calling the md at night when charge disagrees

[fiveofpeep]

Hey Friends

Im looking for some advice. The other night I had a patient who abruptly had a change in their respiratory status and suddenly became tachypneic and had increasing hr. I wanted to call the md because I knew something was up and I asserted this multiple times to the charge nurse, who kept stating that it was too late at night to call and I should wait. The patient ended up decompensating (and wouldnt you after 3hrs of working to breathe?) and had to be intubated shortly after I left. I feel like it's my fault because I should have some how asserted myself differently to the charge nurse, but on the other hand, I also need to be respectful of the charge nurse who has more experience.

How can I respectfully go against the recommendation of the charge nurse next time? I feel like I made my point multiple times each hour that I wanted to call and I was worried she was worsening. I understand that in most cases, I should trust the charge nurse, but what about those times (like this time) when you just know that something is up with your patient? How can I do better next time? I definitely still need to ask before I call, but how can I get around it if they say no and I really really feel like I need to call?

Thanks :)

[Penelope_Pitstop, BSN, RN]

thanks yeah I am keeping my mouth shut from now on.

I am glad I said something because I was able to correct my charting and cover myself and learn how to handle things in the future, but I think Ill just come here from now on and keep my mouth shut.

being a new nurse is hard enough as it is without having work politic problems

Well, FWIW, I'd love to have you as a coworker. :)

[AggieNurse99, BSN, RN]

Politics schmolitics. No matter what, no matter whom, YOUR PRIMARY DUTY AS A NURSE IS TO YOUR PT! You had a duty to inform the MD of an acute change in condition. The tachycardia probably even qualified for a rapid response call. I tell the new nurses I work with, you have to do what's right for your pt, no matter what. I don't care what time it is, that doc needs a call for situations like this. Now a 3 am call for tylenol/ambien? maybe not so much. :)

[EDRN-2010]

I think you would come off as respectful as well as confident if you were to approach the charge and say "I just assessed Mr. Smith and his respirations are X, they have been trending y, his other symptoms are Z. I am going to call Dr. Doctor.

thanks for all the responses everyone.

yeah Im sure the pt would have ended up on the vent anyways. and I think the main reason I didnt call was because I did trust the charge's judgment over my own. It is not a rule to get approval but it's the way we do it around here unofficially and Im only two weeks off orientation so I do not have much experience.

Im not really looking to be told that Im wrong, because I agree that I was. Thats why Im asking for help. I know that this is a valuable lesson for me to learn to trust my own judgment and have faith in myself, but what I need to know is how I can approach the situation differently next time. And she saw the patient and assessed the pt so I figured she knew with her extra experience. But you're right, I should have just done it. I know I will call the md next time, but I mean how can I verbalize it respectfully? In this unit culture, it wont be acceptable for me to just call the md. All the nurses, new and old, talk with the charge about it before the call. I see it happen all the time. Im just more looking for how I can deal with this interaction better.

Im thinking next time that Ill just say, "I know it might not seem like a reason to call to you, but I feel like I need to call regardless to cover myself."