New Grad opens a can of "whup "

  1. Just want to vent a little. Today, we were more short staffed than usual(4 people left early-they were on call and worked until 5:30am) so my supervisor asked if I felt comfortable enough to take a room on my own. I told her yes, as the cases in that room were somewhat familiar to me and not complicated(a hydrocelectomy, a D&C and 3 podiatry cases). Everything went smoothly until it came time to do the first foot case. Anesthesia was short as well, since they had to send staff up to do C-sections. I assessed the patient, the doc did his thing and we were pretty much ready to go. Except...no anesthesia person to do the case. The podiatry doc starts getting antsy and wants to bring the patient to the room anyway. Keep in mind, we had no ETA for the anesthesia person and have been specifically told NOT to bring the patient to the room without anesthesia being ready. Next thing I know, one of the anesthesia docs comes flying into the holding area hollering that he is my anesthesia person(when I last checked 2 minutes earlier, we still had nobody) and I "don't need to know if anesthesia is ready" to bring a patient to the room. He was very rude and boy, I got so mad, people said I turned purple! I then told him that we most certainly do need anesthesia to be on board before proceeding, and that the manager backed me up on this. He storms off to confront her and bless her heart, she actually stood by me. Granted, podiatry patients are usually healthy, stable people, but if something had happened to that patient, and I had taken that patient to the room without anesthesia, I think I'd be in big trouble, not to mention the poor patient. It turned out it was a lack of communication on their part, but as a new grad, they've gotten pretty snippy towards me. I look at it this way-I do not answer to anesthesia for my orientation process and I WILL NOT be rushed when it comes to providing proper care for my patient. That's when mistakes happen and these same people would throw me to the wolves if they thought it would save their fanny. I guess it was kind of an epiphany though-I always wondered if I'd be assertive enough to stand up to a doc when I knew I was doing the right thing..Guess I'm OK on that front!!
    Last edit by ortess1971 on Dec 5, '06
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  2. 16 Comments

  3. by   P_RN
    Just imagine how Mr Anesthesia looks with his knickers in a knot.....literally. You did the correct thing. He did not. You protected your patient, your license and your integrity.

    Good On You!!
    Last edit by nightingale on Dec 4, '06
  4. by   elcue
    Nice going, Tess. Ya done good!

    But please think twice about most podiatry patients being healthy and stable. In my experience, many podiatric patients are there because they are diabetic, which means they are very likely to have all manner of bad stuff going on in addition to diabetic feet.
    Just a heads up from a friendly old nurse!

    Send me a can of that whup 'em, will ya?? :smiley_ab
    Have a great weekend. Linda
    Last edit by nightingale on Dec 4, '06
  5. by   Hellllllo Nurse
    You go, Tess!

    Thanks for standing up for yourself.

    A nurse who asserts herself and stands her ground with docs helps all of us.

    umpiron:
    Last edit by nightingale on Dec 4, '06
  6. by   Hellllllo Nurse
    Quote from elcue
    Nice going, Tess. Ya done good!

    But please think twice about most podiatry patients being healthy and stable. In my experience, many podiatric patients are there because they are diabetic, which means they are very likely to have all manner of bad stuff going on in addition to diabetic feet.
    Just a heads up from a friendly old nurse!

    Send me a can of that whup 'em, will ya?? :smiley_ab
    Have a great weekend. Linda
    I agree, Linda. Many podiatry pts are diabetic, and have all kinds of cardiac, circulatory, neuro, renal, and immunosuppression issues.
    Last edit by nightingale on Dec 4, '06
  7. by   inspir8tion
    Yeah! You are a great example! I work in a teaching hospital and am in my OR program and we are just learning to prep patients. I was prepping an abdomen the other day and had yet another RN telling me that every other RN including my teacher hasn't taught me the proper way and I have to do it her way. Meanwhile one of the residents is standing there and she says "it's going to take longer to prep the patient than to do the whole surgery!"

