[marygirl]

Hi everyone. I am a resource nurse, aka float pool. I began my career on the cardiac unit and now work 9 different areas of the hospital. The other day, I was working on the ortho floor and I began with a delightful group of patients. One patient had fallen and had a surgical knee repair. Her surgeon saw her after my assessment, he told her that she could go home that day if she "did well in physical therapy". Her appointment wasn't until that afternoon, but as it was close to Christmas, she was delighted with this news. I went into her room shortly after the surgeon left to see if she or her neighbor needed to use the bathroom or wanted to get cleaned up, because I was going to leave the floor for break and I didn't want to leave them before checking. My patient told me that she was feeling ill, she had just had a "spell" where she became diaphoretic and then felt extremely weak. She said that she had had a couple of these "spells" during the night and had forgotten to mention them to her surgeon. The following weakness seemed to last for an hour orso. I did a quick set of vitals and a spot chem (patient not diabetic). Her vitals were normal, actually BP and HR better than they had been @ 0800. Spot chem was 244, a little high but too high to be a hypoglycemic recovery. I went to her e-chart and was looking to see who her primary care doctor was when the charge nurse for the ortho floor asked why I hadn't taken my break. I explained that I was going to call the doctor with the symptoms my patient was having. She picked up the written chart and said, "this patient has discharge orders, what are her symptoms?" I explained them to her and she replied with, "did you have an order to check her blood sugar?" Ummm, no, but I'm very sure that you don't need an order to check a chem on a symptomatic patient. She then said, "this is an ortho floor, it's probably just a reaction to taking narcotics, ship her home and have her follow up with her new symptoms with her PCP." During this conversation, I was already paging her on-call PCP--it was the weekend, so not her regular doc. I explained to the charge nurse that it is my duty to make sure my patient is stable and well when she is discharged and I would be happy to take full responsibility for any flack for this situation.
The on call PCP ordered telemetry, stat EKG, CKMB's and Troponins x3, CXR, cardiac consult, and CT of chest with contrast. Charge nurse is a little on edge now, but she asks t/o the day about the results. Patient is in NSR, CXR clear, labs negative.
I accompanied my patient to her CT scan with a DASH monitor that I had to borrow from another floor because the charge nurse thought the only one they had was on the crash cart. She suggested that I take the one off the crash cart (OH NO!) but I rejected that idea. When I returned to the floor, I had been reassigned due to staffing adjustments. Later, I called the floor to follow up with the charge nurse on another situation and she told me that my patient had a PE and they were now trying to figure out what to do about it.
My only thought was thank God I am such a stubborn nurse! If the patient had an ortho nurse, she may have gone home with a PE.
Has anyone else noticed that mentality in the hospitals? treat only the problem you specialize in?

[rntg]

[
My only thought was thank God I am such a stubborn nurse! If the patient had an ortho nurse, she may have gone home with a PE.
Has anyone else noticed that mentality in the hospitals? treat only the problem you specialize in?[/quote]

Wow! Not sure what type of hospital you work in, but I am the CN on a busy orthopedic unit and never would have sent a patient home with those symptoms. When in doubt, always call the doc. All of our patients have medical coverage either through their own primary cares, or hospitalist coverage for just those type of things. Good for you to be diligent in your care, and shame on the "specialty" nurses who focus on ortho only. Sent home, that patient likely would not have made it. That is one of the most common complications of orthopedic surgery, and everyone should be on the lookout for that. I must say I am flabergasted at the attitude of that charge nurse.

[Ms Kylee]

I must say I am flabergasted at the attitude of that charge nurse.

This doesn't surprise me. CN said patient had discharge orders, and she wanted the patient discharged. Next patient.... *Shakes my head* It's sad that this patient could have gone home with a PE. Thank God that you were there and pursued and perservered. God sends Angels when they're needed. My thanks to you.

[sharann]

I think it is unfair to judge a specialty by one event or individual.
This could have happened on any floor by the way.
If I judged by specialty(based on experiences in my hospital) I could surmise that Maternity nurses are lazy and Cardiac floor nurses are cold and inflexible. I could also tell you that the ORTHO nurses(I am not one of them) in our hospital are some of the best and brightest as well as nicest nurses I have worked with.

[marygirl]

I do think that in general, hospitals are discharge happy. I admit people every day who have been home less than 3 days, one man less than 5 hours. Believe it or not, he also had a PE and was discharged off of the Pulmonary floor! Some people get discharged from the hospital across the river and come and check in at our hospital. It's insane.

[stillpressingon]

PE = pulmonary embolism???

[burnvictimRN]

Like someone mentioned earlier, hospitals have a tendency to get discharge happy. It's like anything that happens after receiving a discharge order is not our concern.

Good catch!

As an aside, I hate it when nurses are referred to as angels. Nursing is not a 'calling', it's a career, and one that I'm very passionate about.

