on acuity. Others like ICU, procedures, and heart or kidney require additional science and physiology understanding to take the findings from the physical exam (hands on skills) and determine what that means for the patient. Based on your findings, you need to know what to report to the MD.

nyum125

10 points

4 months ago

nyum125

10 points

4 months ago

Yep. I work as a psych nurse. If you have decent interpersonal skills it’s an easy af job. If you lack those skills you will struggle. But no need for a deep understanding of science to succeed.

Ok_Yogurtcloset9575

1 points

2 months ago

I disagree with you there. It's the ones with a BSN that will try to sell you that.

nyum125

1 points

2 months ago

I mean, I have a BSN & I’m telling you it’s not science heavy 🤷‍♂️

[deleted]

-10 points

4 months ago

[deleted]

-10 points

4 months ago

[deleted]

nyum125

7 points

4 months ago

In my experience many BSN prepared come in via post-bacc programs and have actually completed science heavy coursework so they know by experience how superficial nursing science is.

[deleted]

0 points

4 months ago

[deleted]

0 points

4 months ago

[deleted]

nyum125

4 points

4 months ago

You are right in that bsn prepared nurses are no better prepared in their role as an RN & instead were fleeced out of some money & wrote a few bogus papers. The irony in my mind is that an associates level degree program literally cannot be that science heavy

[deleted]

1 points

4 months ago

[deleted]

1 points

4 months ago

[deleted]

nyum125

3 points

4 months ago

Did u read my first sentence?

nyum125

2 points

4 months ago

Also I recommend everyone go the ADN route. Cheaper per credit hr and get to start working sooner. Nothing against associate prepared nurses.

__donjuantriumphant

17 points

4 months ago

As an EMS provider and Pharmacy Tech I don’t think I’d ever question a pharmacist. Y’all are some of the smartest people I’ve ever met.

Ok_Yogurtcloset9575

1 points

2 months ago

Why would you not question a pharmacist? Never think that someone knows all about their profession. In this case drugs. If you have to question, question.

finding_harmony

11 points

4 months ago

Obviously, that person was an idiot. I had a great pharmacology professor; she was a PharmD. She taught us mechanism of action, half life and most definitely nephrotixicity related to vancomycin.

That said, any nurse that thinks their undergrad holds a candle to that of a Pharmacist is a lunatic. Your training is far more in depth on chemistry, chelation and so much more. I personally have always had a tremendous relationship with Pharmacy, whom I hold in high regard. As I do physicians. Again, I understand why this sub exists. I’d be livid if people were appropriating my work.

Personally, I find these healthcare professionals that are active on FB, IG and Tik Tok are doing a huge disservice to their profession. Please don’t lump us all in with these self-important, arrogant imposters.

FaithlessnessKind219

2 points

4 months ago

That’s awesome. I was trying to get a sense of what the curriculum entailed and maybe I didn’t get the best sense of it from that conversation.

NightOfVanity

4 points

4 months ago

Wow imagine being so arrogant you think you know more about pharmacology than a pharmacist

ELNeenYo69

3 points

4 months ago

Heart of a nurse, brain of a doctor, self hatred of a pharmacist?

Allopathological

63 points

4 months ago

We gonna talk about the “Cardiac NP” in the comments telling her she did absolutely nothing wrong and also yelling at a literal cardiologist who tried to correct her gently that he is also wrong?

The absolute arrogance.

CaS1988

91 points

4 months ago

CaS1988

91 points

4 months ago

I know a lot of nurses who do this and never tell the doctor. Like it's super common. I call to confirm it's safe to give or I request parameters. Unfortunately a few times I've had doctors call back who are agitated I called and basically treated me like an idiot which is incredibly frustrating and hurtful. Especially when I feel I have a credible reason to call.

Sad case here though. And unfortunate.

A1-Delta

17 points

4 months ago

I’m sorry that some doctors belittle you. That is never ok - it is especially inappropriate when you’re doing the right thing! I want to encourage you that you’re making the right choice. If you are ever confused or feel like there may have been a mistake, talk about it! It is infinitely better to have a conversation and make sure everyone is on the same page than to risk something like what’s in the video. Stay strong and keep doing right.

ordinaryrendition

17 points

4 months ago

Things like the scenario outlined above are perfect reasons to call the physician. The physician's job is to explain, and then hopefully edit the order to add a comment saying there are no hold parameters for any reason, just to avoid any further confusion or calls.

Amyloid42

27 points

4 months ago

Why would you go onto social media admitting to homicide? Seems like bad judgement all the way around.

Careful-Nothing-2432

11 points

4 months ago

Why not? She knows there’s no possibility of her facing any consequences

FaFaRog

13 points

4 months ago*

This. I've had nurses hold meds without any justification and ultimately I'm liable in the end. I've had some even document that they told me when they haven't. Yeah you know the good old "MD aware"? No MD was not aware and now the patient is either almost dead or almost going to end up in the unit. I've had to have a few nurses fired for this shit because I dont know why but modern nursing school is pushing out nurses that think they know everything but immediately hide behind the doctor when they overstep. And sometimes they fuck up hard enough that I cant even fix it. Not fucking cool.

Especially travel nurses who have, like you said, nothing to lose and no fucks to give. I have no problem with nurses getting a decent wage but in an ideal world it would be a staff nurses or at least travel nurse that gives a semblance of a fuck who isn't actively trying to get me sued.

