Feeling stupid (and a little miffed...)

[DroogieRN]

I am about to start my second semester of an ADN program. Blood Pressure is one of the first skills I learned this past semester and I've done it dozens, if not hundreds, of times. I took a BP on a friend when I was first learning and it read high, so he went to the doc and sure enough, it was way up there and he was put on meds. My point is, I know what I am doing.

My DH has high BP and has been on meds since 1/08. For the past couple of months, I've gotten readings in the neighborhood of 160/110. He got a tetorifice shot at a minute clinic over the summer and the NP told him his BP was high then, too. I've begged him to go to the MD for ages and after two days of a BP (taken by me) of 174/102, he finally went today. I should say that he called his doc about three weeks ago to see if he should come in and said his wife is a student nurse and got a high reading and the doctor totally brushed it off and said he could come in and have it checked if he wanted to...

He just texted me from the exam room while waiting for the MD and the medical assistant in the office got a pressure of 138/90. Of course I don't want it to be high, but could I be that far off, that often??? I don't think so! He told her it has been high and she said, "Oh, it's just a little high; not too bad." Am I being too touchy because it's my husband? I've had my BP taken by her and she's so fast and talking the whole time and I think she's wrong -- I want the doc to take it himself.

Maybe I just needed to vent! I'm worried about him (not looking for medical advice here -- just wondering if it's within her scope of practice to tell him his BP is OK, and wondering if I need to spend some serious time on the mannequin in the nursing lab once school starts, practicing BPs!)...

Thanks for listening.

[Daytonite, BSN, RN]

people who are experienced and have taken hundreds of blood pressures do let the air out of the bladders a bit rapidly for the patient's comfort and they can talk and listen to their stethoscope at the same time. with time and experience you will most likely take b/ps in a similar manner, especially if you are pressed for time. "oh, it's just a little high; not too bad" was most likely the mas attempt to reassure your husband. it probably wasn't the best thing for the ma to say, but, then again, an ma is not a licensed nurse and not trained in therapeutic communication techniques, is she, so how can you expect a skilled therapeutic response from her?

[DroogieRN]

...an MA is not a licensed nurse and not trained in therapeutic communication techniques, is she, so how can you expect a skilled therapeutic response from her?

I am sure you are right. A lot of it could be that I'm hyper-vigilant b/c it's my husband. I still think she was wrong, and with his hx, that bothers me. His BP has not been that low the entire time he's been on medication, except maybe for a few days in Aug. when the doc doubled the dosage. Regardless, I'm just hoping now that it comes down.

[Daytonite, BSN, RN]

I am sure you are right. A lot of it could be that I'm hyper-vigilant b/c it's my husband. I still think she was wrong, and with his hx, that bothers me.

You cannot expect unskilled personnel to perform at the same high level of skill as you are being trained at. Part of your responsibility as a supervising RN (all RNs supervise subordinate nursing staff) will be to know what the skill level and training of the various nursing personnel are so you will be able to supervise, delegate tasks appropriate and evaluate the work being done. Since this issue has come up, it might be a good time to look up the training and duties of an MA. I would check the website of your state board to see if they have a position statement on MAs. Some state boards do since physicians can also train MAs to do just about anything short of starting IVs in their offices in some states. You cannot expect MAs and CNAs to be able to interact with patients in the same therapeutic way that you are being taught. Some may have a natural ability and pick it up from the nurses they observe and hear doing it. But most of the time therapeutic communication techniques must be taught even to RNs as well as doctors and other healthcare personnel. Where are MAs going to learn it? Therapeutic communication is not a subject I remember being part of their coursework and I used to teach in an MA program.

[kat von b]

an ma is not a licensed nurse and not trained in therapeutic communication techniques, is she, so how can you expect a skilled therapeutic response from her?

when i went through ma school years ago we were taught therapeutic communication but not to the extent that i am now learning being in nursing school. if all ma's are trained that way i have no idea, i'm sure programs vary. i also think a lot of ma's that work in the doctors office have such limited contact with patients that they probably don't event think to use therapeutic communication. just my . like i said in my previous post i completely believe it's the pcp's job to recheck it!! i just wanted to share some of my ma knowledge :chuckle

[ImNotWitty]

Thanks, y'all -- apparently the doc agreed and gave him an ACE inhibitor. I'm just glad he finally went.:redpinkhe

I am so glad that you trusted your gut and your skilss! I hope all goes well w/ school and hubby!

