I'm amazed that doc took that comment without asking a few questions himself. When she said that the patient had shown signs of increased intracranial pressure all night long, my next question would be, "What did you do about it or whom did you call?" Sounds like negligent care to me. That nurse should have been watching for a widening pulse pressure and several other things. The opportunity to intervene was just passed by, from the information given in your description.
Never dismiss a parent who says their child is not acting right.
Always trust the opinion of a parent (unless you can prove it wrong), especially for a chronic patient.
Along the same line, never let a physician/charge nurse dismiss your gut feeling that something is not right. As a float nurse, I once had a pt with a head injury in PICU. All night long, I went to my charge nurse and an experienced PI nurse, telling them the child was very agitated, trying to pull out lines, vomited, etc. What can I do? They told me it was normal for a head patient. To make a long story short, the kid coded at 6:30 am, and the charge nurse made a comment to the doctor that he had been showing signs of increased intracranial pressure all night long. The kid had herniated and died within the next 24 hrs. I still wonder if things would have been different if that charge nurse had recognized the increased ICP when I kept asking her what to do about the agitation. We could have gotten a CT scan, called a neurosurgeon, done something! Hindsight is always better than current sight.
i agree with you. new nurses need to know that the workplace is just that, the workplace. you are there to be part of a team, but you are definitely there to do the job they hired you to do. this could entail helping out a cna from time to time if and only if you have the time to do so. if you go into a new situation with the attitude that you want to make friends with everyone, you might just end up a doormat. remember, harmony at any cost is just not worth it and it an harm a patient. sometimes doing your job may mean that you are not available for a laundry list of favors. so what? you're there to do services for a client that are very different from cleaning them and their rooms. and believe me, when your performance comes up lacking because you've paid too much attention to seeing that the cna's don't have a problem with you.......alone you will be and the fact that you were trying to "help everybody" will just sound stupid/weak to administrators. and it would be. that's why they hired the cna's in the first place; there was a job for them to do and it was not feasible for the nurses to do both jobs. think about it from that perspective. gives you (and me) pause, huh?
while i don't disagree with these, i urge you do them with caution. i don't mean to sound disgruntled (but i am :chuckle ). don't let them take advantage of you! they will sit there and watch you change every wet/soiled pt. if you let them. they are also well aware of the fact that you are 'new', and want to do everything you can to help your patients. many nurses told me this as a new nurse. depending on where you work, you need to make a choice- either be their friend, or keep it professional (so they will do their job). it is very hard, once you've established that 'friendly' relationship, to change that.
please remember this: you can do the cna's job (and the unit sec as well), but they cannot do your job!!! i'm just a little sick of hunting them down, and doing everything for my patients, while they sit on the phone.
When a patient says "I feels something wet under my back/legs..." Put on gloves BEFORE you peek under the covers. I promise you won't be sorry you took the time!
Just as a small addition to this, I have tried to get into the habit of making sure I have a spare pair of gloves in my pocket at all times. It saves having to run off and get a pair at the most inconvenient time. :imbar
I once checked a baby's tube placement, checked for residual and made sure the cutie was in great shape, cozy and swaddled. Then I carefully set the feeding tube into the pump and programmed it for the correct volume and time. Then I left.
Forgot to actually hook the baby's tube to the feeding syringe's tube. I realized the error of my ways when one hour later the kid was screaming from hunger and the full volume of his food was on the floor. :imbar
Lesson from tonight - never decide to leave an ileostomy bag check until after you take a break. Do we have an icon (I just can't call it a smilie in this context!) for VRE-positive poo all over the bed? Note to self: even worse when you drop said loose stool on the floor...
HI, Thanks for your messages guys, great topics, it helps a lot all of us nursing students. I am a second semester RN student going to OB/GYn Peds, and very excited to learn. It's a a very new field to me, especially OB , I am a male but so far everything is going well, just trying to do my job professionally and learn what has to be done correctly. I heard many things about men going to OB and having a hard time,it can be understandable in some cases. Unfortunately there is still this dilema in nursing , it's getting better slowly, which is very good for everyone and the profession.
NEVER stand in a line of seven of you staring at someone who is making mistake after mistake and then when the new RN makes light of it and says "i guess you're getting a lesson in how not to do this." you quip with
I agree nurse goodguy. Not a kool move! If you found it, need it called on, DO IT YOURSELF! The couple extra minutes you spend just shows you do take your job seriously. People that count do notice.
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Bonnie Nurse
111 Posts
I'm amazed that doc took that comment without asking a few questions himself. When she said that the patient had shown signs of increased intracranial pressure all night long, my next question would be, "What did you do about it or whom did you call?" Sounds like negligent care to me. That nurse should have been watching for a widening pulse pressure and several other things. The opportunity to intervene was just passed by, from the information given in your description.