Answered wrong on Interview Question

Kooky Korky, BSN, RN · Nov 28, 2012

LOL Depending on who it is that wants the update, that person might be your 1st priority. Just kidding. Unless it's the spouse of somebody powerful who can get you fired. Talk about reality.

redhead_NURSE98!, ADN, BSN · Nov 28, 2012

I said the SOB was a primary concern but if they were just coming and they had the nurse with them I would go to the chest heaviness and then give pain meds and then go to the post-op nurse to get report, I'm not sure if deferring to the RN bringing the patient to the floor is a good idea....

That RN likely has more experience than the floor nurse does, probably more than two floor nurses put together. I mean if it was specified that this person already has a recovery room nurse with them and they haven't turned over care yet, then I might not go see them first either.

I wouldn't stress about it either way. They just want to hear you talk it through and make sure you're not totally off the reservation.

Guest343211 · Nov 28, 2012

To make you feel a little better, last Tuesday my best friend's wife, who just finished her MD Fellowship in a North Texas Pediatric Emergency Program, had her first interview at a mid sized City's Level II ED.
She was asked ("pimped out" they call it when senior MDs put Jr. MDs on the spot) to give a PALS example of a choking infant(doll) where nervously, and with sweaty hands sent the poor baby "flying across the room like a lawn dart!" To make matters worse, she picked the baby up by the head causing the MD to holler, "You reckon you might need a C-Spine Allignment there?" Causing her once again to drop it like a hot potato.
She graduated 3rd/100, in her 4 yr class. I will hold this over her head for a long time to come. I have already bought her some 3M grip gloves for Christmas- I think if you let them know you messed up they'll be alright about it if the rest of the interview went well. Nurses are harsh self critics, were also human;)
Your actions following a mistake say tons about your character!!:)

LOL. So darn funny. It happens. 3M grips. . .lol. . . you are cool. Too true about nurses. . .and they can be on the unforgiving side--depends on how well you are liked---very capricious.

I bet they were all have a laugh somewhere over that fellow's incident. Funny thing is, in RL, people don't tend to handle babies like they do dolls.

Thanks for the laugh.

Guest343211 · Nov 28, 2012

I agree with Boston.......If the OR patient coming from the PACU with a nurse and that nurse was still with them......I would check and be sure that nurse needed nothing (so I guess checking that patient first) then I would go to the dizzy chest pain as that can be a PE, MI or cardiac arrhythmia....I would then treat the pain and delegate the family member until I had time.

I mean really how far off in transit is this pt from recovery? Upon report, I'd see about getting the PACU RN to deal with the SOB--if someone is having SOB post-op recovery, they shouldn't be sending him out, and the ologist needs to address the issue with the recovery nurse. Having done recovery, that's definitely how we'd handle it. Now, I may have to be on the phone while I'm going into see the the angina, syncope patient, but I mean you learn to deal. You do an assessment and you should have already called for EKG for the angina, etc. People are supposed to work as a team; therefore, you get another nurse, who is not as busy with a higher priority issue, to check the pt/chart and order/ and MAR for the particular pain medicine. That's how we rolled on the floors or in the unit. No one can be everywhere at once. So you get the resident or whomever is covering to check out your angina/syncope pt, after reviewing stuff with him or her, as well as meds, and if the SOB post-recovery pt is now stable and en route, you make sure you have what you need for his admit to your floor or unit, and get that rolling. On the way to getting things you need for this, you speak to the family member and kindly but quickly as possible. You also check in on the patient that received pain meds, and then you roll in with the new admit from the PACU. The resident or covering person will usually find you, and if they just write orders and walk away, they will hear a good deal of crap from me--but if they have any sense, they will find you as you are in with new admit, and let you know about orders and plan for angina/syncope patient. And you know, it goes on like this all day or night, and you somehow manage to get everyone's meds done, labs up-to-date, notes up-to-date, and orders up-to-date--although, depending on how things go from there with these and other patients, you may have stay a bit to catch up on your documentation.

That's kind of how it rolls, and you learn to adapt and deal and delegate and do your very best while prioritizing and being as careful and supportive as possible. You do the best you can, pray you have a good deal of people with which to work--so sadly not always the case, and you go the heck home, only to get some sleep and come back in in a few hours to do it all over again. Such is nursing!

Don't sweat the interview. Some people may answer differently depending upon how the information was presented--that is, was the PACU patient still in PACU with SOB? Did the SOB just start in transit? These things make a difference in terms of how you handle prioritization. But a fresh post-op patient shouldn't be released from recovery if unstable, and SOB, if real and not just an anxious response post-anesthesia, is a form of "unstable."