[Daytonite, BSN, RN]

doctors hire mas primarily because they are less expensive than a licensed nurse and because they can shape and train the ma to do a multitude range of tasks in their office that a licensed nurse will not do. they are a bargain for them. doctor's offices are busy places these days because of the focus on outpatient care. the mas in these offices direct and manage the flow of patients and others who are there to conduct business, sometimes code and bill, give shots, draw blood and take ekgs as well as answer phones and file. saying to a patient about their blood pressure "oh, it's just a little high; not too bad," instead of something like, "is that a high reading for you?" is not likely to be something to cause a cost conscious doc to get real upset with his ma. when upset with the performance of one of the doc's employees, tell the doc about it because he is their boss. but i can tell you from years of management and supervision that interpersonal behavior, especially the specific words coming out of people's mouths, is very hard to supervise, evaluate and discipline. there are none or few rules of employment that cover this which making it hard to discipline.

[OrthoFNP]

I would make a diary and record his BP rates. BP changes often throughout the day. Or I may even ask for a BP over night monitor. I donated a kidney to my mom in June of this past year. Her renal failure was due to POORLY managed high BP. She was on meds and everything!!! The doctors did not regulate her pressure and it led to the loss of two organs! This is your husband. You have every right to protect his health. I would not worry at all about seeming pushy. When I was being evaluated to doante they wanted me to wear the monitor for 24 hours since BP changes so often. Tell them you have noticed it is high at times and demand a monitor!!!

[grace86]

I wouldnt worry. I recently went to the doctor's office and had quite the experience. First of all my blood pressure stay around 110/70...give or take some. Im a smaller girl...I know there's more to blood pressure than size but when she pumped the cuff to almost 240!!! and about blew my arm off I got a little irritated. She let the air out all at once and told me my blood pressure was 80/45.....

Ive gotten my blood pressure taken many times, and NEVER been that low...

This is supposed to be an experienced, educated nurse.

Anything like that could have happened at the doctor's office, so I wouldnt worry about it.

[patrick1rn, MSN, RN, NP]

I did clinicals for my FNP school, the MAs most of the time, they did a decent BP, but their was one who did not know how to take a BP. I dont trust the MAs BP reading, and neither should you . Ask the MD or a RN or the NP to check the BP next time instead of the MA.

[Cinqui73]

You cannot expect unskilled personnel to perform at the same high level of skill as you are being trained at. .............. Therapeutic communication is not a subject I remember being part of their coursework and I used to teach in an MA program.

Not to be snotty, but I've encountered plenty of RN's who are plenty unskilled in therapeutic communication, alot of them on this very board (not you personally, Daytonite), unfortunately!

In my 17 years in the medical field, I've heard the most embarrassingly idiotic comments come out of various people's mouths of various licensures - I've dealt everything from the dumbest MA's to RN's who jump to hysterically wrong conclusions, all the way up to incompetent MD's who are complete morons. Although I DO understand what you are driving at with this sentiment, it's hardly fair to label ALL M.A.'s as "unskilled"; I was fortunate to work with alot who were very conscientious and careful about everything, not only BP's. One of them was me! I think taking blood pressure for more than a decade and a half has hardly left me UNSKILLED at it.

The reality is, as you said, MA's are far more cost effective and this is very true - but another part of that reality is that doctor's do their darnedest to hire inexperienced MA's fresh out of school so they can pay them scrap pay instead of hiring an MA with experience. Part of the reason I need to go back to school to get my RN license is because no one wants to pay me what I was earning as an MA at my last job!!

This particular MA that told the OP's husband was most likely trying to not get him worked up, although it was not her place to make any "diagnosis"...that was up to the doctor. Some of us KNOW the scope of our practice because we figured it out long ago! This is part of the learning curve of talking to patients; there are many innocuous things we tend to blurt out that we never realize can compromise patient care.

And, frankly, in my opinion, 130/90 is NOT a good BP and I would of been concerned if his wife was claiming high readings at home.

To the OP, you should NOT feel stupid...as Suanna stated, blood pressure is not a static thing. Although I'm ONLY an MA, the doctor takes my blood pressures that I take on my husband (also hypertensive) at home seriously.

Of course, as any GOOD doctor would do, *always* rechecks them in the office HIMSELF...both arms twice! :) No doctor in their right mind is going to prescribe medicine based on a blood pressure he/she did not take personally.