Question about neutropenic patient...

  1. Hi all,
    I'm PRN at two places, both oncology/med surg floors. Well, I worked last nite, had an awful nite. I had a 43yr old pt that just got diagnosed with lung cancer with mets to brain, liver, and bone. Then I had two surgicals that nothing was done on, had to get consents signed, do preps, and start the surgical checklist and then had a lady all the way down at the end of the hall who "accidently pulled her IV out because she hit her bedside table". Then I also had an IV left for me that was bad, wasn't even taken out, but didn't flush. Okay, so my lady who was neutropenic, the aide didn't get the second set of vitals until way late like maybe 9:30pm...told me in passing she had a 101.1 fever. Didn't even relate her being neutropenic so just gave her Tylenol for the fever. Luckily her fever came down. But got a call from my manager this afternoon stating the doctor had a fit because he wasn't called. That she could have gone septic and died. And at my other place, the standards are not the same. Well, we have eight or nine pts so if someone is running a fever, I relay it to the charge RN who then will call the doc. She's considered our desk nurse and does all the calling of the docs. Does anyone else feel like every little thing we do wrong is picked out, but we don't get appreciated for anything? Plus they had a "code review" this afternoon regarding a code that happened involving a 53yr old pt whose now a vegetable because the husband is really upset, saying we didn't respond quick enough. I think I'm getting burnt out and I've only been a nurse for THREE years. Now my manager wants me to come in and read the policy book on cancer pts, which will take about two hours so I know the policies at their place. Like I'm just a crappy nurse. I do feel bad. I'm glad the pt is okay. But I don't need phone calls at home regarding this stuff. :angryfire :angryfire
    Amy
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  2. 7 Comments

  3. by   Tweety
    Sorry you had a rough night. Seems we do work in a punitive, rather than supportive environment, and people just cover their butts and fry who happens to be in their way.

    Whenever there's a bad outcome, people always sue and want to put the blame on someone.

    Ultimately, I'm sure you realize, that while you consult with the charge nurse, it's still your responsibility, to assure the proper calls are being made.

    Good luck!
  4. by   adria37
    I think that this is where management gets us with the thinking that a nurse is a nurse is a nurse. As the prn person that does not regularly do oncology, a highly specialized area, I do not think that you should be placed in a position like the one you had last night. The nurse is a nurse is the kind of thinking that leads to burn out and nurses leaving the profession. A temp greater than 100.5 in a neutropenic patient needs in depth investigation where I work. I am sorry you had such a night but rather than coming down so hard on you they need to examine the situation and shoulder part of the responsibility for it. If the patient in cardiac arrest wasn't seen to quickly enough instead of just placing blame on the nurse they should look internally and realize maybe they need more help. Hugs to you, Adria
  5. by   Stephanie in FL
    I, too, am sorry that you had a bad night. I floated to an oncology unit years ago and it was tough. Yes, I often think that nurses receive little appreciation from management.

    I am an RN who has ovarian cancer. I am receiving chemo. When I am neutropenic, a nurse reminds me to call if my temo is > 100.4

    Stephanie
  6. by   KMSRN
    Febrile neutropenia is an oncologic emergency. When a patient is neutropenic it basically means they have no immune system so infection can take over very quickly. Fortunately the outcomes are usually good. Always call for T. > 100.4 (I would call for less if it looks like it is rising). I'm very sorry this happened to you. They shouldn't be letting you work there without training for your sake and the patients. It's very demoralizing - I've been there. Maybe they have a class you can take.
  7. by   meownsmile
    I dont work oncology but i understand what you are saying with management. I hate to be at home sometimes at a certain time of day because i know if i am going to get a call about something i can almost tell you what time it will be. I have gotten called about not calling a doc about a temp in the AM. Which really torked me off, considering it was the 7AM vitals and i knew the doc would be coming in within an hour, give or take a few minutes. I was aware and was monitoring the patient and would have called had he not come in soon. But, oops i didnt have time to remember to go back and chart that considering i had 9 other patients also. I had them call me about a code status on a patient, after i bent over backwards to get a copy showing the primary POA had a guardianship and it was reverted to their second choice.(Management didnt bother looking any farther than the code sheet wasnt signed by what appeared to be the "primary" but second in line for POAHC). So see they arent always looking at things the way it IS but the way it APPEARS. Hang in there.
  8. by   leslie :-D
    hi amy,

    actually it wasn't the aide's responsibility to tell you the pt. was neutropenic, but it certainly was the nurse's from the previous shift....did you get report at change of shift?
  9. by   AmyRN1227
    I knew the pt was neutropenic at the start of the shift. Yes, it was on the report sheet. But because there was so much going on towards the end of the shift, when I was told she had a fever I wasn't thinking of her neutropenic status. Honestly, I didn't know about the policy being over 100.4 and I've been working Oncology for almost two years.
    Thanks, Amy

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