    I stopped what I was doing, turned to her and said, "I'm learning, just like you're learning". And I went back to what I was doing. She didn't say anything again and later my senior nurse said "good for you for standing up to her".

    I am learning because the first time a surgeon did something wrong, I didn't do anything but look helplessly at my senior nurse (a different nurse). When my senior nurse didn't say anything, I just stood there frustrated. I went and talked to my instructor and she gave me some advice and in the next case with that surgeon I was able to state what I would and would not stand in regards to my patient.

    I also was afraid I wouldn't be able to stand up to people. My fear is also that I won't be able to be assertive (which I was in my first example), and that I'll be passive (like the second example), or aggressive because of all the pressure in the room and in my developing OR RN skills. But someone said to me "no matter what happens, they can't kill you."

    Thanks for your posting Tess!
    Last edit by nightingale on Dec 4, '06
  8. by   elcue
    [QUOTE=inspir8tion;1930117]

    I stopped what I was doing, turned to her and said, "I'm learning, just like you're learning". And I went back to what I was doing.

    GOOD GIRL!!! :flowersfo Excellent response. You will do well in this environment!
    Linda
    Last edit by nightingale on Dec 4, '06
  9. by   inspir8tion
    Thanks!

    [QUOTE=elcue;1930129]
    Quote from inspir8tion

    I stopped what I was doing, turned to her and said, "I'm learning, just like you're learning". And I went back to what I was doing.

    GOOD GIRL!!! :flowersfo Excellent response. You will do well in this environment!
    Linda
    Last edit by nightingale on Dec 4, '06
  10. by   ortess1971
    You guys are right. No surgery is minor surgery,IMHO and they all have the potential to go badly. I was proud of myself for standing up to him but it turns out, I'm not one of these people who can handle being riled up and angry for long...Last night, I had the worst headache(I tend to clench my back teeth when upset/angry) I took two tylenol, had a cup of chamomile tea and went to bed early! LOL...I sound like a little old lady. Opening up "whup @ss" cans is exhausting work! PS...With this doc, most, if not all, of his patients are a 1 on the ASA scale. Most of the podiatry cases we get are healthy. I wonder why? For a while there, Orthopedics was stepping in on the "touchy" patients with a ton of problems. Just recently, they came out from under ortho's thumb, and got their own head of their service. We do a lot of hammertoes, bunions and cosmetic stuff, which is good because I'm not sure I'd trust some of them with a patient who is unstable!
    Last edit by nightingale on Dec 4, '06
  11. by   tessa_RN
    I am glad that you stood up for yourself..Feels good doesnt it..I had a moment like that last week..We needed to do a colonoscopy on a woman..well she was a level 3 and I am BLS so I cant monitor anyone over a level 2..I told the doc that..he got mad and yelled at me..I told him I could not monitor this patient because I was not trained to monitor that level (you have to be ACLS)anyways I am glad that I didnt because this patient got a femoral line and blood during that procedure..I am just glad that I stood up for myself..Anesthesia done the case..I went over there anyways to help..Im glad I didnt monitor her because she told me if she got any sedation at all she quits breathing..Docs get so mad about things like that but we are looking out for our own job to....
    Last edit by nightingale on Dec 4, '06
  12. by   nightingale
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    foul language

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  13. by   ewattsjt
    good that you stood up for yourself. let me give and example of what i have seen happen. one of our anesthesiologists had the circulator to bring the patient back while he left the floor to give an epidural on the ob suite. "bring the pt back and i will be there shortly." the patient was brought into the room and held until the anesthesiologist returned. it was almost 1 hr later (50 some min) after the original epidural was difficult and 2 more were added that he returned.

    nothing has to happen to the patient physically but there was placement of undue stress and anxiety on the patient in this situation.
    Last edit by ewattsjt on Dec 5, '06
  14. by   ewattsjt
    Yeah, sometimes it's bad!

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