How would love to hear some of the things coworkers have done at work that just make you mad and frustrated.
For example, the other day we had a lady who was clearly terrified of needles. Now we all have patience claim they're scared of needles. But this lady was a little different. She came into the ER clearly in pain and flat refuse to let the doctors draw any blood work, or start an IV.
She had abdominal pain but would not allow us to do anything that involves a needle. Try to figure out a diagnosis for abdominal pain without being able to do any kind of lab work or use any kind of IV contrast.
Now I'm not the first nurse involved in taking care of this patient. In fact, I actually asked to take over care for this patient because nobody else was getting anywhere. After sitting there and talking to her for 20 minutes I finally got her to agree to let me draw blood do doing finger sticks with micro tubes just like I would have a very small child. So I went to gather up the necessary supplies.
Now I am a new employee and was oriented to the ER. My preceptor took it upon himself to walk in and try to convince the lady to let him start an IV. She's already told for people know she would rather leave. She had even said she would rather go home and die then let someone stick her with a needle and she was crying when she said so.
When I got back she was signing the AMA paperwork and leaving and nothing I could do to stop her.
. I've been a nurse twice as long as he has I just happened to be new to the hospital. I think he was wrong and out of line.
Actually, it really kind of is that simple - in the sense that those issues are not going to be resolved with an ED visit. What were they going to do? Call psych? The finger stick labs would have been useless without the ability to act on them. If the phobia is truly as bad as is being implied, I highly doubt EMLA or intradermal lidocaine would make a difference.
Maybe some PO Ativan, and EMLA, and taking some time starting with non-needle things first would have helped, though. You can get a history, do a physical exam, and run stool and urine samples without needles. You can even get an ultrasound or x ray or CT scan without IV contrast.
Maybe some PO Ativan, and EMLA, and taking some time starting with non-needle things first would have helped, though. You can get a history, do a physical exam, and run stool and urine samples without needles. You can even get an ultrasound or x ray or CT scan without IV contrast.
Ultrasound would serve a use but for an acute abdomen you really want a CT abdomen/pelvis with contrast (PO and IV is best) if you can get it. CT w/o contrast would only be useful for renal stones though.
But a scan is better than none I guess, urine and a good H/P helps as well.
OP, I can see how you would feel stepped on, but I agree with giving your preceptor the benefit of the doubt. Or at least find out why his judgement call was different from yours.
If if it turns out to be just your basic urinary track meet, I'd let it go and move on. The only behavior you can control is your own. Besides, who has the time?
When you have a phobia, it's really not that simple. It was probably a huge effort for her to even come to the ED and shows how desperate she was.
I'm wondering if EMLA cream was offered?
This is exactly what I thought reading the OP. To have a phobia this severe and then to not be able to overcome it for the sake of ensuring your life isn't in danger from severe abdominal pain is pretty intense. I'm surprised that no benzos were attempted. I'd request an order for 0.5-1 mg of Ativan PO. If it makes her sleepy and relaxed, she may be far more agreeable to plan of care.
(Obviously I'd be up front with her, and if negotiation was needed to help build trust, I'd put the time in to make that happen. She'd have to give consent before the Ativan was on board anyway.)
I would not be upset with the preceptor. And I'd be afraid of what ended up happening after she left. Did they at least get whatever imaging they could without contrast? I do feel like more could have been done without an IV than what was described in the OP. Was it?
You can lead a horse to the ER but you can't make them let you start an IV. I think that sometimes we need a pseudo ER for the fakers and the crybabies
I thought this thread was going to be about something that's worth being upset about. For example, the night I got to work (many years ago) & had a 4 year old getting a transfusion. The 3-11 nurse had only been working there a few months but was an experienced nurse. At the time, we didn't do bedside report. I walked into the room after report to find the tubing disconnected & most of the unit of blood on the floor. The 3-11 nurse hadn't left yet so I went & got her & asked her to help me clean it up & do an incident report. Her response: "I gave report, I'm going home ".
If she had agreed to fingerstick labs, I would have also tried to get her to agreed to an IV. Trying to draw the needed labs with fingersticks would mean WAY more sticks than one IV, where all labs would be drawn and then she'd also have IV access. Plus fingerstick labs you risk getting inaccurate labs from interstitial fluid mixing in. Venous samples are accurate.
So your plan: about 5 painful (fingersticks hurt) needle sticks, possibly inaccurate labs, no IV access.
Your coworker's plan: (hopefully) 1 stick, accurate labs, IV access.
This woman had her mind made up. I'm guessing when you got back there with all of your pipettes she'd be on her way out.
Specializes in Psych, Addictions, SOL (Student of Life).
In the scenario you described I think you are over reacting - In the ER where patient volume is often high there is not time to cajole adult patients into the care they need. Now a child would be something different. I also feel that starting a thread about the things co-workers do that make you mad is counterproductive to the whole teamwork concept. As I get older I am amazed at people let others disrupt their serenity. There is almost nothing a person can do that will make me fuss and fumed enough to post a scenario on a board. Yes things upset me but I cool myself down and move on. I have enough drama in my life without creating more.
In the scenario you described I think you are over reacting - In the ER where patient volume is often high there is not time to cajole adult patients into the care they need. Now a child would be something different. I also feel that starting a thread about the things co-workers do that make you mad is counterproductive to the whole teamwork concept. As I get older I am amazed at people let others disrupt their serenity. There is almost nothing a person can do that will make me fuss and fumed enough to post a scenario on a board. Yes things upset me but I cool myself down and move on. I have enough drama in my life without creating more.
Hppy
OP was just venting. We all flounce a bit. Okay, not all, can't speak for anyone else. I flounce a bit, usually get a little loud an then I'm over it. Yea, and if I worked really hard to get someone to stay (which, let's face it, I may not, depending on this situation) and came back and saw that foiled I would have thrown my hands up in frustration.
OP was just venting. We all flounce a bit. Okay, not all, can't speak for anyone else. I flounce a bit, usually get a little loud an then I'm over it. Yea, and if I worked really hard to get someone to stay (which, let's face it, I may not, depending on this situation) and came back and saw that foiled I would have thrown my hands up in frustration.
Have to agree here. Whether or not you can "cajole" (as a prior poster pointed out, though I disagree as this implies the patient has been persuaded) a patient into having labs drawn or an IV placed, having worked so hard to make this patient comfortable only to have them sign out AMA is frustrating.
What's more, I don't really see a reason why the OP's co-worker even felt a need to get involved, especially if not explicitly asked for help.
TL;DR: I would be annoyed too. Maybe not enough to say anything, but enough for it to ruffle my feathers.
blondy2061h, MSN, RN
1 Article; 4,094 Posts
Maybe some PO Ativan, and EMLA, and taking some time starting with non-needle things first would have helped, though. You can get a history, do a physical exam, and run stool and urine samples without needles. You can even get an ultrasound or x ray or CT scan without IV contrast.