What mistakes are ok for a nurse?

sadiebean · #1 12-31-2010, 01:06 AM

Hi all,
I'm really torn up over here. My son has been home for 4 months, and has been faithfully cared for during the day by a wonderful nurse.

But, she has made mistakes with the vent that have me scared and have put Paul in danger. After much back and forth, yesterday she made a couple of mistakes and I decided it was too much of a risk and I let her go. Now I wonder if my standards are just so high that no one will be able to meet them. I mean, I've made mistakes too...

The main problem is that from what I've witnessed, she freezes in an emergency. So far, somehow, all the emergencies have happened with me there. How do I know what she would do on her own? Paul is very O2 dependent, and though more stable each month, he doesn't give a lot of room for error before desatting. I do know that she has done emergency trach changes for prior patients, so she's handled emergencies...

Once in October, on a drive to an appointment part of the circuit became detached. First she couldn't "hear" it. Then when I pointed it out, fumbled and couldn't fix it. I had to pull over on the highway, and reattach it myself. He desatted until he passed out.

A few other times she didn't "hear" the vent (that whirring noise, even if the vent alarm is silenced), and I had to let her know that Paul was disconnected.

Her scariest mistake was right before Thanksgiving. She accidentally ripped the humidification chamber open, and didn't realize that Paul was no longer getting his breaths or his O2 with the circuit disconnected. She was set to change out the circuit without putting him on the backup vent, and anyway without realizing the circuit was intact - a new humification chamber was what was needed. What would have happened had I not been there?

At this point, I brought it up to her and the agency and she went to vent re-training. But I knew that just in bringing it up I was going to undermine her confidence... yet what was I supposed to do?

Still, a week later, I heard him alarming during a trip back to his room. He was desatting, and I assessed and realized he had almost decanned, and needed to have the cuff deflated in order to get the trache back in. I took over, asked for a syringe, and she handed me the ambu bag and just in general fumbled. He desatted to blue.

Last week, while he was sleeping she had set him up on the travel/back up vent to get him ready to leave his room when he awoke, and intended to connect him to the O2 tower instead of waking him by filling the portable O2. Only instead she hooked the two vents to each other. I happened to go in, and see he was crying... turns out, because he wasn't getting O2. He started to desat and luckily I fixed the situation.

Yesterday, the humification chamber ripped again... this time she knew to put him on the back up vent. Only, again, in her rush to get Paul safe, she hooked the vents to each other, instead of the back up vent to O2. Then, when she went to put him back on the regular vent, she first mistakenly turned off the vent instead of silencing the alarm. I went in when I heard the pulse ox go off for too long, to find him desating to 40s-50s, and hooked up to a vent that wasn't on.

I don't think it's the mistakes that scare me as much as her difficulty assessing and fixing quickly. But I can think of 4 times off the top of my head that he desatted or would if today he weren't more stable because *I* did things like forget that the portable O2 was going to run out, or accidentally leave the suction ballard partially inside his trache. These things happen, they shouldn't, but we're human.

I'm rambling, but just really would love some insight from you. We all know that good nursing is gold. I love this woman, she is amazing with Paul, and so loyal and good and otherwise outstanding with patient care. And Paul was a hard boy to care for in the first couple months, and still not all that easy. Are these mistakes just part of being a human being, who's spent hours and hours caring for a child dependent on machinery, and that we have to pray aren't catastrophic? Or was I right to ask for a new nurse, and just feeling brokenhearted at losing a relationship with such a fine caretaker of my baby? And I really am heartbroken... she had become a member of our family, though maybe that's a mistake to do with nurses?

I feel like an idiot, and have half a mind to ask her to come back, though who would when they've had their abilities so put into question. What to do... I just want to make sure I'm putting Paul's needs first. And in all other ways, she filled his needs better than I could have dreamed of from a nurse.

Anyway, thanks so much for any insight or thoughts,
Ann

jamie · #2 12-31-2010, 01:24 AM

Ann I have no answers, but I sure wish I had you around here. You seem to be calm in an emergancy. We do not have a nurse, so all the accidents are my own.
Once I cuffed Evan's trach before taking off his cap, while he was sleeping. essentially suffocating him. he sat straight up and ripped the cap off. thank God, because I was unaware of what I had done.
Second I hooked Evan up to the vent and promptly walked out of the room guess what I forgot to do. turn it on.... and yes he was blue when I came back in.
Many times his trach has come out while he rolled over in his sleep. it gets stuck to the vent. and I forget ot deflate the cuff before putting it back in.
I am sure there are a lot more goof ups.
I wish I had another person here to keep me in check.

CJmom · #3 12-31-2010, 01:41 AM

I don't think that any mistakes are actually OK, unfortunately they occur. If you felt that his life was in jeopardy you have absolutely done the right thing. Your sons life is more important than the feelings of or relationship with a nurse.

