I've been a member of this board for a long long time. Some background on me: 6.5 years of nursing, started as a CNA, worked as an LPN and now I'm an RN on a Med/Surg floor for the past 1.5 years.
Last week, I had a patient who was on remote tele and was an older gal with various co-morbidities including obesity, diabetes, CAD and recent CVA with minimal residuals. I had this lady for a total of 5 days and my doctor assigned to her was a internal medicine resident who doesn't have the best reputation.
The first day I get this patient, her pulse is in the 30 to 40 range, the tele is picking up 3 to 5 second bouts of asystole and her BP is 200ish/90 ish. The patient is lethargic and gray, and is very difficult to wake up.
I immediately page the doctor. No response for about 15 minutes. Meanwhile I have my CNA and myself in the room doing vitals, trying to wake up the patient, ect. I page the MD again and calls me, says he's aware of the situation and plans to make rounds on her in about 30 minutes or so. I tell him I feel he needs to be here sooner than that, he blows me off and says he will come when he's doing rounds. I page my charge nurse, tell her the situation, and she tells me to call the CAT. Which is Cricical Assessment Team Nurse, or the charge nurse up in ICU. The CAT nurse comes down, assesses my patient and agrees that the patient should be up in ICU on a drip. He pages the doctor. He gets no response.
2 HOURS LATER the doctor finally shows up, declares the patient to be fine, her BP is now around 160/80 and she is much more awake and looks to be in better color. He orders an oral BP medication and consults with cardiology, and the patient ends up getting a pacemaker. Meanwhile he and his attending physician scold me on the floor, and insinuate I don't know how to properly take vital signs. Apparently my charge nurse or the ICU nurse don't know how to take a blood pressure either.
Yesterday I get a call from my Clinical Coordinator that I need to have a meeting with her and the Unit Manager, and that its "Going to take too long to pull me off the floor so we need you to come in on your day off."
Nurses, did I do something wrong here? Did I rush things, or am I justified in initiating a CAT response? Thanks for the replies, this has been eating me up.
Speaking as a rapid response nurse you did the right thing. Repeat: YOU DID THE RIGHT THING!! Your manager was wrong. Do not ever be afraid to call a rapid response or a CAT if you feel your patient needs it. Rapid Response nurses want to be called, and not needed rather than needed and not called.
This sucks because just yesterday I got the Daisy Award and I was being paraded around like I was an example to nurses everywhere, and today I'm dog ****.
I stand by my prior assertion that those things are CURSED. Has anyone ever received one and not been fired almost immediately afterwards???
In any case, I am sorry for the outcome of your meeting. It sounds like you were treated very unfairly.
Wow. From your description, the patient was unstable with a symptomatic arrhythmia that could have progressed to cardiac arrest. A rapid response was appropriate. The cardiologist ended up putting a pacemaker in.
It's probaly because you didn't respond fast enough. That should have been a code response IMMEDIATELY. I'm an RT, so not really sure how you all do it on the RN side, but if I go into assess a patient who's bradycardic (especially to the 30s) and not responding, I'm pulling the code alarm.
IF they tell you that you are wrong for calling the CAT, I would stand up and politely tell them that you will work where they don't advocate killing people, hand them your badge and leave.
So I got done with the meeting and I left in tears. It was a laundry list of things I should have done. I didn't check a blood sugar. This event happened at 8ish in the morning and the last BG check on the patient was at 6, which was 123 and there was no insulin given.
Also I apparently told the CAT nurse that the patient needed IV push medications and to be on a drip up in the ICU. I did no such thing as I have zero experience with these meds. I also got told I over reacted, as both the nurse before me and the doctor thought the patient was stable.
Anyway, it was a good old fashioned ass chewing and I'm sitting here drinking wine and questioning my entire career choice. Yay Nursing!
Some days I very much regret taking out so much student debt to get so much abuse. This sucks because just yesterday I got the Daisy Award and I was being paraded around like I was an example to nurses everywhere, and today I'm dog ****.
Sorry for the pity party guys.
Just read this. You need to quit, that place is unsafe. It's incredibly easy to find a job as a nurse in most states. I would resign and go somewhere else. Just my 2 cents.
It's completely inappropriate to question the nurse who was at the Bessie's decision to call a rapid response. Who cares what the physician or the previous nurse says? They weren't there. Clearly it was decided that this patient did need cardiac intervention if they went on to get a pacemaker. This place has a dangerous culture if this is how things are done. Our rapid responses are always taken seriously, and I've been to many for patients far more stable than that.
If you are part of a union, notify your union rep. The only thing that I might have done differently is outright either called RRT or hit the Code button.
**in my best "mom" and best "ICU RN" voice** You did the right thing. You are not dog ****, you are a consciensous RN who recognized a change in condition and intervened for your pt.
Apparently cards agreed intervention was needed, if they decided she needed an invasive medical device to keep this from happening again. She could very well have been stable for the prior RN (or prior RN could have had her head in the same place the resident and manager did)...but giving her the benefit of the doubt, the pt could have been stable. When you arrived for your assessment however, she was having a symptomatic bradyarrhythmia -- which in the ACLS world means give IV/IO drugs and seek an expert opinion. In this case, cards.
I agree, you should start looking for a new job -- one that encourages evidence-based intervention and actually cares about their patients.
One last thing: enter the meeting time on your timesheet. You went in on your day off, you must be paid for it. Hugs!
I completely agree with the posts that say you did nothing wrong. In my opinion, you did exactly what you are trained to do. Feel good about your choice regarding this patient. And follow the advice of the others who have told you to leave such an unsafe and unsupportive environment.
Congratulations on the Daisy award. You did the right thing.
SierraMoon, ADN, BSN, RN
215 Posts
Yeah, it's time to bounce. Even if the patient was stable, there's no need to beat you up about calling a rapid response. It's so counterproductive.