Unstable Admission - page 3
Hi everyone. I need some input. Today I was told I was getting an admit from the ED (no big deal). They had been hypotensive for over 3 hours after 2 boluses and by hypotensive I mean a Map of... Read More
May 11It wasn't that I couldn't care for this patient. I've been a nurse a very long time. It was that they had given more than one bolus to increase blood pressure and it wasn't working. I never refused to take the patient, I simply wanted to know what our plan was. My director and charge nurse were there and neither would call the MD because he has a history of being difficult and rude to nurses. I was told to call MD myself so I did. Made a couple of possible suggestions to increase BP and was told no...we will just watch. I said ok and hung up phone. Next thing I heard pt went somewhere else because MD was mad that I made suggestions. Director mad at me, stated I shouldn't have questioned and just called RRT if I needed to.
May 11If all you asked was if there was a plan for treating the BP and if so what it was then no, you did nothing deserving a reprimand. It sounds as though this may just be part of a larger issue with the culture where you work if there are MD's that have an established inability to communicate appropriately with the nursing staff.
May 12Question 1:
Was the PT appropriate for PCU. Impossible to know given the limited information about the PT and the capabilities of the floor. If the only issue was MAP of 58 in an ESRD HD PT was a chronically low diastolic, and use of pressors was deemed highly unlikely by the admitting doc, then that is one thing. A bp of 77/49, trending down in a pt with decreasing mental status is different from a PT who frequently has pressures of 93/40, and looks to be at baseline. both these PTs have MAP of 58.
"I'm so confused and got severely reprimanded for questioning this"
Should a nurse be severely reprimanded for ensuring that a PT is admitted to an appropriate unit?
Not much of a question here. If true, well then your supervisor is an a**hole.
OTOH, It seems really common in this field for there to be an interaction, and the two people involved have completely different perceptions of what occurred.
How did the PT make out?
May 12Quote from ptsfirstI still think you did nothing to deserve a reprimand. It sounds like you questioned r/t trying to advocate for the patient. Nothing wrong with asking questions about potential care that may be needed once they come to your floor so you can plan accordingly.I never said that was being reprimanded - that came later... in front of the entire unit.
If (whoever did the "reprimanding) they needed to talk to you about what happened, that should have been done in private.
May 12I'm becoming suspicious that we aren't really being given the entire picture here. Now we are being told that the physician was also called and given suggestions which he did not appreciate. Frankly, I think this was badly handled from all sides and nobody is innocent. Still being publicly called out is never right and I would be upset too.
May 12A MAP of 58 is so borderline, I wouldn't question it. With fluids the MAP increased, and the patient may need blood, but a PCU can handle that.
I don't think you did anything wrong and you were acting in the best interest of the patient. Don't dwell on it. You questioned the doctor when others wouldn't, and you did your job as a nurse. If anyone questions you for why you questioned the doctor, just tell them that you were being an advocate for the patient to ensure the patient received the proper care. It's the truth, and only a fool would argue against that reasoning.
May 12Ah. So all of it is convoluted. Nursing admin who avoids or caters to Mr. Mean. Nurses who would rather summon the RRT when the patient is in trouble than communicate with Mr. Mean ahead of time. And then, at the risk of sort of defending Mr. Mean, there's this:
If you know there's gonna be a throwdown (because it's Mr. Mean, after all), you better have your subject matter well in hand and be sure of your position. That would include understanding the patient scenario, not just worrying about a number. It's one thing to ask the ED RN what the thought/position is on the B/P and another to call the physician and start making suggestions based on numbers taken out of context when you haven't even seen the patient.
May 12Numbers don't mean a whole heck of a lot if you don't have your eyes on the patient and if you don't know their baseline. I have asked questions regarding admissions in acute care settings in the past but never got reprimanded, others who have done the same did get reprimanded. WHY? Because those nurses would question almost every admission, and I am not saying this is true in your case, just giving a different scenario.
Recently I questioned an admission for hospice, patient had a face-to-face performed by one of our hospice physicians, legal paper work done, I arrive to do admission and patient did not meet requirements for Parkinson Disease. I called my administrator on call explained the situation, called the hospice physician director who agreed she was not appropriate and then had to do a lot of back pedaling with a very confused unhappy family. The point of the story is you have to put your eyes on the patient.
By no means should anyone be reprimanded in front of others.
May 12Just call rapid response after they get to you...
I work rapid response at my hospital and that happens all the time. Nurses don't like what landed in their bed and they call me to evaluate the patient for appropriateness and transfer to ICU if needed.