Knowing too much

Sometimes I feel the phrase 'I know that I know nothing' just about sums up my nursing knowledge.Does anyone else feel this way? It seems that the more I learn, the more I realize how little I know. This is a good thing really, as over confident nurses can be dangerous. An example of an overconfident nurse happened last year, although I will add that we were in a difficult situation and I'm still undecided if what we did was right or wrong. I'm curious to hear what you think.

I'm currently working in a private boarding school in Europe, high up in the mountains. I work with two other nurses, one of whom was a very experienced emergency room nurse from the USA. Every time I had a question, she always knew the answer. She also kept herself up to date with the latest advances in medical procedures. Unlike me, she could name all the bones, muscles, and ligaments in the body. I felt rather inferior, even though I've had twelve years of work experience.

Anyway, it was a sunday night and one of the children (17yrs old) managed to dislocate his shoulder falling out of his bunk bed. By the time I managed to see him, 15 minutes after receiving the call, it was eleven o'clock at night. His left shoulder was definitely not where it should be, so with the help of a few of his dorm mates we hobbled along to the infirmary, which happens to be in the same building where the kids sleeps.

We lay him down on the examination table, the pain severe. He was pale, sweaty, understandably very vaso-vagalish. Unfortunately, our regular village doctor who we got on very well with, was away on holiday, and so we were left with a locum doctor.

Unfortunately we had had some run ins with the locum, especially as he had refused to come and see a patient of mine earlier on in the week, which resulted in me taking a one hour drive in the middle of the night down the mountain to the nearest hospital. The poor girl had the worst migraines I had ever seen. Nothing worked for her, and she is the only migraine patient that I have seen morphine used. She was in the back seat, supported by two of her friends as she vomited nonstop the entire trip. It was a harrowing experience for all, but we had no other option.

Back to my patient with the dislocated shoulder.

So before calling the doctor I called my colleague for advice as well as moral support. "It's defintely dislocated" she said to me after examining our patient. "Well, I'd better call the doctor" I said. She looked at me and smiled, "I can fix this. I've seen it done many times in the ER, it's easy." I began to protest "I'll call the doc first anyway, he'd better know what's going on." My colleague agreed, although I could see she wanted to have a go at the shoulder.

The doctor didn't answer his phone. I tried three times and no reply. The hospital was an hour away, it was night time and our patient was in agony. I watched as she put his shoulder back in place.

The relief was instantaneous. The lad was praising my colleague, as were his friends who watched the procedure. We placed him in brace and gave him some Ibuprofen, and sent him to bed. "Told ya it was easy, nothing to worry about" my colleague was in high spirits. "If we get another one, I'll let you have a go." I shook my head, "We're not supposed to do that" I mumbled, unable to look her in the eye. "I guess it's a bit out of our scope of practice, but did you really want have him suffer in the back of the car all the way down the valley?" She had a point and I kept quiet.

To this day the incident still upsets me. What if he had a fracture as well as a dislocation? What if some vasular damage had been done. The boy was x-rayed the next morning and everything was ok. But I guess what worries me the most the way in which she was so sure of her diagnosis, was so sure there was no fracture. She was skilled and knowledgeable, too confident, but lucky...this time.