Did I handle this situation wrong?

[Nurseinthemaking]

I have a little situation that happened yesterday and with me being a newbie I am not sure if I handled it right or not.

As a GVN who has not taken her boards yet, I cover for PCT's while they are at lunch, have patients that are assigned to me and am also being trained with the caths (take off is very easy as far as cath care by the way, but put on I am still nervous about) anyhow. Here is the scenario:

Lunch time coverage is taking place. I have 6 additional patients to cover plus the 2 that currently I am caring for. 7 of them were doing fine, no problems to mention, one I noticed he was sweating and started yawning, so I do a BP on him, (when he arrived it was 140/86) this was almost 2 hours into his Dialysis, his BP started dropping and was at 88/64, I asked him how he felt he said he felt fine, but new it was dropping, I laid him back and gave him a damp cloth, 5 minutes later it had dropped to 76/56, so I gave him 200cc's NS, the patients eyes started watering, but he really was not complaining, I wasn't for sure if he was being tough or felt like doo doo and couldn't muster up the energy to talk. Amongst all these 5 minute BP's, I am adjusting the cuff and making for sure I am getting a right reading. 5 more minutes later it had dropped to 66/44. I requested a Hypertonic from the Med Nurse, who was on the floor, his response was "he is not my patient, I have another hypertonic to give, plus Immodium to one patient and another Med to give to another patient." I am thinking OK, maybe he will give the Hypertonic and be over here after that. 10 Minutes later the pt's BP was down to 55/35, Charge Nurse was gone to lunch and Med Nurse still had not come over there. The whole time I am documenting my 5 and 10, minute BP's, pt's symptoms, request for Hypertonic yada yada. This is where hell breaks loose, Correct me if I was wrong. I documented with the 55/35 "Hypertonic was pending Med Nurse Arrival".

I never left the pt's side, I stayed with him and finally a tech came by and I asked her to get either the charge or the Med Nurse now, she got the Med Nurse and he walked up with a pissed off look on his face and I showed him my VS on the Screen, informed him once again of everything I did. I told him, I needed to go and check on my 7 other pt's and I would return. Done, I thought, oh heck no, I got jumped by the PCT who was/is my preceptor (mind you these both are of an International origin and they do stick together, they also speak in their language on the floor while caring for patients who do not speak their language) anyhoo. She told me that I was documenting wrong BP's and why would I Take BP's every minute and document I was taking them every 5 mintues, she felt like I was trying to get the nurse in trouble and we don't document like this, we cover for our Nurses. I told her that as a GVN, I have a legal obligation to document what I do and the time that I do it, she told me know I don't. She told me that I should never, ever of wrote that and that I was wrong for doing it, I then got the rath from the Med Nurse, stating that if I had looked at his previous BP's I would have noticed that he came in with a low BP. He told me that the PCT who was taking care of this patient falsified BP's on Paper but if I had looked at the machine, I would have realized that. NOT because what he was looking at was the BP's that the Monitor was showing, he didn't scroll up and so I told him that if he would scroll up on the screen he would see that the patients original BP was what the PCT had documented. He told me I was trying to make him look like a bad nurse and I promptly replied, "you know what, I am not here for your license, I am here for mine and for these patients and if you don't like that, you know where you can put it."

So now that I have had time to breath and reflect, did I do something wrong here, should I not have documented what I did?

Before I give you my Charges response to all of this, I want to here what everyone has to say. I don't want to sway anyone. I want a God's honest truth.

[Nurseinthemaking]

WOW. I, too, am shocked.

If this patient had a reasonable BP to begin with and began dropping, you did the right things by documenting, giving a NS bolus of 200 ml, and continuing to recheck and redocument. All those things were perfectly correct.

Personally, I would have also dropped the patient's goal by 500 if the above did not help bring his pressure up, and you were having a hard time getting the hypertonic you needed. Or, give another 200 ml NS... and then another...whatever it takes. We cannot allow the BP to just CONTINUE to drop.

I think there is a major attitude problem where you work, and it is an unhealthy one for both staff and patients.

While our unit gets hectic and crazy, too, I can at least be grateful that we ALL work as a team... nurses and techs alike. We cover each other's patients look out for what our colleagues might need in the way of assistance. This would have been unheard of at my unit.

The med nurse was way out of line in that situation. Anytime a patient starts crashing, it is time to ACT. The other meds could have waited until this was dealt with. Shame on the med nurse !

Are you not allowed to give meds yet? If you are, I'd have certainly begun drawing up that hypertonic rather than wating on him/her !

Just keep giving a slow NS bolus in the future, or drop the goal in increments of 500 until that patient's BP comes back up.

Never EVER falsify ANYTHING.

You did well. Stand tall. Continue to provide the competent care your patients deserve. :icon_hug:

After much thought and consideration, I am looking for another place of employmnet. I cannot continue to work here as I am still being chastised for this event. I had yet another nurse come to me and tell me we never document like that and what do I think Medicare would think if they saw that kind of documentation. It made me sick to hear her say that, but I asked her what does she think medicare would have thought if this patient would have coded? Does she expect me to cover for another nurse? She said yes we do that around here. We take care of one another. I told her, I am here to take care of the patients. She said to me, "you will learn real quick we take care of one another. My stomache flipped and flopped after that. I had another situation happen that night where someone took one of my patients off for me while I was taking off one of my other patients. My pre-ceptor came to me and asked why the tech did it and I told her I was unsure but I thought because she was working as a team member she was just doing what we do. She told me that I was wrong for letting her do that. I coulnd't believe what was coming out of her mouth. If someone is willing to help get patients off then let them, we all try to help one another (those of us that work as team players) she continued to drill me on this over and over, it was almost like she was trying to get me to blow a fuse or something. I threw my hands up in the air and said, " I am not going to argue with you over something like this", walked up to my charge nurse and asked him if he had anything else I could help him with and he said, nope, looks good, you can go home. I walked out in tears and cried on my best friends ear all the way home. Started looking online and in the paper and faxed several resumes out. I have gotten great response, had an interview on Friday, they called me back an hour later and asked if I would come in for a second interview. I was thrilled because this position fits me, my beliefs and my family to a T. Crossing my fingers for a successful interview.

[jnette, ASN, EMT-I]

((((((((((((((((HUGS))))))))))))))))))) to you, Nurse in the Making.

Chin up, and be glad to get out of there ! I, too, would NOT work in a place like that. I can hardly believe how things are done there ! :uhoh21:

You've done well, and stood your ground for what you know is RIGHT.

Wishing you all the best in your upcoming interview.. hope it's all your heart can hold ! :kiss

Do keep us posted ! :)