Me vs. the charge nurse - page 3
Was I wrong in what I did? I need some other perspectives. I was working a few days ago and had a conflict with my charge nurse. It was basically about whether to call the doctor about something... Read More
May 24, '07Just within the last week, I found out that, s/p CVA, BP is often kept in the 180 systolic range to maintain cerebral perfusion in the immediate post-CVA period. Since this pt was just 24 hrs post-CVA, I'm thinking that may have been where your pt was at-within the desired range. Perhaps that Charge Nurse hadn't been brought up to speed on that.
Again, it looks as though some ASSUMING was going on here, on both sides. To have been on the safe side, it would have been best to check w/the MD, just to be sure. Not best for your ego, or hers, but the best thing for the pt. I do understand your perspective, and that of the Charge Nurse. You are wanting to maintain your autonomy w/your pts and have her respect your nursing judgement, but she is the one who is supposed to keep track of what is going on w/her pts on the floor. If she let that BP slide for another couple of hours (and shouldn't have) what do you think would've happened to her?
I think the best thing to have done would be to do as she asked you, and then later, when you had an opportunity, politely ask her about it. Try to remember-pt care first, egos second.
May 24, '07I am a charge nurse and have been in similar situations. However, that BP is borderline for our facilities call the doctor guidelines, and since it was already being treated and had been noted in the progress notes I wouldn't have taken it too seriously.
Some BP meds take more than 30-60 mins to work. I would have not worried - maybe look up the onset time for the specific med you gave - some are quite a long time to onset.
As far as the charge nurse thing - the charge nurse at my facility is NUMBER ONE above all else - responsible for pt welfare. I am not responsible for the action of others - just the welfare of my pts. I don't see that BP as being that high risk to pt welfare.
I'd say let it go, she probably felt she was being more "safe than sorry." It never hurts, when in doubt, to call the Dr. Even if it Pi@@es them off. She probably was going on that assumption. Maybe she has had a bad experience with that doc or with a similar situation or maybe she lacks some experience.
I can say I have less than some RN's I charge over - and have had fits sometimes getting some of them to call the Dr - over much more serious things. Sometimes I just do the calling. Then they get upset because I "over road them." Pt welfare first - making friends last. If she was that concerned she could have just asked you for a quick pt report for more info and done her own calling.
May 24, '07Well here is how I would have evaluated the charge nurse's instructions.
This is a strict risk-benefit thing.
Would calling the doc kill anyone or make anyone sick? No.
Could not calling him deny him the opportunity to give orders that would prevent another stroke? Now here is the tricky part. If you didn't call after the charge nurse told you to and the patient stroked again, how would that make you look?
See, the only reason I can think of to not call is to keep from irritating the doctor, who may think I'm stupid. Now just me personally, people think I'm stupid all day and it doesn't bother me, so having been directed to call by the charge nurse, I'd have made the call.
Next time I saw the doc, if it really bothered him, he'd let me know because I am known for taking criticism well, and I'd say, well you know, that's what I was thinking, but the charge suggested it and I thought better safe than sorry and besides I figured she's charge for a reason.
Anyway people are always saying how they hate to work nights because they hate interrupting the doc's sleep, and I'm thinking, better that than interrupt him on a beautiful day when he's out on the links with his buddies!
May 24, '07OK let me put this another way. A wise old nurse once told me that when someone tells you something, gives you information, a warning, or just scratches their head out loud, you have to do something with what they said. And if you look at the risks, and these days everyone in a hospital bed is running some pretty hairy risks or they wouldn't be there, then you figure out what they are and you spread the accountability far and wide to whomever it may be relevant. You tell the doctor or the nursing supervisor or your manager or all, as many as the situation relates to, and now the hot potato is burning in their laps too. So going by this rule, you would definitely have told the doctor. For sure, by telling you to call, the charge was obeying this rule by spreading the responsibility to you, and you being the patient's nurse and all, you pretty much have no choice. So I was very wrong in my simple two-choice scenario. The questions really are: (1) Would calling the doc kill anyone or make anyone sick? (2) Could not calling him deny him the opportunity to give orders that would prevent another stroke? (3) Do I see anywhere in this situation the possibility I could lose my license?