Warning from Las Vegas ER nurse: Always ask questions

She's seen a lot in her 30 years as a registered nurse in hospitals in Las Vegas and elsewhere across the country ...

There was the gentleman who was minding his own business in an ER waiting room -- a place where several-hour waits aren't unheard of -- but still had security called on him.

"He brought his cooler in, sat down and proceeded to pop the top of one of the beers in his six pack and watch TV," the nurse recalled. "Actually, I think it's a good way to pass the time, but drunks tend to be a handful -- especially when they're together."

And, on New Year's Day one year, there was the man who came to the ER with his wife. A plumber, the man quickly showed medical staff what had somehow happened on New Year's Eve -- he had a 12-inch pink dildo in his rectum that he couldn't get out. Surgeons were able to remove it without damage to the colon.

"If it were me," the nurse said, "I would have crawled in a cave somewhere and died rather than go to the hospital in that situation."

Yes, this nurse who has worked in ER, surgery and ob-gyn has gotten more than a few grins from largely harmless situations during her nursing career.

Yet some of what she's seen should make us all concerned. Because she said nurses who are publicly identified with airing "dirty laundry" don't have jobs long, she requested anonymity.

"Believe me, what I've seen, other nurses have seen at hospitals throughout Las Vegas. We talk about it. Don't assume things are being done correctly. Always ask questions."

There was the time, she said, when a midlevel administrator hurriedly walked into a surgery waiting room and called out the name of a baby for a procedure.

"Some parents stood up with their child and gave her their baby. The problem was that this was the wrong baby and this was the wrong surgeon.

"Staff and providers are in such a hurry that they aren't doing simple things to prevent errors like checking a patient's armband. … The happy ending to this was that the baby was scheduled to have ear tubes put in anyway, but by a different surgeon. It was a very uncomfortable moment when the surgeon had to tell the parents that he had operated on a patient that was not his."

Then there was the patient scheduled for a knee arthroscopy. The nurse said the anesthesiologist rushed to put the patient to sleep so the surgical team could get started.

"The surgeon then walked into the room for the first time and looked through the chart and didn't know which knee to operate on. He had discussed doing scopes on both knees, but because he didn't take the time to speak to the patient before he was put to sleep, he didn't know which knee. So the patient had to be awakened so the surgeon could talk to him, and then the patient had to be put back to sleep again."

At the heart of so many of the medical errors in hospitals and hospital-acquired infections -- researchers now say the death toll from the two pushes 200,000 in the United States each year -- is the seemingly unending need of hospital administrators to demand that work be done in a hurry, the veteran nurse says.

And that means checklist protocols that should be followed to prevent both wrong-site surgeries and infections from insertions of central venous catheters often aren't followed.

"Hurry, hurry, hurry," the nurse said. "Our times are monitored. I get tired of it."

Too often, she said, anesthesiologists are even bringing back the next patient to the operating room when staff are still cleaning the OR from the last patient.

"That kind of hurry just breeds infection," she said. "And there's no need for the hurry. These aren't life-threatening emergencies I'm talking about.

"Yes, time is money. But these are our patients and their safety should be our No. 1 concern. So what if it takes five more minutes to ensure that?"

Paul Harasim is the medical reporter for the Las Vegas Review-Journal. His column appears Mondays. Harasim can be reached at pharasim@reviewjournal.com
or 702-387-2908.