i'm really angry.. should i be??

[goats'r'us]

i work on an ENT ward, and yesterday looked after a man who came in a few days ago via ED with epistaxis (i'm told he was a bad one).

he came to us with nasal tampons in one nostril and a foley catheter and gauze in the other one.

all went as planned for him, and his packing was to come out yesterday. I'd never done it before, so got the assistance of the education nurse on the ward, who talked me through it and told me what to expect. she came with me when i first started letting the catheter balloon down (it has to be really slow, like 1ml every half hour) and had a long talk to the man about how now that the packing was coming out, he had to be really careful for a bit, stay in bed while we were doing it etc, to keep his BP down.

Anyway, i took the last of the water out of the catheter and took all the packing out right on shift change, and then the doc wanted to see the guy straight away in the clinic downstairs (she'd wanted the packing out at 1300 and to see him at 1330, but didn't realise how long it took to take the catheter down, so was sitting downstairs waiting anxiously for him so she could go home).

I called the orderly, and asked politely if he could take the man down to the clinics as soon as possible, and the orderly asked if the man could walk. I told him he was mobile, but had to go down in a wheelchair because he was on strict instructions to rest as much as he could in case of re-bleed. the orderly sighed and said something like 'well there's no wheelchairs on the ward, i'll have to go looking for one', to which i replied 'yes please, he really needs one'.

imagine my surprise when i was leaving five minutes later and came across the orderly WALKING this man to the clinics.

i stopped him and asked 'couldn't you find a wheelchair?', and he replied that there were none on the ward and that the clinic was just down the hall (about 150m) and then just out of the lift.

i drew the orderly away from the patient so as not to worry him, and explained again that the man was on strict rest as he was at great risk of re-bleed, and that that meant he was not allowed to walk anywhere. I also explained to the orderly that if he did bleed again, it wouldn't be a little trickle, it would be a big gush and that people could die from nosebleeds very quickly (at which point the orderly started to look a little shamefaced).

he then carried on walking the man to the clinics.

i knew from the amount of time that had passed that he had not looked for a wheelchair at all, and had gone straight to the room to walk the guy instead, and i am so mad.

i hate to pull rank, but as the man's nurse, i did know more than the orderly, and was really angry that he had gone against what i had told him. he's the sort of man that does things like that a bit, cutting corners to get a job done faster and easier.

so yeah. i'm really angry.

[Patti 2nd gen RN]

Yes. A--The clinical situation required your judgement not his--you were right. B- Even if you were going too far for any other reason in being cautious--it sets an example of how he and anyone he tells can and will treat you--with disrespect. We as nurses get disrespected enough---Stand up for yourself and for nursing as a whole.

[Marie_LPN, RN, LPN, RN]

One word: insubordination.

[RNAnnjeh, MSN, CNS]

This is definitely a matter of patient safety. Sometimes it's easier to not look for the wheelchair, play the odds, whatever. But when it hits the fan, it's the patient we need to worry about. If this orderly has a history of not following directions, then your written concern will provide more support, and his supervisor (hopefully) will take action. If this is the first time a documented complaint is received, then (again, hopefully) action will be taken AND you'll inspire others to document their concerns.

It doesn't matter if you've been there a day, a week or a century. This patient was put at risk of bleeding b/c your instructions were not followed.

Annjeh

[tigress_8207, ASN, BSN]

I disagree he doesnt need writing up he needs firing.He endangered a patients life by not following direct orders.If it were a nurse they would have been through the door a long time ago.So whats up with that?

[JoeTheNurse]

I bet that if the the orderly new from the begining that "if he the patient did bleed again, it wouldn't be a little trickle, it would be a big gush and that people could die from nosebleeds very quickly" he would have had that patient in a wheelchair in a New York Minute.

I'm not saying that discipline should not be considered here. I'm suggesting that maybe we shouldn't assume that everyone is on the same page as us.