The medical-surgical nurse gets the report on a 49 y.o. man, that fell into a thorn-bush and a foreign body is embedded into his arm. Nurse Allen, who is a seasoned nurse has 4 patients and is receiving a report on Mr. Smith. Allen’s current assignment is an ORIF (hip surgery) completed 2 days prior, MI rule-out, a pain management client that has been requesting PRN pain meds on a scheduled basis since last shift, and a patient that was unresponsive under a bridge yesterday that tested positive for opioids, THC, and alcohol, with a BAL 378, that in the ED was rebounding with IV fluids. Mr. Smith was admitted yesterday and being held in the overflow ED area until some unit beds were discharged. Allen is having a very eventful day as usual and extremely busy, so are the other nurses.
The patient finally comes to the floor, IV is halfway out of the patient’s arm, the site was now edematous and told that it must have just happened enroute. Nurse Allen asks for assistance for the vitals and he would be right in to say hi to the patient and start their head to toe assessment. Allen stops the fluid, assesses the area and starts another IV site then starts working on the skin assessment. Nurse Allen immediately sees multiple dots/lines in a row that are healed over but the area on his forearm is red, angry, swollen and painful to touch. Mr. Smith was diagnosed with cellulitis and is ordered to start IV antibiotics with an OR consult. Nurse Allen starts the antibiotic therapy, antipyretics, and the patient had a visitor. This was a particularly normal person, a female that holds some resemblance to Mr. Smith and introduced her as his sister visiting out of concern for his well-being. Nurse Allen attempts to take a break, notifies his colleagues and is so excited that he can get to the coffee shop for a little pick-me-up. The charge nurse Maggie walks in to adjust Mr. Smith’s IV pump, it is beeping and annoying the patient in the same room. When Maggie walked in, she saw Mr. Smith actively using a needle to inject a brown liquid into his IV line, this is why the pump was beeping. A code blue was activated as the patient was slumped over and leaning against the bathroom wall, a needle hanging out of his IV tubing.
This patient was sent to the ICU, nurse Allen was written up for not adequately performing a skin assessment, as the needle casing imprint was on the patient’s leg, where the TED hose was pushed down. A blood test was performed, the patient tested positive for opioids and meth that was injected into his arm. Should Allen be liable if the needle was not there during the skin assessment and was possibly brought in from the visitor? Some say absolutely and others may not see it that way. Security is minimal in all healthcare facilities, so much that nurses and CNA’s are unable to keep up with their own assignments and tasks than to be in the room observing contact between a patient and their loved one. Syringes, along with many other objects are being “pocketed” in rectums or flesh folds, not to mention the female genitalia or even brought in by friends and family. This article is not to condemn those who are addicted but to bring awareness about addiction and how it is straining healthcare workers, who are not adequately trained with nursing education or from their facility. Furthermore, a set up for failure. It is not fair or right that nurses should feel that standing up for what is going wrong in healthcare that it is pointless to report. Many lives that we work with depend on healthy nursing staff, we cannot remain healthy if not protected from harm or have resources to become a stronger and a happier workforce.
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