At any rate, that patient should be going to a unit bed if PE is suspected. Depending on all pertinent factor with the patient, they'd try to confirm PE without imaging/scanning--and if the person was tachypneic, tachycardic, desaturating, or hypercapneic, there is no way he should have been sent out to the floor--and if there was a strong suspicion of SOB being r/t to PE and not other probable issues, treatment in a ICU would ensue. In that situation, the patient shouldn't be coming alone, and a physician should be right on top of this patient. Even in the unit, someone would be getting the EKG on the other angina patient, while you are working to assess and treat/stabilize the SOB/R/O PE patient.

You'll get it as you work it. Don't beat yourself up. As strongly as I feel about controlling pain, I do my best to get another good nurse to give the pain med if I could, but you know, I have to do first things first--and preventing patients that are at least potentially seriously problematic from getting worse--or a least treating them efficiently by way of the best practices is the priority. You will learn to function as if you have roller blades on at work.

chrisrn24 · Nov 28, 2012

I would've said SOB first.

Pain is the 6th vital sign but it doesn't mean it's the most important vital sign.

When in doubt, think of your ABCs.

wooh, BSN, RN · Nov 28, 2012

LOL Depending on who it is that wants the update, that person might be your 1st priority. Just kidding. Unless it's the spouse of somebody powerful who can get you fired. Talk about reality.

Hehe, I was thinking, "Who is it that's interviewing me?" If the interviewers are wearing business attire, family member at the desk is seen first, followed by pain, and ignore the other two as if they'll die, they won't be filling out a customer service survey anyway, so who cares what happens to them? The bigshots don't, they only care about customer service. (I kid! Ok, I actually only half kid!)

Chest pain first. My rationale for chest pain being first, is PACU RN is with the SOB, nobody is with the chest pain. If PACU RN can't handle the patient on her own, she shouldn't have left the PACU with him. These being adult patients, cardiac arrest is more likely than respiratory arrest. And while we all think ABC, even CPR is now CAB.

Ntheboat2 · Nov 28, 2012

My first thought was....airway....SOB patient. However, I didn't notice you said a nurse was already with them. If one patient is having an MI and two nurses are with the SOB patient....well, that doesn't make much sense to me.

Anyway... I had an interview and was asked a question about an order involving a medication and I flat out didn't know the answer. I said, "Pharmacology is my weakness. I know as I work more often with the medications and become familiar with them then I'll recognize the correct doses, and I'll look up medications I'm not familiar with, but off the top of my head....I don't know the dose for that med."

I answered every other question well, and they offered me the job at the end of the interview. So, even IF you got the answer wrong, it doesn't mean you won't get the job. I have a friend who I actually told her the questions I was asked so she could prepare for her interview at the same facility, and even knowing the questions and having answers ready, she didn't get an offer. There's much more involved than whether or not you know the answer to every question.

BostonTerrierLover, BSN, RN · Nov 28, 2012

The "wrong'est" answer would go...

I would get the family member haunting the desk in a headlock, followed by a good thorough nurse education, just as soon as I got OR to hold that Grunter long enough for a smoke break since I've been on my feet for 12 hours, and they thought it would be cute to send an unstable patient from PACU at shift change! I already missed lunch, have a full bladder, and will return in "5." Upon Arrival,...(After throwing my locater into a passing laundry basket,...

I would then go code the 97 year old "full code" chest pain patient who just started alarming on the tele monitor while I finished refusing report on the OR guy- for 15 minutes until fresh horses get here.

Then I would set down and chart for 2 hours past time to go on my 5 patients, and the code, then if that patient's family member doesn't press charges, I would like to go home and soak my feet before House MD comes on, because the TIVO is already full of stuff I missed getting called in to OT!! See ya' tomorrow.

joanna73, BSN, RN · Nov 28, 2012

@ Boston terrier: Hilarious! Laugh out loud! I wish I could "like" a hundred times your last post. I would love to be a fly on the wall in that interview!

BostonTerrierLover, BSN, RN · Nov 28, 2012

See, I even saved the hospital a hipaa violation, and saved the patients privacy and confidentiality(It was probably just a mother-in-law being nosey anyway!)

I wouldn't have done that post, but so many had nailed the "right" thing to do, I thought I would pull out the pitchfork, lol:)

wooh, BSN, RN · Nov 28, 2012

Family member at desk wants information?

Right answer: Don't tell them anything, HIPPO ATTACK!

Right answer: Tell them anything they want to know, customer service above all!

sckimrn · Nov 28, 2012

If the SOB has a nurse with them, I would go to the dizziness and chest heaviness first. We were always taught airway first, but according to ACLS, perfusion is first, then airway....especially if that patient already has a nurse in the room. Then pain, then family (they are not technically my patient :cheeky: )