Monday, October 23, 2006

Nurses who shouldn't be

Back in March, Jo at Squander Two mentioned a minor qualm with the change in hospital procedure.
NHS hospitals are now insisting that no patients be allowed to administer their own medication, and that includes diabetics giving themselves insulin. When a diabetic is admitted to hospital, they are expected to give their insulin to the staff and rely on nurses to check their blood sugar and inject their insulin. This is a Bad Thing.

He's not wrong.

Today, Jo blogs about his impending joy potential disaster; his wife is due to give birth in a little under a week, which is lovely; but she is a diabetic, which is not. I don't know if Jo is read by Doc Crippen, because this should be right up there with the best of Crippen's Nurse Quacktitioner stories.
Vic, my wife, is diabetic, so, as you might imagine, one of the things that has been worrying us both about the impending birth is her being killed, put into a coma, or otherwise badly damaged by a nurse giving her an insulin overdose. It's not as unlikely as you might hope. We've had first-hand experience of exactly the arrogant idiocy I was writing about above. A couple of years ago, she was admitted to hospital the night before a minor operation so that she could be put on a glucose drip — you have to fast before being given a general anaesthetic, but fasting, obviously, is dangerous for diabetics, so they get brought into hospital the previous day so they can be given a glucose drip and have their blood sugars controlled without eating. This is entirely sensible. On being admitted, Vic was faced with a ward nurse who refused to give her the glucose drip on the grounds, when you get down to it, that she thought she knew better than the surgeon, the anaestetist, and the diabetic consultant, and it was her opinion that mattered because she, unlike them, was there. The drip was the only reason Vic was even in hospital — were it not for that requirement, she wouldn't have come in till the following morning. So the nurse in charge refused to give her the only thing she was in hospital to receive. The next morning, unsurprisingly (to us), Vic had a hypoglycaemic attack — ideal preparation for an operation. I'd love to say that this experience was a one-off, but it wasn't. It's the norm.

This is absolutely fucking disgraceful: that nurse should have been fired on the spot with immediate loss of all rights. This ridiculous arrogance could have cost the life of a young woman and it would have been, at the very least, manslaughter: I hope that the nurse was, at the least, given a severe dressing down and a permanent black mark put on her record.

Let me make this clear: you do not toy with other people's lives.

Jo is, of course, rather worried about the further complications to diabetes caused by pregnancy.
So the prospects aren't good, even before you take pregnancy into account. Pregnancy, you see, does a couple of things to diabetics: firstly, you need lots of extra insulin to convert sugar into a baby's body; secondly, your insulin resistance increases dramatically — a lot of non-diabetic women, in fact, become temporarily diabetic during pregnancy. Both these things mean that your insulin dose increases — by the end of the pregnancy, by a factor of about three. What this means, for those of you who don't know much about insulin, is that a heavily pregnant diabetic woman is injecting herself four times a day with what would usually be a lethal dose. As soon as she gives birth — within minutes, in fact — the required dose goes back down, not only to what it would be usually, but, as sugar is now being converted into milk instead of stored as fat, even further down that that.

So, you have nurses who know sod all about diabetes and are arrogant enough to overrule the instructions of diabetic consultants and the protests of experienced patients, in charge of giving insulin to a diabetic whose required dosage was about twenty units a couple of hours ago but who would now be killed stone dead if injected with twenty units, whose ideal dosage is far lower than anything that has ever been recorded in her medical records, and who, on a drip and having just given birth, is in no condition to resist being given the medication. Really, it's amazing only two people have been killed.

Your humble Devil does know a wee bit about diabetes (his mother's father and two of her brothers both have the disease), as it happens, and has seen (and had to help deal with) a hypoglycaemic attack: it is quite a frightening experience for all concerned.

Diabetes is one of those diseases that we tend to be quite blasé about these days because we are, usually, able to keep it under control. That does not mean that it cannot kill; that does not mean that it does not kill. It can also have a number of other very nasty complications.
Since the first therapeutic use of insulin (1921) diabetes has been a treatable but chronic condition, and the main risks to health are its characteristic long-term complications. These include cardiovascular disease (doubled risk), chronic renal failure (it is the main cause for dialysis in developed world adults), retinal damage which can lead to blindness and is the most significant cause of adult blindness in the non-elderly in the developed world, nerve damage, erectile dysfunction (impotence), to gangrene with risk of amputation of toes, feet, and even legs.

It is not something to be buggered about with and certainly not by some stupid Nurse Quacktitioner who thinks that she knows better than a qualified doctor. Bugger off, you silly bitch, get back to doing your job properly and stop putting the life and health of your patients at risk.


Anonymous said...

I am a nurse, and I would like to say that this kind of thing doesn't happen, but of course, it does. You should know that patients have rights though, and if you believe that you are not receiving safe treatment you need to do whatever it takes to get that treatment. I have been on both sides of the bed, and I have had to kick and scream to get the treatment I needed. Nurses are overworked and underpaid. We are given unsafe patient loads, and we have to deal with patients who are not always honest with us and doctors who think they are God himself. This in no way exonerates the dreadful behavior described in your post, but we must always remember that health care personnel are HUMAN and as such, are prone to making mistakes. It is up to the patient to fight for their rights, and it is up to the hospital to make sure that their staff is safe and knowledgable. I ALWAYS listen to my patients, and if they question a decision I always go back and check the records, and if necessary, call the doctor to clarify the order. Too many nurses are afraid to go the extra mile, maybe they are burnt out, or too inexperienced, I don't know? But please, please, please, don't judge all of us by a few bad apples. Some of us are dedicated professionals who would never purposely harm a patient.


Devil's Kitchen said...

I think that we all appreciate that most nurses are very good at their jobs, and we know that they are overworked. I was an Aux for a year, so I appreciate the strain that you are under on a daily basis.

Unfortunately, nurses who do not go the extra mile shouldn't be nurses: they are in a rather special position because their failure could cost someone's life.


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