I am just finishing one year as an ICU nurse, have 4 total years experience. The Charge Nurse has been a nurse for 31 years, only a little more than 1 year in ICU. I work nights. I have been previously reprimanded for "not wanting to take direction", that is, not wanting to follow a Charge Nurse "suggestion" when it was clearly wrong (I refused to give meds via an NG tube when I could not hear the air bubble and no xray had been done.) By the way, I have known since the reprimand that this hospital is not the place for me. I've been trying to wait one year so I can go somewhere else that isn't so crazy.
The patient had come in the evening before, septic. Hypotension. DNI, and son was going to make a decision about DNR after consulting with the nephrologist. Dementia, 83 y.o. Less than 5 ml/hr of urine. On neo and levo, a bicarb drip, NS @ 200 and heparin drip (one MD thought she might have a PE). Lactic acid of 7 and going up. On that first night I had her, I had titrated the pressors until she had a decent BP on the monitor. During the day, the day shift nurse apparently no longer could get a BP off the monitor and started doing a doppler systolic on her. She also started cutting back the pressors. She gave me no reason why she did this and I failed to ask (my error). I had hoped to see some mention of this in the chart.
The Charge Nurse, as soon as the shift changed, started barging in, upping the pressors with "hope you don't mind me just barging in". Soon, the levo was at max and the neo was 2/3 of the way to max. There was a BP reading on the monitor. Charge Nurse said, "we've got to get a reading on the monitor". By midnight, the pt's HR was 125, up from the low 100's she had been running all day. She was losing ground on the pressors. I had had enough and called the MD (which I probably should have done as soon as the Charge Nurse started making adjustments to the pressors). The MD was furious, stating, "If the doppler systolic was good enough all day, why would you want to raise the pressors". I got an order to cut back on the pressors and just do a systolic doppler (which had been between 90 and 100 all day and was now 92). Her HR started to go down. I titrated down very, very slowly on both pressors. At 0400, she started to brady down very, very quickly and coded. She was resuscitated after epi and the MD called the son and son agreed to make her DNR, comfort care only. As soon as the pressors were taken off, she expired.
Please give me your input to this.