Problem with clinic nurse

I'm not entirely sure that I'm not over reacting to this situation, but I certainly do need some feed back.

My clinic has six nurses, and I've seen each of them when I've been in for blood tests. Sometimes when things are really crazy, one of the scientists will come out of the lab and help with taking blood. Five of the six nurses are fantastic and I've never had problems with them taking blood. The scientists that I've seen to have blood taken have also been fantastic. It helps that I've got great viens, I'm an exceptionally easy person to take blood from, and all pathology collections I've had have been fine. Except for this one particular nurse at the clinic who inflicts great pain. She's fairly new (started in June last year), and is very nervous about taking blood, so she inserts the needle extremely slowly. As we all probably know from doing our own injections, the slower the needle goes in the more it hurts. I've spoken to her about this, but she does not change the way she takes blood.

It's not just the blood-taking pain issue that bugs me.

This was the nurse responsible for communicating with me the results of my blood test yesterday and ensuring I had further instructions from there. She was quite content to end the call after "your levels are fine and we need to see you again on Sunday". The call didn't end then because I just can't cope with not knowing what my numbers are, so I asked for them. Again, after giving me the numbers she was content to end the call. I am very used to having dosages adjusted after each blood test (it has happened with each blood test in each cycle due to my history of non-response or over-response), so I asked if there were any dosage changes. If this nurse had just said "you need to continue on your current dose", I'd have been completely screwed at this point. What she did say was "you need to continue on your current dose of 150 units". Problem being that I have not been on 150IU this cycle, I've been taking 200IU. When I questioned her on this, she double checked the paperwork and said I needed to reduce my dosage to 150IU.

There's a very fine line between me responding appropriately and over-responding. In fact, this is the first time I've ever had an appropriate response to puregon. I'm absolutely terrified at this point of what may have happened and what may happen in the future if this incompetent nurse continues as she has so far. She hurts like hell when she takes blood, and the only reason I got all the right information out of her yesterday is because of past experience I knew (sort of) which questions to ask. What if it was a patient not as experienced as myself? In particular, another one with this same tendency to hyperstimulate. I know my FS has several patients that are "difficult" like myself, and I absolutely shudder to think that this nurse being unable to convey all necessary information in a clear and accurate manner could cause someone to become ill.

Is it appropriate for me to say something to the clinic? If so, how? The whole situation is really difficult for me to deal with as my pre-existing anxiety problem is made MUCH worse by the presence of high levels of estrogen. Estrogen levels leading up to a normal ovulation are enough to trigger anxiety attacks in me, let alone the levels found in a stim cycle (lets not even think about how bad I get while hyperstimulating!)

Suggestions? Advice? Should I just continue on and grit my teeth if she's taking my blood and ensure that I always double check information with her on the phone? I probably can get through the cycle that way, but it's extra stress that I don't need.

Sorry this is so long.

BW

BW: I think you have more than enough reason to raise the issue of this nurse with the Clinic. Not only is this an emotionally harrowing time for you, but for goodness sake if an incorrect doesage could have major health consequences for you, then her dismissive attitude is very concerning.

Perhaps you could make a confidential complaint to one of the nurses you know and trust and ask that your details not be revealed to the nurse in question. You are right, you are fortunate to be vigilant but what if someone else just takes her word.

Good luck
Spring

BW, I have to agree. I think the clinic need to be made aware so that they can deal with the situation. This nurse needs to be made aware of this and what could have happened if the call had of ended without you having to ask for more information. Mistakes unfortunately do happen, but in this case she just didn't read your file correctly - all of the right information was there, she just didn't communicate it with you. It might take a complaint from you to get the seriousness of this issue through to her so it doesn't happen again. I also agree with Spring, an anonymous complaint may be a good idea if it will make you feel more comfortable.

Yep, I'd say document your issues - unclear instruction, poor communication, etc, along with poor technique taking blood - and submit a letter to the clinic. Perhaps include the dates/times these things happened, and that you were dealing with this particular nurse every time. I think it would be wise to try to keep it very polite, but firmly state your concerns for your health, and the health of others using the clinic.
All the best!

BW

I think you absolutely have to make some sort of complaint as it will help to ease your conscience that you have at least tried to do something. I agree with you completely about the concerns of an inexperienced patient or someone who is just not dealing well with the drugs and therefore not thinking too clearly at the time of the phone call (which is often me ;)) - they just may not ask the right questions, but then nor should they have to. As you keep saying, this is what we pay good money for. If you are not getting the service you need and expect and the service is not up to par with the other nurses, then a complaint needs to be made.

Can you speak to David directly about this if you don't want to put anything in writing?

Whatever you decide, I really hope I don't get to see her when we are up there in a few weeks, hopefully :pray:, as my veins are real b*ggers to get blood out of some days unless the person taking it knows what they are doing.

xx

I think you definately need to bring it up - even if its like Chez said - with David first.

The thing is, it just isn't good enough - a tiny error in your dosages can be a dramatic difference in your outcome...and in your case, potentially a dangerous outcome - but as a representative in an IVF clinic, she can't afford to be this vague - IVF deals with some serious medication.