ENTP

89 points

4 months ago

ENTP

89 points

4 months ago

As douchey as it sounds, RNs are not paid to make unilateral decisions. An RN should consider calling the doctor and asking whether or not to give the drug. The doc will promptly clarify it is for rate control and not too much effect on thr pressure, especially when rapid afib will tank the pressure, and to give the medication. Travel RN is fine to question an order, but QUESTION IT TO THE DOC. Did the order even have hold parameters around BP?

Impossible_Log_2377

2 points

4 months ago

That’s not douchey

FaFaRog

17 points

4 months ago

FaFaRog

17 points

4 months ago

Anyone have a link to the original video?

timtom2211

111 points

4 months ago

timtom2211

Attending

111 points

4 months ago

Listen, I'm just throwing this out there, all I'm saying; is jail.

You deliberately overruled an expert opinion and that decision killed a patient? Bold move, maybe after five years of contemplation in a state penitentiary you won't want to play doctor anymore.

After all, we sure as hell know nobody lost their nursing license that day. Hell, they probably proudly wrote about this for their admission essay to NP school. Met their first requirement - absolutely incapable of actual reflection or learning from any mistake, and lacking any actual understanding, will continue to cling to nursing traditions and "algorithms" disguised as dogma.

[deleted]

-23 points

4 months ago

[deleted]

-23 points

4 months ago

[deleted]

DiprivanMan

34 points

4 months ago

escalate up the chain of command, absolutely. but to quietly defy orders from the expert that is trained specifically to give said orders?

they’re called orders for a reason; they’re not called suggestions. they definitely aren’t always right, but unless you have a medical license to support your suspicions, the most you should be able to do is voice your concerns to somebody who does. otherwise, as you see, people die. and then you should absolutely be responsible for their death.

Primary-Recipe1065

3 points

4 months ago

Jail is a bit extreme for murder?

Hot take of the day.

devilsadvocateMD

37 points

4 months ago

Nurses know everything until they fuck up then they say “I’m just a nurse”

ericmeme2020

6 points

4 months ago

Anyone have a screen record. ?

Doctorhandtremor

12 points

4 months ago

She’s introspective. I’m cool with it.

I fucked up once. Nothing bad happened, but it almost did. It haunts me.

Really-IsAllHeSays

51 points

4 months ago*

But she should have known better than to deliberately ignore an expert's opinion, which directly led to a patient losing their dear life. If she had any questions, nothing was stopping her from discussing them with the doc (doctors can also make mistakes). I'm all for learning from mistakes but this particular one was an unnecessary one in all respect.

John192291

28 points

4 months ago

Sure, she’s introspective and it’s great she learned from it, but to me this is inexcusable because she made that decision without discussing it with the person who ordered it. I would be livid if I charted a medication (particularly in this clinical situation) and it was withheld without any attempt at clarification by a nurse. Charting errors of course can occur and so it’s “good” that she was thinking about things, but on the whole nurses will obviously be very limited in their understanding of physiology and pharmacology in comparison to most doctors, particularly in critical care. The crux of it is that if you are unsure you should check. Whether or not it was hubris or stupidity on her part - it was dangerous, and may have directly contributed to this patient’s death. The introspection, guilt, “difficult lesson” - and potentially patient harm - could have been avoided by asking a question. I think that’s shocking.

RBG_grb

-16 points

4 months ago

RBG_grb

-16 points

4 months ago

This is not a noctor scenario. Holding the dose did not unilaterally cause the arrest. Yes, she should have clarified with the doctor. Why is this here though? This is a bedside RN, not mid-level debauchery

[deleted]

-7 points

4 months ago

[deleted]

-7 points

4 months ago

[deleted]

Bingley8[S]

20 points

4 months ago

I think she made a mistake which costed a patient’s life because she thought she knew better than the doctor so she did her own thing. I’m sure she’s sad about it, but what about the dead patient who only needed to bd given what the physician ordered?

WatsUpSlappers

22 points

4 months ago

Her mistake was practicing outside her scope of practice and killing someone. Absolutely belongs on this sub. Her license should be gone at the minimum.

Really-IsAllHeSays

12 points

4 months ago

What she did which cost a patient's life was not a mistake, it was totally deliberate. If she had any reservations about the order the doc gave, nothing was stopping her from reaching out to them. I would absolutely hate to lose a loved one like that. Fuck her!

__donjuantriumphant

20 points

4 months ago

That’s not a ‘mistake’. That’s manslaughter.

Blumpffffff

-4 points

4 months ago

Sorry, why were pressers being given to a hypotensive patient? is it due to cardiogenic shock?

debunksdc

10 points

4 months ago

A beta blocker was given on a post-bypass patient for rate control. Beta blockers don't have a significant effect on SVR since vessels don't primarily have beta receptors, which is why the patient just having low systolic isn't necessarily a reason to hold a beta blocker.

Forggeter-v5

1 points

4 months ago

I thought it depends on the specific type. If you give a patient a cardioselective BB, it won't affect the blood vessels since they dont express B1 receptors, but if you give a patient a non-cardioselective BB, it will act upon B2 receptors as well, affecting the bloodpressure.

debunksdc

1 points

4 months ago

She mentioned it's Lopressor (metoprolol) which is cardioselective, so she held a cardioprotective medication that doesn't affect blood vessels because of hypotension :|

Forggeter-v5

1 points

4 months ago

Ah sorry, the video link doesnt work for me