[sharann]

I forgot to say good catch to you as well. Sorry. I have been in your position before and understand how frustrating and ridiculous it seems to D/C a patient who is obviously not ready or is in distress.
i have stood my ground as well and it can pay off sometimes. Yours did. Just lay off the ortho nurses as a whole. Perhaps that particular charge nurse(I use that term loosely) was a new grad just off orientation, or just a lousy nurse. Our ORtho nurses ar also Oncology nurses(yeah great combo on that floor) so they are pretty bright. I have also worked with some of the worst ICU nurses you would ever be sorry to meet. Anyhow, just wanted to tell you that I am not unsympathetic to you, just to the title of the post.

[lovelylpn]

First of all, good catch. That patient was lucky to be assigned to you that day. Also, like some others said, this could have happened on any floor. I've seen a pt discharged from the a med-surg floor still in mild respiratory distress only to be readmitted the same night for pneumonia. I believe that was the original diagnosis, but she was not really stable enough to go home. Her x-ray upon readmission looked worse than the x-ray from the first admission (I now wonder if she was either resistent the antibiotic given, or just not treated long enough). Unfortunately, and this is hard to admit, I was her nurse. I was an LPN and still new to med-surg at the time and though I was concerned, my charge nurse told me to proceed because that was her baseline status. Being young and only having long term care experience at the time, I listened to this experienced nurse and trusted her judgement when I should have gone with my own instinct. Lesson learned. The patient spent a few more days in the hospital before being discharged home again, that time for good. I've learned to go with my gut feelings and get second opinions from other nurses when something just doesn't seem right now.

[Angie O'Plasty, RN]

Originally Posted by marygirl

Hi everyone. I am a resource nurse, aka float pool. I began my career on the cardiac unit and now work 9 different areas of the hospital. The other day, I was working on the ortho floor and I began with a delightful group of patients. One patient had fallen and had a surgical knee repair. Her surgeon saw her after my assessment, he told her that she could go home that day if she "did well in physical therapy". Her appointment wasn't until that afternoon, but as it was close to Christmas, she was delighted with this news. I went into her room shortly after the surgeon left to see if she or her neighbor needed to use the bathroom or wanted to get cleaned up, because I was going to leave the floor for break and I didn't want to leave them before checking. My patient told me that she was feeling ill, she had just had a "spell" where she became diaphoretic and then felt extremely weak. She said that she had had a couple of these "spells" during the night and had forgotten to mention them to her surgeon. The following weakness seemed to last for an hour orso. I did a quick set of vitals and a spot chem (patient not diabetic). Her vitals were normal, actually BP and HR better than they had been @ 0800. Spot chem was 244, a little high but too high to be a hypoglycemic recovery. I went to her e-chart and was looking to see who her primary care doctor was when the charge nurse for the ortho floor asked why I hadn't taken my break. I explained that I was going to call the doctor with the symptoms my patient was having. She picked up the written chart and said, "this patient has discharge orders, what are her symptoms?" I explained them to her and she replied with, "did you have an order to check her blood sugar?" Ummm, no, but I'm very sure that you don't need an order to check a chem on a symptomatic patient. She then said, "this is an ortho floor, it's probably just a reaction to taking narcotics, ship her home and have her follow up with her new symptoms with her PCP." During this conversation, I was already paging her on-call PCP--it was the weekend, so not her regular doc. I explained to the charge nurse that it is my duty to make sure my patient is stable and well when she is discharged and I would be happy to take full responsibility for any flack for this situation.
The on call PCP ordered telemetry, stat EKG, CKMB's and Troponins x3, CXR, cardiac consult, and CT of chest with contrast. Charge nurse is a little on edge now, but she asks t/o the day about the results. Patient is in NSR, CXR clear, labs negative.
I accompanied my patient to her CT scan with a DASH monitor that I had to borrow from another floor because the charge nurse thought the only one they had was on the crash cart. She suggested that I take the one off the crash cart (OH NO!) but I rejected that idea. When I returned to the floor, I had been reassigned due to staffing adjustments. Later, I called the floor to follow up with the charge nurse on another situation and she told me that my patient had a PE and they were now trying to figure out what to do about it.
My only thought was thank God I am such a stubborn nurse! If the patient had an ortho nurse, she may have gone home with a PE.
Has anyone else noticed that mentality in the hospitals? treat only the problem you specialize in?

I haven't read all the posts on the thread, but you can be my nurse any day. Excellent response! I'm so glad that you stuck to your guns. Sometimes it won't turn out to be anything wrong; sometimes it will. But that one time it does turn out to be something, it makes all the others worthwhile.

I don't think it was so much a "treat only the problem you specialize in" as much as it was a "patients with her Dx need to leave after 'X' amount of days" rigidity. I've seen premature discharges in all units.