What if this happened to someone who DIDN'T think to ask any more (like you did) about the levels, etc and they ended up in hospital with OHSS or something else because the nurse was incompetant... thats not good enough.

Trust your instinct & definately raise the issue - you don't need to be nasty about it, so don't feel guilty about doing it - you're doing it for the safety of yourself and the other patient's safety as well xxx

I agree BW, you need to say something, particularly about the misinformation she gave you about your dosage. We all know how serious it could have been if you'd continued on 200...

If you're feeling anxious about it - can you email David in the first instance? That takes care of the phone phobia??

Hi

I agree with the others, you need to let your clinic even if its just a private conversation with someone in authority and then to your FS.

As we all know ivf is not to be taken lightly not to mention the expense involved. Its way too important to have someone who is incompetent.

Good luck :)

i'm in agreeance with everyone else - the clinic NEEDS to be told. if a nurse can't pass on instructions correctly, she's not doing her job - and not meeting her duty of care. that's not on in ANY medical field - but especially in a position where the viability of a very expensive cycle is at stake - and certainly not when the health of a patient is at risk!

i know how anxious confrontation makes you, and i know that you WANT to address this, but also that you might find speaking about it too hard. if you want to put it in writing, go for it. i really think this needs to go further up the "food chain" than a fellow nurse that will just take her aside and word her up - it needs to go higher so that it is addressed formally

thinking of you this morning, and hoping you get another great result to you BT this morning

BG

OK, survived getting to the clinic - praying the whole way in that the evil, stupid and incompetent nurse wasn't on. That's one prayer that was answered at least!

I even managed to survive speaking to the nurse who was on about the phone call. She also expressed grave concern and said she'd "pass on the information".

With that, I'm happy, for now. As long as I never end up having to speak to the evil, incompetent nurse again. I suspect that if I do end up with her talking to me about my blood test results and getting instructions from her again I'll simply end up calling the clinic back to double check the results with a different nurse.

BW

I hope that the Nurse does pass your thoughts on. I agree with what everyone else has said above. I can only imagine it being such an emotional time anyway without being given incorrect info and feeling anxious each time you go wondering if you will get the incompetent nurse.

wow reading this remines me of a situation i found myself to be in just the same

good to hear that you have since talked to the clinic

we had a huge stuff up by a nurse giving me the wrong info once

It's exceedingly obvious that someone at the clinic has spoken to the nurse in question.

She called with my results today, and I not only got E2 levels before I asked for them, but I also got a discussion of today's E2 levels compared with yesterday's and how these ones compared with my previous cycle. I even got a discussion of my current LH and P4 levels as well. Not sure why I wanted to know that, though!

The most important thing, though, was the further instructions part of the phone call. She got to that with no prompting and was extremely clear and concise and not only talked about what to do with my puregon dosage, but also stated that I was to continue with the same lucrin dosage as before.

All this with me barely able to get a word in edge wise in order to ask whether the massive jump I'd had was preoblematic! I'd rather have too much information than not enough in this case. I can always filter out what I don't need and I'm not interested in, but it does amazing things for your confidence levels to KNOW that you're getting everything you need rather than worrying about whether you've asked the right questions or not!

I'm still not particularly fond of this nurse, probably never will be. But if she can maintain that level of competence on the phone, then the vast majority of my problems have been solved! Thank you to who ever it was at the clinic that spoke to her!

I'm greatly relieved that problem is fixed... now I've just got to figure out how to stay calm while my E2 levels are trying to climb!

BW

BW

That is great news that you have seen such an immediate change as a result of your actions. I am sure it is not just you who is now getting this more comprehensive phone call. You have obviously made a world of difference to lots of other ladies at NGF. Congratulations. I won't be so concerned about talking to her when given the option next time.

xx

Hi BW,

I'm a bit late reading this but, as a nurse, wanted to weigh in. I'm really glad you spoke to the clinic and that they spoke with the nurse in question and that she seems to be improving.
I was going to, wholeheartedly, agree with the others that you need to talk to the clinic about the nurses performance. You said that she is new to the clinic and it may have been as simple as her not knowing what was expected of her when calling patients. Whilst it is a given for people who work in that field to provide certain information, she (I assume it is a she) may have come from another area of nursing where those details aren't needed to be given (highly likely since she gave you ALL path results this time - including ones you felt were less important). Or one where it is the role of the doctor to provide pathology details and not the nurses. Regardless, it is very important that the nurse be made aware that she is not carrying out her role as required and how to best care for patients in this setting.
With regards to taking the blood, venepuncture is a difficult skill for some people to learn. Some people need to enter the needle slowly for fear of losing the vein - it is a confidence thing. It could be that she hasn't had the need to take blood before starting at the clinic as some hospitals have people who come around and do it for the nurses. But then, some people just suck at it! Hopefully her skills will improve and she won't hurt as much! It could also be the angle she uses.
Again, good on you for talking to the clinic about this nurse. I know how difficult it must have been for you.

MG