Some context: Pt had surgery, and doctors did not resume some of pt's BP meds. Since the previous day, Pt had SBP in 200s. Nurse on each shift called the doctor to complain pt's BP was that high. The doctor would order an extra PRN and SBP would go back down. Later though, it would spike back up.
During my shift, his SBP was 200. Called the doctor who told me to wait because I had given his regular medications and PRN medications (I called 30 minutes after giving IV BP medications and not seeing a change) by 12pm SBP is 169. They ordered an extra one time dose PRN and told me they were aware and monitoring. Informed my charge nurse (and clinician) of this guys BP, who called the doctor personally as well. She looked through his chart and said he's done this before. By 4pm, the pt's BP spikes back up, I give all the PRNs again. At shift change, I told the nurse I gave BP medications roughly 40 minutes ago. I reminded the charge nurse his BP was crazy high, and she told me to give the extra prn medications. I was hoping it would go down on night shift because I gave the most potent one ordered.
Also during the shift, he pulled out his dobhoff (completely alert and oriented patient, he was just "moving around and it came out"). By 6:30pm I found out it was coiled in the stomached, and it needed attempted reinsertion. His IV also went bad and he's a hard stick which was replaced during my shift.
I passed this onto night shift, who complained the whole time. She was mad his BP was high and was mad she would have to reinsert a dobhoff. Both of us never did it before. I got a senior nurse to help me, and I suggested she do the same.
Anyway She sent me an email the next day, complaining the charge nurse was mad his BP was so high all day, and complained she spent multiple hours in the room and neglected her other patients. I thought this was completely unprofessional and rude. I did what I could.
I am a nurse with 8 months of experience, so I'm still learning. Is there anything you can suggest? I felt I did what I could, but this coworker doesn't think so.
You left an Iv , ng tube, and high blood pressure....... Sounds like you tried your best....but this pt was not well managed. Logical or not..... Most nurses get frustrated at the other nurse when getting a pt like this. ( ps. I tried never to leave a ng tube or Iv for the next shift.....either I found a nurse sitting around or did it myself( both tasks take five minutes max)
the IV had been replaced, and the BP was addressed.
Not to be argumentative, but if the tasks only take 5 mins (I would say they take a little longer all and all), why is it a big deal that they were passed on? Just making that point. I agree that NGT insertion being left behind might annoy me, however...sometimes, you have to give the other shift slack that they ran out of time.
Lol because I don't like to be talked about[emoji12]..... And we all know that right or wrong that is what is going to happen if you leave stuff.( or they write your manager). This is the culture of nursing..... At least everywhere I have worked
I am out of bedside nursing as of 4 months ago..... And this post just reiterates to me how much I love my new job[emoji23]
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
When I worked med-surg, I made it my mission in life to leave all loose ends tied up by end of shift. The oncoming nurses sometimes told me they liked taking care of the patients I had had. However, it's not realistic to be able to do this all the time. Sometimes you inherit a train wreck, work your butt off and then pass on a train wreck. Or someone goes south just before shift change. In those events, I'd apologize profusely to the oncoming nurse and let them know the situation so they didn't find surprises. This saved me from a lot of flak.
But - if someone wants to throw a hissy fit anyway, that's their choice. I refuse to own that, and if anyone wants to take it further, I calmly stand my ground. You are certainly not responsible for what the doctor chooses to order.
"I would just ignore the other nurse and assume she was having a very frustrating day. "
Disagree. Cannot ignore or condone the oncoming nurse's behavior. Oncoming nurse cannot deal. S/He needs to be called out this.
I'm not a fan of "shift wars" so I'll tend to play nice and give the other side a chance to meet me in the middle. I have no problem standing up for myself when I need to, but I don't have so much pride that I won't tolerate a little bit of bad behavior once in a while. I like to think of myself as the one who sets the tone ...or at least tries to.
Why didn't the darned doc reorder the pre-op BP Rx?
I'm sitting here reading the OP and I'm thinking the doctor seems to be making more work for himself by not ordering the pre-operation meds. I thought I was missing something too when no one brought it up until like 12 posts down, Lol!!
I think you absolutely did everything you could. I think people tend to think that if you knew something needed to be done then you should've done it, which obviously is not always realistic.
And when someone says "the charge nurse was really mad" I think they're blowing smoke up your butt. They just want you to feel guilty or like you did something wrong. And as far as neglecting her other patients sounds like a personal problem with time management and she's just looking for someone to blame.
I think you did a great job, I wouldn't fret over it!
The other nurse is not the boss of you, OP. and if had read the chart, would see that you HAD been actively keeping tabs on BP's, new IV's etc etc.
It would have been up to the charge nurse on the oncoming nurse's shift to then realize that the patient needed more care, and re-assigned accordingly, or transferred to a higher level of care if in fact the patient was a 1:1 as described. But that did not happen, and I am sure on-coming nurse was upset that she had a heavy patient for the shift. Not your issue.
A poorly managed patient is a poorly managed patient at 3am or 3pm. Document, cover your behind, you asked charge for assistance, and even she couldn't get the MD to just order the meds already.
And be gosh darn if I would attempt a procedure that I was not competent and signed off on just so the oncoming nurse doesn't have a hair across her butt. That also would more than likely not end well for the patient.
You did fine. Your magic wand can't do it all. But a job that requires 24 hour care can.
I would go one better with this oncoming nurse. This is a form of bullying. You are not inadequate. You did the best you could. Both this nurse and HER charge nurse need to be called out for this bullying. You don't need this hostile work environment. Sorry that it happened. But as a new nurse, you are still learning. She is lazy and trying to intimate you. Stand tall!
Specializes in Adult and Pediatric Vascular Access, Paramedic.
I could never understand why nurses and everyone else OBSESS about high BP! Yes it's high, is it going to kill him right now NO it isn't. What do you think it's doing to the patient when you are in taking his BP every 10 minutes, it's making him nervous and worry, add that in with being in pain and nervous and stressed about being in a hospital!
For god sakes people, STOP obsessing about high BP. Yes it may harm someone over a period of years, but right now it isn't going to kill them, but obsessing about it may!!!!
morte, LPN, LVN
7,015 Posts
the IV had been replaced, and the BP was addressed.