advice on being written up when I dont think I should have been...

[anniegirl1988]

I was told today that I was written up for not notifying a dr about a patient situation.. here is a little of what happened.

I picked up a patient in my shift with 4 hours left to go. This pt has 3mg scheduled dilaudid Q3 and 50mg of Benadryl Q6 with orders to hold for sedations. nurse that gave me this patient had given the 0000 dose which both were due at that time.. he said that she wasnt waking up but pushed it anyways... okay so that irritated me right away because I knew the orders and had had this patient a few days before and she was A&O... so went in to see the patient and she was lethargic and not really responding just groaning. So I told my charge what happened and held her 0300 dose of dilaudid and continued to monitor. When I went in at 5 to do my nurse draw I messed with the patient did my draw pulled her up in bed blah blah blah. still only moans to answer. This patient by the way gets lots of narcs and usually dose okay. Kidney function and liver function good and vital signs good. I told my charge again that it was bothering me that she was like this and we decided to call our rapid team to see if she possibly needed narcaned or something. When I called I told the nurse So I just needan opinion at this time I am not calling this as a rapid response. She said okay and came up saw the patient and decided also that it did not need a rapid response. However she filled out her paper work which since I had only called rapid response twice before thsi and they were actually rapid responses I did not know she did not need to fill out paperwork for this visit. I however assumed it was just part of their charting. Since nothing more than just continue to monitor patient was done we did not notify the MD even more so because it was still our on call doctor and not her and she would be in in a few hours. We did leave her a note telling her hey maybe think about order changes.

Now I find out I was written up because I did not notify the Dr about a rapid response on her patient. But again I was only calling for an opinion per my charge nurse. Is it right for me to have been written up for this or should I protest it like I want to do?

[Momma1RN, MSN, RN, APRN]

This. When in doubt go up the chain. It's your license- not the charge nurses, not the docs, YOURS.

[VANurse2010]

The patient does not have to be unstable to warrant a write up. A change in LOC is a significant finding. Can't just assume" A little bit of overnarcing".

Your overnarced patients are on a vent, big difference.

Whatever, they had the opportunity to make this a teachable moment, or a punitive. Choices, choices.

[psu_213, BSN, RN]

but I didn't read anything here that indicated true instability.

I have to disagree on this point. Of course I wasn't there to actually assess the pt, however decreased LOC--only moaning--presents a awful lot like head bleed I took care of recently. More than likely, the pt was snowed, but there are definitely more sinister causes for her ALOC.

Anyway, with a RR, the primary should be notified…if the note gets lost of otherwise not read by the primary, there is a chance that the narc/Benadryl order may not be adjusted.

Did it warrant a 'write up'? Well, that term mean different things everywhere I have worked…but, I would say probably not. A teaching moment existed, and a write up makes it punitive, not teaching.

[APRN., DNP, RN, APRN, NP]

I am an RRT RN as well as an RRT Rounder.

If a nurse feels uncomfortable about what is going on with a patient, an RRT Rounder can come take a look at the patient to support both the nurse and the patient.

If the situation warrants the physician to be called, I'll help the nurse with that thought process and give him or her guidance.

If a patient is altered and that is not their baseline, the Dr should be notified. The Dr will probably want to adjust the orders and evaluate the patient.

[tyvin, BSN, RN]

I haven't read any of the other posts but that's a huge no no! If rapid response was called, whether they did anything or not, the doc should have most definitely been called right after you called rapid response. Think about it, if you were the doc, would you want to know?

[Emergent, RN]

It's been three days since this thread was started. I hope all is well with OP.

[VANurse2010]

I have to disagree on this point. Of course I wasn't there to actually assess the pt, however decreased LOC--only moaning--presents a awful lot like head bleed I took care of recently. More than likely, the pt was snowed, but there are definitely more sinister causes for her ALOC.

Anyway, with a RR, the primary should be notified…if the note gets lost of otherwise not read by the primary, there is a chance that the narc/Benadryl order may not be adjusted.

Did it warrant a 'write up'? Well, that term mean different things everywhere I have worked…but, I would say probably not. A teaching moment existed, and a write up makes it punitive, not teaching.

I wasn't here to assess the patient either, obviously, but I doubt very seriously this was some random head bleed given the information presented.

[psu_213, BSN, RN]

I wasn't here to assess the patient either, obviously, but I doubt very seriously this was some random head bleed given the information presented.

I doubt it also, but it certainly has to be a consideration given the ALOC. Also, we don't know anything (hx, VS, etc) about the patient. Just saying that it could have been a serious situation.