New nurse, opinion?

  1. Would like to know what others think inthis situation

    I am a new RN, second week off a 12 week orientation on a Heme/Onc floor.

    i felt on top of it tonight. Saw my pts PCA bolus order was expiring. She needs/wants it on the dot q4hrs. She was due again for 6mg bolus of morohine at 615. At 3 am I page don't the intern to let them know that I needed a new order placed for the bolus dose for my PT at 615. I told him she gets it every 4 hours on the dot

    he comes back to me, can't figure it out. Tells me he's working on it. So I wait. He puts in a some orders that don't make sense. So I page him again. Asking him to please get this in. I believe my PT is in pain. I also know AM shift is coming in and I try REALLY hard to give a good report and to be able to do as much as I can before handing my pts off

    anyway, AM nurse, try to update her on this PT (she's had before) she's not listening to anything expect the fact that the bolus dose isn't in yet. I told her I paged many times and that the MD is aware and is working on it. He came out and actually told me he was going to ask day team for help putting the order in.

    anyways the AM RN is bossing me around telling me to frantically page pharmacy asking for help and then tells me to follow her as she barges in the physicians room to try to get an order. It's 7:20 now. And I have 3 more reports to give, on pts who have other things going on besides an hour late bolus of morphine. I know my PT is ok, she's got a basal of 0.5 and PCA dose of 0.8 every 30 min. She's a leak PT with abdominal pain from colitis. the AM Nnurse is literally Frantic about this, and will not let me handoff until it's resolved.

    What are you thoughts?
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  2. 2 Comments

  3. by   pmabraham
    Personally, I would have told the oncoming nurse I have x other reports to give, let me go give those quickly and come back to that nurse to see if that nurse still needed help and potentially get the charge nurse involved. You did your part, the system is 24x7, and your shift is over.
  4. by   3ringnursing
    You did everything you could possibly do to get this done before day shift arrived for report, and before the bolus was late (potentially leaving the patient in pain) except for attempting to hold the intern hostage and threaten bodily harm.

    I can't really see how this could have played out with a different outcome considering this particular intern was involved. You had to give him or her an opportunity to try to enter the order - and since you don't have a crystal ball, or mad precognitive/psychic abilities to predict difficulties ahead, how would you have known to get the charge nurse or pharmacy involved before things went sideways?

    I agree with pmabraham about shifts being 24/7 and your shift was now over. Not allowing you to hand off was a bit extreme, and also a bit selfish on the receiving RN's part toward someone whom has already been there for over 12 hours (factoring in lunch) and is likely dead on their feet tired.

    About 20 years ago I worked at a facility that was part SNF, part ICU (we were a long term care facility that specialized in patients that were predicted to have extended stays due to difficulty weaning from ventilators, as well as prolonged ICU status type patient's with all the expected tubes, drains and lines whose DRG days had run out at an acute care ICU setting). Nearly all were in isolation due to MRSA, TB, or VRE, and nearly all were train wreaks. Our patients stayed long term, so it was not typical that we had admits or discharges on a routine basis.

    One day I got a late admit patient from a tiny hospital located in a smaller neighboring community after receiving a telephone report (and a crappy one at that). The patient arrived via EMS transport with vasopressors infusing into a triple lumen central line, and their A-line clotted off - you'll love the reason: instead of a pressure bag on the TKO heparin infusion bag, the bag was tied with a tourniquet (when I called the discharging nurse about this curious improvisation her response was, "We reuse our pressure bags, so I didn't couldn't give it to you".

    Wait ... Isn't this a disposable item billable to the patient?

    Anyway, settling this late admit was not simple: the main ICU room which held 4 beds had it's own telemetry station and was having difficulty synching correctly (was likely broken), as was the swan (ditto). The pressor bags were nearly dry, and of course we had to get another A-line in pronto.

    The night nurse arrived to discover during the 45 minutes this patient was under my loving tutelage that all admission orders wasn't finished. She hit the roof, demanding I stay until every last item was completed to her satisfaction. Every. Last. Thing.

    I was dog tired - and bit cranky but relented. Thankfully the charge nurse noticed me still working on settling this patient 45 minutes after I should have skedaddled.

    Saved!

    She let the night shift nurse know that on no uncertain terms that her expectations were unacceptable, and she was unimpressed with her attitude/behavior. She also echoed pmabraham's above sediments about we were a 24/7 facility - that one shift had ended and another had begun. She said it was unreasonable to expect me to stay to finish all the admission needs when my shift was over.

    The night nurse had no choice but to relent and apologize - likely while grinding her teeth to powder.

    When I still worked doing bedside care I always tried to keep in mind while taking report that there will be shifts that the road apples hit the fan, and more often than not they're isn't a damned thing you can do about it. Sometimes you just have to fly by the seat of your pants and roll with it. It happens to us all eventually - if it happened to me, I had to concede that it happened to others too, and tried my best cut my coworkers some slack.
    Last edit by 3ringnursing on Nov 27

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