What would you have done?
- 0Aug 19, '13 by bendyprissyBeen a nurse for one year at an Ortho/Neuro/Trauma post-op med/surg unit. Moved to a new hospital but on a general post-op med/surg unit. Had an ortho, same day post-op patient. At 2230 noticed patients' foot was dark red, warm/hot, edema +2 on the leg that had the TKR. Patient had a knee immobilzer (with an order to leave on all night) over ACE wrap. Pulses were thready & cap refill was <2s. Brought in the "Ortho" nurse, because they have 2 pods specifically associated with their Joint program, & also brought in the charge only to have a second opinion since I was new there. I was already going to call the surgeon regardless. Both nurses told me to call the dr to cover my butt. Patient was grateful I called. Surgeon stated he could not understand why I was calling for swelling, even though I had listed all the other symptoms. He then asked why he had the knee immobilzer on to which I stated because you put the order in. He told me to remove the immobilzer & ACE if needed. I removed the immobilzer which after about 3 hours resolved the situation. I charted all. Come back to work next night to find myself removed from that pod & put back on orientation with another nurse. That surgeon got so mad at me for calling about a concern with his patient that he spoke with them & rather than them having my back, of course they agree with him. The manager is out on vacation for another week. One nurse told me to leave it alone but now everyone there thinks I am incompetent. What would you do?
- 2Aug 19, '13 by loriangel14 GuideThat's awful. If the patient had come to harm and you didn't call the MD you would have been toast. Even if he felt you didn't need to call he shouldn't have gotten you in trouble.I always call when in doubt. That's what they get paid for. You couldn't have removed the ACE and the immobilizer without his order to do so.I don't think that you acted inapporpriately, especially when you got advice from more experienced nurses saying you should call.
- 4Aug 19, '13 by serenidad2004Always always ALWAYS call the doc if you have concerns. You did what was best for the patient. The doc can get as mad as an old wet hen but your responsibility is the safety and well being of the patient.
You did everything correct... called on your more experienced colleagues and followed up with the doc. Dont let an angry physician on a roll make you think anything different!
- 3Aug 19, '13 by Sun0408I would send your NM an email re this issue and you being put back on orientation. Nothing in your posts suggests you should be. You saw a problem, asked for help from more experienced staff and notified the MD to get new orders. The MD should be more careful with his orders hints him not knowing he ordered the immobilizer to stay on all night...
- 3Aug 19, '13 by turnforthenurseRNI agree, when in doubt you should always call. That's what the MDs are for and that's why they make the big bucks. Sure, they may get annoyed if you call them in the middle of night over "seemingly frivolous matters" (to them, anyway!) but that's their job. What would have happened if you decided not to call and then something happened to the patient? That would have been a much bigger problem. You did the right thing and this shouldn't warrant you being placed back on orientation.
- 0Aug 20, '13 by bendyprissyQuote from mclennanThat is fantastic advice! Man I wish I would have thought about that! Unfortunately I can no longer add notes after the 24 hour mark has passed but you can bet that will be my note if and when this happens again!I would have charted "charge nurse Jane Smith RN and Ortho nurse Joe Blow consulted at 1839. Both recommended MD be called. MD called." Then, have the two nurses co-sign the note before end of shift.
- 0Aug 20, '13 by bendyprissyThank you all so much for your advice and I would do it the same all over again! It's just so frustrating when every word during orientation for ALL places in general is such BS. I had been going through their "month long" orientation process where they even brought in the medical Chief of Staff who spent 30 minutes talking about not being afraid to call the dr's with your patient concerns no matter what time of day/night. Evidently a croc! They also stated you could go to them with complaints without fear of retaliation...well we all know how that would go! And so on. This is a "Magnet" facility that I won't say the name of but man did they preach about evidence-based practice, being a patient advocate, and patient safety, safety, safety! Another bunch of BS!
Here's how orientation should go. The dr's are always right, under every circumstance, and we will listen to them at all costs because they are the hospital's meal ticket and so if you were wondering who we are going to side with every time then wonder no more. Any questions?
Just seems to me they could cut out a major chunk of orientation and get us worker bees out on the floors a lot faster. Ok, that's my rant.
- 2Aug 20, '13 by TaylorMaidRnFirst, I believe you absolutely did the right thing. Do not let this situation deter you from advocating for the patient! Like the others have posted, I would definitely get a second opinion from another nurse before calling the doctor, and then charting that you did so, including their name and title. Second, when your nurse manager returns, I would ask for a sit-down with them to clarify if you were moved because of the phone call, and what would be the best way to handle the situation in the future. If you were moved as punishment, chances are they'll be forced to admit you did exactly as you should have done.