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

[goats'r'us, ASN, RN]

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.

[weetziebat]

Not that you're asking for advice, but I'd write up the orderly. Its insubordination to do what he did. He risked the patient's life because he was lazy and didn't want to listen to the nurse. Yeah, he deserves to be reported, IMHO.

[GatorRN]

I would definately write the orderly up. He blatantly went against what you told him twice. If he is the type to take short cuts regularly, maybe next time he'll think twice before doing something like this again, if he's written up. You have a right to be angry, I would be too.

[jmgrn65, RN]

Yeah That :)

[traumaRUs, MSN, APRN]

Write him up - he endangered this pt.

[vamedic4, EMT-P]

Get your pen ready and start writin'!! Ummm, hello...what the heck was he thinkin'?????

vamedic4

[goats'r'us, ASN, RN]

but because i'm new to it all, i don't know if i'm making a big deal out of nothing, or if this really is a big deal.

i mean, i know he should have listened to me, but i don't know whether it's as big a deal as i feel like it is.

[justpoorfect]

I'm not a nurse yet, but why in the world couldn't the doc come upstairs to see this patient?

[TazziRN, RN]

No, you're not wrong to be angry, and yes, you need to write it up. It would be one thing if he honestly could not find a wheelchair and thought it was okay to chance it (not right, but understandable). It's something else entirely when he disobeyed a direct order. It would be a stretch but in a way he was practicing medicine without a license, making a decision about a pt's welfare.

[Gompers, BSN, RN]

Yep, gotta agree that a write-up is in order. As a nurse, you delegated a task to the support staff with specific instructions, and these instructions were not followed. Not just once, but TWICE. We're talking about protecting this patient's life here! Had the man bled out on the walk down the hall, it would have been on your license for not insisting he went in a wheelchair.

[goats'r'us, ASN, RN]

i think what really annoys me about it is that he's been at the hospital for ages and seems to think he knows all about everything that goes on, and therefore knows be4tter than the kid who started there a few weeks ago/

[limabean]

Absolutely write him up! We have a transporter very similar to this at my hospital. He refuses to sign anyone out (which may not sound like a big deal, but when you go into your pt's room and he is not there it can kinda freak you out sometimes). Also he always wants to take the patient by wheelchair. More than once he has come to the nurses station to ask if the pt could go by wheelchair...we say no...then he goes back and asks the pt if he thinks he is up to going by wheelchair. Usually the pt will say yes b/c they do not want to be a problem. What the transporter does not realize is that we usually have a very good reason to say no to the wheelchair.

You are ultimately responsible for your patient...so write him up and maybe even call and speak to his direct supervisor.