I have had similar experiences with some of my nurses. One example: He was sitting in his high chair right next to a and decanned with the vent on. I walked in and told the nurse that his trach was out. She didn't even realize and the vent was alarming. I had a great relationship with this nurse, but that was too much for me and I called the agency and told them not to send her back.

My son has been home for 2 years now and we have had maybe one or two nurses that we actually felt was fully capable of caring for him. Yes some of it might be having high standards, but he is my child. I hope that you find a nurse that you feel comfortable with can also properly care for your child, there are a few out there!

sadiebean · #4 12-31-2010, 01:45 AM

I'm so sorry you don't have any help. Yes I'm calm in an emergency, didn't know that about myself until I had to face one every day.

If we can screw up, why then isn't it reasonable to think a nurse will too? Wow, I may have made a huge mistake...

sadiebean · #5 12-31-2010, 01:51 AM

Quote:

Originally Posted by CJmom

If you felt that his life was in jeopardy you have absolutely done the right thing. Your sons life is more important than the feelings of or relationship with a nurse.
.....
Yes some of it might be having high standards, but he is my child. I hope that you find a nurse that you feel comfortable with can also properly care for your child, there are a few out there!

That's exactly how I felt when I called, like I had no choice but to protect my child. I just also know that life has to happen, I need to be able to trust a nurse, even if she isn't perfect. Because otherwise this whole thing called family life doesn't work. That partly it's faith - just taking him home from the hospital was a huge act of faith. I just can't decide how much of my trusting this particular nurse has been faith, and how much is emotion.

jamie · #6 12-31-2010, 02:00 AM

I don't think you made a mistake, as a mom you need to go with your gut feelings. In a perfect world our children would not need trachs and vents, but because they do, we have to know that those in charge of their care are properly trained and capable too. in our case the reason the hospital refuse nursing for Evan was that they said home nurses are not trained for vents. I think that is crap, but i can see where good home nurses are true wonders.

JaymesMom · #7 12-31-2010, 03:03 AM

You need to think about Pauls safety over the quality of a nurse. I have gotten rid of nurses just because they won't cooperate with me when it comes to parenting. I am a young mother, but I'm not stupid. She may be a good nurse, but she should not be working with vents. I also got rid of a nurse for not doing her inventory. We ran out of Jayme's most important med at 2am. And the next day ran out of inline suction catheters. Both obviously very important. The next day I saw Jayme fall and my hands were full and I looked at the nurse and she was laying on the couch looking at her phone - wasn't watching Jayme. If Jayme would have decannulated the nurse wouldn't have known. Few days later Jayme DID decannulate. My nurses reaction? Hold the trach. Mine? Grab the obturator - put the trach in. Then my nurse patted me on the head and said "Now we know she can breath through her stoma!" And I'm like "Yeah, I'm glad you payed attention to that.." Next day: Caught her sleeping. I ended up kicking her out. Right before Christmas.

It is their job to react better than parents. To know more about what they are doing than parents. And to stay awake and alert at all times.
You should get rid of her - I read your post to my nurse and she said that should be grounds for termination.

MomofTwoBoys · #8 12-31-2010, 08:03 AM

I don't think you made a mistake at all. A good relationship and loving care is important for your child... BUT having a nurse who can both react in an emergency and also prevent an emergency trumps it all! The mistakes you describe her making could have easily been catastrophic and far too many for just four months. Yes, everyone makes mistakes, but in the medical field their is a big difference between a small mistake and numerous large ones... she is paid and trained to care for medically fragile children... their shouldn't be tons of life threatening mistakes.

I've gotten rid of nursing for far less.... you followed your mommy gut! You did the right thing!

twintotwin · #9 12-31-2010, 09:49 AM

Quote:

Originally Posted by sadiebean

I don't think it's the mistakes that scare me as much as her difficulty assessing and fixing quickly.

This is exactly the problem. She's not focused on her job. She's a liability. You were 110% right in firing her. You would hate yourself forever if you kept her and something awful happened.

Vent nurses must be focused and quick-thinking multi-taskers. That's it.

She could have something going on in her personal life that is relatively traumatic and that is distracting her. Or perhaps she's just not cut out for this type of work. Scary stuff.

kadiera · #10 12-31-2010, 10:36 AM

FWIW, I think I would have fired her too. Our experience has been that a big mistake should never happen twice - and yet you're mentioning things being connected the same wrong way more than once. Additionally, you describe a pattern of errors - the same types of things, over and over and over again. For me, that's always been the line - it suggests the person isn't reliable enough to leave them alone, and if you can't leave your nurse alone with your child, why are they there?