Been there,done that 49,575 Views
Joined Aug 4, '09.
Posts: 5,503 (74% Liked)
"My family doctor has cleared me for nursing school day I can do all the lifting and everyone just fine."
What is your issue?
You have just completed a difficult curriculum.. and are just beginning to learn hands on care. Hands on is an ongoing skill.
Focus on taking care of your rehab patients. You have MUCH to learn right where you are.
It was unprofessional of your manager to mention it. You are all grown up, your black eye is your business.
If you had sent the patient to the ER, the ER physician would have ordered the head CT. The patient had a hematoma already. I don't know why you are relying on the Neuro assessment so much. A lot of times, those changes are late changes, meaning the damage is done. And to be perfectly honest, I don't expects you guys in LTC to be Neuro experts and pick up subtle changes.
My last terminal wean was a guy who fell, hit his head, thought he was fine. Took a nap, friends found him covered in vomit hours later. He was done at that point. The bleed was too massive.
Neuro is tricky and unpredictable. Take it from me. You are worrying too much about liability instead of the fact this pt should have been sent your the ER.
Like I said before, call your malpractice carrier.
For an emergent transfer of course we call 911. This does not require a Dr's order.
To get a CT scan to head when pt is otherwise stable, that requires a drs order. Now some Dr will give nurses room to make those judgment calls, but some Dr's will refuse to order a CT to the head after the fall unless pt is on coumadin, eliquis, xarelto, lovenox, heparin, etc. I've seen Dr order CT's after a fall to be done days later, as well.
If i had just sent the pt w/o a physician order, and lets say pt sustained injury during transport or in ER, then i would have been liable for that. I'm sure the Dr would have thrown me under bus (as Dr is trying to do now, throw me under bus for NOT sending him out w/o order, bcuz HE decided to turn off his pager all night).
I want to emphasize this pt had a primary RN doing neurochecks all night and was reported to be stable, no change in hematoma, no change in condition, no report of pain. How can i order a 911 EMS transfer for a stable pt? And again, getting a CT to the head require a MD order. I could have just assumed MD would be okay with that (and that was probable), but its also *possible* he wouldn't be, and there is always a small risk with anything, even pt transfer to ER. I've seen pts get injured during transport as well.
If i had the legal authority to order diagnostic tests and transfers i would have of course ordered this pt to get a CT then. I do not have that ability, I am a nurse not a MD, and the pt was not unstable requiring 911 EMS call.
The only thing i could have done differently was call the medical director. In hindsight i should have done that. But again, the pt was stable, as per report from the primary RN who was the one actually assessing and monitoring this pt.
If any piece of the catheter WAS floating around the vascular system, it would have killed the patient long before 2 weeks.
"All the world's a stage, and we are merely players." Oh no Betty! I am so sorry it took me so long to get your ice! Should I run up 3 flights of stairs to get the crushed kind you like?
Think of yourself as an actress, until you get enough experience to blow that pop stand.
Worked for me.
There are many threads here regarding this topic, check them out. Many responders say... go for your dream.
Nursing is a physically demanding profession. Pulling it off in your late 50's will be difficult. Do you think you can stand on your feet for 12 hours without a break?
I started to feel the physical demand in my 50's and had to push myself everyday to do my job. Nurses also have many job related injuries that are exacerbated by age.
Best of luck with your decision.
Report the issue to the facility and the agency. That would be plenty enough for me to quit the assignment.
You should be able to walk away with the proper documentation, I have done it.
You have tried the healthy interventions to change your circadian rhythm to sleeping in the daytime, without success.
Now you want a magic pill. Refresh yourself on the side effects of hypnotics.
Find a day job.
You have paid in advance for union support, use it.
Never let them see you cry... you will automatically lose the battle. When the issue is laid out, do not sign ANYTHING until discussed afterward with your union rep.
Let us know.
Do it anonymously.
I'm a pretty smart chick. I'm thinking I should challenge the Medical Board Exam.
How much training did you receive to interpret rhythms? You can't be expected to know all the nuances of telemetry interpretation.
Atrial fibrillation at 110-120 is uncontrolled. Patient is at risk for CHF. Was the patient symptomatic, was the patient uncontrolled on the prior day shift?
As a new nurse, assess your patient, find someone to consult with STAT ( no matter what it takes) until you get more experience.
Best of luck, it's a jungle.
No. Basic skills must be learned first, before than can be applied in critical care areas. I have worked with several nurses that started out in ICU, and even though they were eventually successful, they are sorry they did it. Also, there is NO way they could handle a med-surg assignment, and they know it.
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