[canoehead]

With a change in mentation, and a need for a NRB at 945, the doc needed to assess the patient, as she was trending towards worse, instead of better. I've also found any patient that questions whether they are OK, or whether they will make it or not needs a serious reassessment, but that knowledge came with experience. I think there was no question that something additional was going on, because she was trending toward worse instead of better.

At 1015 she definitely needed critical care interventions to maintain cardiac and respiratory function, and was going to code without them. PO meds would be minimally helpful at that point, and if your charge was still not concerned at that point I would question her competency. YOU got a doc though, shortly afterwards, and did well. Next time you antennae will go up that much sooner, and you'll be that much more experienced.

ACLS would be a huge help, you'll understand so much more about what to expect. My only suggestion would be that you insist the patient go to ICU, if she's going, ASAP, and get the orders started DOWN THERE. So often you get a page of orders on a sick patient and someone wants to wait for the blood draw, or the Xray, or whatever, before moving them, and they end up spending another 30-90 minutes on the floor. If you've anticipated the transfer and gotten all the moniters, O2, chart, in the room and ready to go, get them OUT. You can always help out or finish notes when you get there.

I agree with the others that you did very well in assessing your patients. Your charge and the doc needed to be kicked harder, (with spurs apparently) but experience will give you the strength you need to do that. Think about how your concerns will be listened to after this great catch- Nice job.

[ghmccart]

what an experience,

First off, if you still like being a nurse, and you want to, then dont let one experience where you DID advocate for the pt get you too down, but I too would have felt bad about that situation. All of the instict advice you got is right on. For me the point in which I would have been strongly advocating to get that pt what she needs is when she threw up and had to have 6L to be in the 80s, all though it is so different looking at things in hind site. with the s/s of CHF showing, and maybe some other acute event. sometimes it is the destiny of a nurse to be in a situation where they might be the only one to think that a pt needs something more or different ( including docs).

[BandEmom]

Thank you everyone for your replies. The weekend was plenty of time to process everything that happened. I do think now that the critical point was when I put her on the NRB. I had the charge with me though, and he wasn't as nervous as I was - that was the time I should have gone with my guts there. I work tomorrow, and I bet it will be a much better day

[BBFRN]

The best thing you can do is use this as a learning experience, and not as a reason to beat yourself up, and you'll be fine.

[nursejill155]

Don't be to hard on yourself, this was a good learning experience for you. I work in the ICU and have many tools on hand that you don't by working on the floor. The ICU nurse was right, that you did wait to long the first reason is...if the pt is on a NRB and their O2 sat is only 90, this pretty much means they need to be tubed. The hospitalist should have been in again to see the pt also. I'm not being mean so don't think I am, but the best advice to give is to TRUST YOUR GUT INSTINCT, always push the dr. to be more proactive don't just "trust" their opinion because their drs. and take this learning experience and grow from it. You did the best you could and thats all that matters, you are not an ICU nurse and the ICU nurse who said you waited to long should understand that. Good luck! You'll be fine!!

[Suesquatch]

Originally Posted by BandEmom

She said that there wasnt enough support for me upstairs because all the nurses up there were inexperienced and the charge was busy downstairs.

Well, the ICU nurse nailed it. No, it was not your fault. As new as you are how should you have known what to do and when to do it? You're psychic, maybe?

You ran and got the the physician. You did good.

[sharona97]

I'm impressed that inspite of you letting other "team members" know of these changes, YOU LISTENED to the patient and went with your gut! Good Job and I'm sure ACLS will be a confidence builder for you. Good job!

[Nurse_RaRa]

I hope you didn't give up nursing or if you moved that you moved to a different facet of nursing like in a rest home where the acuity isn't so stressful. thanks - I learned from your post.

[jamato8]

If your charge nurse was informed she/he should have stepped in, that is part of their job. I never back off calling a doctor and put it squarely on them. Call until you get someone in the chain and if you have to, get the nurse supervisor. It is tough at times with the pt loads and until you get the flow of things. Yes, ACLS is very important and get to all the codes you can as they help you see in a crisis the ebb and flow.