Bad situation and mad coworker? What could I have done?

[missind33]

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.

[TheCommuter, BSN, RN]

Your coworker is in for a rude awakening if these things get her that upset. You did your job and when her shift started it was time for her to do hers.

I wonder how long the OP's mad coworker has been a nurse. If she's not a newer nurse and has a significant number of years of nursing experience, this overreaction might be a reflection of a difficult personality.

[LainieATL]

I would approach her and thank her for giving you feedback. Then ask her how she would have handled it because you are learning.

[KelliBSN2006]

A lion never looses sleep over what a sheep thinks.., just do your job. That's it.

[Maevish, ASN, RN]

Some people are just rotten no matter what. You did everything you could and she should know that, some nights, you are with one patient more than the others. Sh*t happens! I'd be upset that I was crazy busy, but not upset with YOU. lol Personally I was surprised that nurses insert Dobhoffs at your hospital cause I've always been told that was something the doctor had to do (or someone with extra training).

She wasn't right to send you an email like that and, if she was that upset, she should have mentioned something to you face to face. Your charge nurse also should have passed on that that was a (rather large) issue through your shift as well.

xo

[Nurse SMS, MSN, RN]

I hate "it only takes 5 minutes". Pretty much EVERYTHING we do takes only 5 minutes. All those "little" 5 minutes add up to a whole lot of time. If it "only takes 5 minutes" then it should not be a big deal to get passed to the next shift.

[NursesRmofun, ASN, RN]

I wonder how long the OP's mad coworker has been a nurse. If she's not a newer nurse and has a significant number of years of nursing experience, this overreaction might be a reflection of a difficult personality.

I had one that was a new nurse, but around the 1 yr experience mark. along with her education, she thought she was a true "know it all" and absolutely hated anything left over.

[MassED, BSN, RN]

Some coworkers are just jerks. You do the best you can, but it is a 24/7 operation and sometimes your messy pt becomes the next nurses messy pt. We hand off. We may not like it, but we hand off and go home. We will be in that situation again, it's just life. You document what you have done, document what the docs have done or what you're attempting to do. Let them *****. It makes them look bad. Try not to get too mad. This is nursing after all.

[ClaraRedheart, BSN, RN]

Unfortunately you can't magically make the blood pressure resolve. It sounds like you, and previous shifts, had tried all that you could. As far as the dobhoff, stuff happens. I absolutely HATE leaving stuff like that to the next shift, and I'm not too happy when I come onto a shift with that, but it is what it is. You can't expect the previous shift to stay over 12 hours to take care of it. That just sucks. I try to treat others how I would like to be treated and I find that my co-workers are generally kind to me in return. If I am not back the next day, and I know I'm leaving a rough group with a mess to a poor nurse, I'll ask the charge nurse or supervisor if I can stay or help with specific things after my shift, such as starting a difficult IV, setting up a patient that just arrived to the floor when the night nurse is getting another back to back etc. Usually, they're ok with that. I feel bad, but if I'm back the next day, I've got to get out and get some sleep so I can care for my patient's the next day.

[ruotingw]

I don't think that there is anything else that you could have done. As long as you charged that you have talked to the physicians multiple times and if any new orders were given you should be fine. I am a new nurse too and if I were you I would go to charge nurse too if an issue remains unsolved. I might stay for a bit longer to help the next shift nurse to put the dobhoff in but it is totally up to you. I don't see a better scenario than this that could have happened.

[PrimeRib]

Oh man, don't you just hate nurses like this? I didn't read the replies before me, so I'm sure this was already mentioned, but the cliche is true, nursing is a 24-hr job.

Of course we all would like to have everything wrapped up in a nice little package by the time the next shift comes on, but this just isn't always feasible. Things do happen right at shift change, and quite often. The patient goes into a-fib, blood pressures suddenly way higher or softer than they've ever been before, "panic attacks", huge code brown, foley/NG/IV/Chest tube/whatever gets pulled out. It sucks, but these things do happen 10 minutes before shift change.

My advice - continue to do your best work, keep the physician team in the loop about any major changes throughout the shift so nothing comes as a surprise when the next shift has to call them, get your meds passed, keep your patients clean and your rooms neat and organized (this for the sanity of the oncoming nurse, nothing is worse than walking in at the beginning of your shift to find a patient all kitty-wompus in bed, full of poop). When these things do happen around shift change, stay to help with what you can, i.e. stick around to turn the patient/help clean up the code brown, call the physician team to update them about any major changes/continued VS out of wack towards the change of shift - it's easier for your to stay a couple minutes late to talk to a doctor about an ongoing issue than for a nurse who doesn't know the patient to have to do that, and it sets them up for success, at least you've got a plan in place.

As far as dealing with the attitudes, brush it off. Do take into consideration things you could have done to improve your work, but absolutely do not apologize for things you cannot control. The night charge nurse was "mad" that the patient's blood pressure was high all day? Boo hoo. Sounds like you kept the MD team up to date and were fairly diligent with the prns, I would say you did what you could. Make sure you're cycling BP readings often enough (every few minutes if they're that labile) and document, document, document accordingly, and update the team frequently if you need to, move up the chain of command (to fellows/attendings) if you're dealing with residents and not getting the results you need. Oh, and ask for advice/help from co-workers, especially the experienced ones, which it sounds like you were doing.

With the nurse who emailed you, I'd confront her personally (in a nice way), extend your condolences that they had a rough shift, perhaps ask what she feels you should have done differently (you are still learning, after all, and you did your best), make a mental note (does this nurse have a valid point, or are they just being dramatic?), learn from it, and move on. Some nurses can be the worst people to work with and you just learn how to deal with these attitudes after a while. To be fair, I would have a very difficult time with not asking this person, in a passive-aggressive manner, why they felt that emailing you was a good idea vs. just mentioning it to you in person. People are so strange...

[ggrn29]

Offer to tackle the IV & NG together after report

[evolvingrn, BSN, RN]

I hate "it only takes 5 minutes". Pretty much EVERYTHING we do takes only 5 minutes. All those "little" 5 minutes add up to a whole lot of time. If it "only takes 5 minutes" then it should not be a big deal to get passed to the next shift.

There is a lot that has to be done at the start of a shift. If it can be done by the leaving shift....... It should be.......... If it can't ....no biggie..... But let's not act like we all wouldn't roll our eyes if we got left with this pt....