Please let me VENT!!

TexasPediRN · Nov 17, 2005

All I can say is "document, document,document!!"

"NP informed of pt condition, vitals unstable, twitching, drifting in and out of consciousness, CBC ordered for next day. NP aware of situation"

Takes liability off of you..

I guess I have to get ready for work and stop reading this threads but Good luck. I do suggest you take this up the the MD that NP works under and also to let adminstration know. And honestly.. Jan 2nd is fairly far away if you have a GI bleed... :/ I'd def. follow up with someone else.

Just b/c you're a new nurse doesnt mean you dont know how to assess a pt. If the skin is cool/clammy and they cant complete a thought, and this is uncharacteristic of them..then you have a problem. Good catch!

Good luck!

HappyJaxRN · Nov 17, 2005

Ok..I am a new nurse with less than 4 months total in the field and currently in LTC.
A couple of weeks ago, I get a call from dialysis letting me know that my pt hct is steadily dropping 26.4,24.7,22. (they draw labs every 2 days and these were one week's results) I do a guaic and its +ve for occult blood. they suspect GI bleed and want an appt with a GI doc. so I call the NP and he recommends an MD the only prob is when I call for the appt, the earliest I can get is Jan 2nd I call the NP back and ask would he recommend another doc and she says no that date is fine. So now my poor lady is probably bleeding inside, and she's having to get blood like once a week to keep going to dialysis and we won't find out what's wrong till next year!!!
Last week, one of my AAOx3 pt goes completely disoriented, her speech is completely incoherent, can't provide an answer to 'what's your name?' type of question...when she tries to talk, she can not complete a thought. skin cool and clamy (not diabetic, blood sugar 122) rolling eyes to back, going in and out of alertness, c/o n/v, having twitches all over body. I mean completely uncharactestic of this pt. vitals completely unstable. I call NP and what does she say? do a CBC in the morning??
I don't know what, but I feel like something is missing. maybe there's breakdown of communication, maybe I am reading too much into symptoms, maybe I expect too darn much, but I am feeling completely frustrated. My supervisor just says 'do what the NP said'. As you can see, this is just a vent and I don't really have a question, but these are just two occurences out of many that make me question both my sanity, and my career choice.
Thanks for letting me vent.

OMgosh! That's horrible! I concur with what someone else said....DOCUMENT! DOCUMENT! DOCUMENT! Times you call the MD or NP...what they say...for new orders...document your assessment whenever you do one. This lets you out of the loop of blame if...I mean, most probably when a lawsuit occurs....

MarySunshine · Nov 17, 2005

Isn't there a doctor that works over the NP? I would go to him/her, even if it meant calling in the middle of the night esp. for the patient with change in mental status that you described.

Tweety, BSN, RN · Nov 17, 2005

Sounds like the patient needs to go to an emergency room for a complete workup with those kinds of symptoms.

At the very least a chemistry besides a CBC, and not in the AM, STAT.

Anemia in renal failure patients is quite common, but this sounds dangerous.

Good luck.

jschut, BSN, RN · Nov 17, 2005

We have a doc that will D/c all meds on pts, refuse tests we ask for, and all sorts of interesting things....

if we spell his name incorrectly on a fax or do not sign our names to the fax, he won't answer it...

I sent a lady to the hospital once after performing CPR on her...filled out paperwork and everything, ran into the next shift...the next nurse told me she would call doc to let him know since it was his patient.

She didn't. (Ended up getting in trouble for that one too.)

He refused to care for that patient while she was there because, "No one called him..."

How babyish is that??? I can't stand him.....

Good luck in learning to handle yours...we call the oncall docs to get what we want for our patients. Can you try that?

steelcityrn, RN · Nov 17, 2005

I have seen this before.House physicians/crnp who either do not call back or give a stupid order. Of course you would always tx problem with your standing orders first, if pt remains the same or declines, call 911.

nicunana · Nov 17, 2005

Just documenting that NP is aware does NOT relieve you of liability in a lawsuit. If you truly believe that the order is inappropriate for the situation, it is your responsibility to go to the next person in the chain of command to get an order that meets the reasonable standard of care for the particular complaint. You will be mercilessly grilled on the stand as to why you accepted an order that did not meet the standard of care. Do not be surprised, either when the NP claims that you did not make the gravity of the situation known to him, because if you had he certainly would have given you a different order. This situation is legally not any different than telling the Dr. that he is about to perform surgery on the wrong leg, having him deny that, and allowing him to proceed. After the wrong site surgery, you are BOTH to blame, despite your failed intervention! If you know it's wrong, you must intercede on behalf of the patient or be just as guilty as the person wo gave the inappropriate order.

Document, Document, document will only bite you in the butt, if you do not have the courage of your convictions to take your concerns to the absolute authority available in your workplace.

Alibaba · Nov 17, 2005

I finally figured out what my question was. How do you get the confidence to stand up for your gut feeling? like when you just have a feeling the orders given by the NP are not complete and you even suggest someother intervention and the NP shuts you down? and when your nurse manager and supervisor both think you need to listen to the NP....but your gut feeling (remember am a new nurse and they are old hands at this) keeps telling you that your patient needs an ambulance stat???

unknown99, BSN, RN · Nov 17, 2005

The quickest way to get this patient treated is to send them to the emergency room. There, they will admit the patient, and a G.I doc will see the patient within 12 to 24 hours.

Been there, done that. Saved the patient's life.

1Tulip · Nov 17, 2005

Wow. I haven't been in exactly this position... but let's think about this.

If your patient is failing, they are in a dynamic process. Things are going on. Symptoms will worsen. New ones will start to appear. Now, maybe this is passive aggressive, but I'd probably be on the horn with each new assessment. (Whilst documenting, documenting, documenting.) I'd probably be "sharing" each observation with my nurse supervisor. I mean, they can't exactly tell you "...I don't want to hear any more about how sick the patient is!"

Squeaky wheel gets the grease.

papawjohn · Nov 17, 2005

Advocate! Advocate! Advocate!

Hey Y'all

I agree with all those here who point out that calling the NP is not the end of our responsibility and that the character flaws of the Med Director are not sufficient reason to stop short of doing everything we can do for our Pts. No one told us it was all going to be clear or easy.

Stand up for yourself and your Pts, Alibaba!!

Papaw John