Bad Nurse Judgement

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Hi all.  I have been a nurse for 3.5 years and am really questioning something I did today.  More like kicking myself, but also feeling like maybe I wasn't too far off.  I am hoping for your kind, but honest opinions.

Today I had a pt report to outpt clinic.  He was new to our clinic.  His VSS but was tachy 122-125.  He was in no distress, stood up to weigh himself just fine.  Talking to me just fine.  He body was also decompensated (skinny, little muscle mass, likely dehydrated).  I thought maybe his tachycardia was r/t pain, so I asked.  He stated it was 10/10 (but clearly he was not in 10/10 pain...please let's disregard the convo right now of pain is what a pt says) and it was in his left shoulder and radiated down his arm.  Yikes!  But he also said he had had this pain for three days so in my mind that doesn't align with MI.  And absolutely no mention of chest pain or any other symptoms.  Also, last HR a couple of weeks ago was 119, so tachycardia is his baseline. I told his provider and provider asked me to take the pt to the ER.

I spoke with the pt who declined going to the ER and I asked further questions.  He said the pain was really just in his left shoulder.  I told provider who asked he get an EKG, which he did not order stat (meaning techs would have come to pt.)  In my mind because pt is new, tachy, and reports pain provider is doing a CYA.  But he is also clearly not worried.  I decided to take the pt to the EKG lab myself and asked that they transport him back to the clinic when he was done.

So turns out EKG lab filed a complaint saying the RN left him when he could have had an acute attack.

Was my nurse judgement far off here? NOTHING in my spidey sense said this was a MI but perhaps I should have stayed while pt got a EKG. Also as a FYI - I am new to this facility and did not realize the EKG room did not have any sort of code cart or nurses - just a bunch of techs...I've never had to deal with this before so just didn't think about it., but it makes sense.  And I didn't think about not leaving him because I truly did not think anything was wrong.

Turns out EKG was totally fine.

So tell me please, how awful was my nurse judgement on this one?

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**EDIT: Paragraph that starts Was my nurse judgement far off?  

Should continue to say NOTHING in my spidey sense said this was a MI but perhaps I should have stayed while pt got a EKG.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

Your reasoning is well thought out. For all the reasons you mentioned it was highly unlikely the patient was experiencing an acute event. And you didn't place the EKG order so any complaint should be directed toward the ordering provider. If he felt the patient required constant monitoring then he would have ordered it as such. I wouldn't worry about it, unlikely anyone will remember it, unless someone particularly has a bee in their bonnet over stuff like that. 

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12 hours ago, MajesticDancer said:

So tell me please, how awful was my nurse judgement on this one?

Sounds decent and you should disregard their complaint.

This can be an interesting situation for the nurse. I look at it like, "if the provider is going to do what s/he wants to do to reassure everyone that the patient is not having a cardiac event, then I too should proceed as if that is at least a small possibility." Of course, time and resources figure in to how this scenario will be prioritized in the end, meaning that if there are patients that need me more then yes I'll take my cues and take my chances that this patient is not having an MI. But it puts you in an awkward situation when everyone is covering their bases to prove that he isn't.

12 hours ago, MajesticDancer said:

In my spidey sense said this was a MI but perhaps I still should have stayed. Also as a FYI - I am new to this facility and did not realize the EKG room did not have any sort of code cart or nurses - just a bunch of techs...I've never had to deal with this before so just didn't think about it., but it makes sense.  And I didn't think about not leaving him because I truly did not think anything was wrong.

If you need to answer this complaint, leave alllllll of this (and more) out of it. It's possible the complaint was made because the techs imagined that that someone new there didn't know what they were doing ?. So don't spin in circles defending yourself. If asked anything just say that the provider was aware of the situation and it was not though to be primary cardiac issue.

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Specializes in ER.

I would not dwell on this too much. If they want you to do things differently next time you can have them clarify their policies and procedures. Hopefully you documented well, and it sounds like the patient did fine.

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Specializes in ER.

What I find puzzling is when people fail to say anything in the moment, such as these EKG techs who did not utter a word to you that they would like you to stay. Then they make a tattletale complaint. 

I've seen that before many times in healthcare. It is the behavior of sniveling cowards who just want to stir the pot.

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Specializes in ICU/ER/Med-Surg/Case Management/Manageme.
19 hours ago, Emergent said:

What I find puzzling is when people fail to say anything in the moment, such as these EKG techs who did not utter a word to you that they would like you to stay. Then they make a tattletale complaint. 

I've seen that before many times in healthcare. It is the behavior of sniveling cowards who just want to stir the pot.

I so totally agree with this comment!!  This type of scenario is what finally caused me to be totally done with nursing.  Nursing is a T-E-A-M sport...it takes a village...etc.  Not a single one of us can have perfect judgement every minute, or see into the future or any on that type of stuff.  We are supposed to be professional colleagues whether we are RN's, ancillary people, CNA's, Managers...whatever. We're supposed to be there for the patient and as such, should consult, advise, assist where needed. The entire essence of nursing is lost when we have to constantly be playing the CYA game.  

And OP, stand your ground.  With good thought and reasoning, you did what you thought was the best in the moment.  You won't always be right but as long as you use well-thought out reasoning...well, I would want you on my team any day.

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Specializes in Short Term/Skilled.

You mentioned it to the provider who told you to get an EKG.  Breathe. 

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Specializes in Medsurg.

Those people are haters. You get alot of those in this field. Keep your head up boo.

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Specializes in Psychiatric nurse.

First of all, he was not admitted to inpatient care. He is a patient in the community being transported to an outpatient service, regardless of who has transported him. The EKG lab sees many patients for services and they have access to 911 in the event of an emergency. 

You did not make a bad choice. 

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