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.
where I worked a code blue is when your patient has stopped breathing, a rapid response usually is when the patient's vitals or anything alarming but short of not breathing is going on. Yet some places may call the rapid response instead of using code blue (sounds better overhead announcements) I guess ??
You were absolutely correct calling the team! That's why we have a rapid response team or whatever your hospital calls it. I don't know about you, but my number 1 priority, is the patient! They should be telling you what a good job you did. I'm sorry you were treated poorly.
I'm curious: For the people working on the wards, what's the difference between a code blue and a rapid response?
Code blue- cardiac arrest. CPR needed. Pulse less
Rapid response - not doing well. Someone is concerned. Needs urgent intervention and maybe a move to ICU. Called to prevent a code blue.
Realistically, they are paged out the same way and bring the same group of people who document on them the same way. They're different in name only, essentially. On night shift every inpatient unit is supposed to send one RN to a code blue, but not a rapid response. We have plenty of "code blues" that should be rapid responses and the occasional rapid response that quickly turns into a code blue. And we have a handful of nosey adrenaline seeking nurses and aids who will show up at the rapid responses- where they're really not welcome.
I would stop letting it "eat me up." It sounds like you did everything you were supposed to do, followed protocol, and used your nursing judgement. I would make sure you write down everything you have stated here, and go into the meeting confidently, not on the defensive. Just because a physician makes the final determination does not mean your assessment and judgement were incorrect at that moment. Plus, you have the ICU/Charge Nurse who assessed and documented similar findings.
Stay calm, breathe deeply, and go in confidence! Keep us posted and I WILL be praying for you.
That's terrible! I've been there done that.... I've learned over time that it was worth changing jobs a few times to find a manager that will back her nurses. I literally almost left nursing over how We were being treated... all of us in that unit were so miserable. I can say now that I am glad I didn't leave, and it just takes time to find the right place.... bottom line is your patient got what they needed. And I don't know what kind of idiot would ever say that gray color, AMS, with a symptomatic arrhythmia is stable. Good gravy. I highly recommend taking ACLS if you haven't already... it helped me to gain confidence in my decision making skills. Shame on your unit for not educating and supporting the nurses to call rapid response first- it better than letting the patient deteriorate because the doctor isn't calling back. Enjoy your glass of wine, and then dust yourself off- remember why you became a nurse! Hugs!
I am a nursing student and was wondering if you could explain the glucose. It is my understanding that a glucose of 123 is not critical-in fact it is fairly normal for a diabetic, correct? If that's the case, what would have caused the blood sugar to have been the issue? Your post said insulin was not given, so the bg would not have dropped. What was the purpose of rechecking the sugar? Thank you for any answers given!
I am a nursing student and was wondering if you could explain the glucose. It is my understanding that a glucose of 123 is not critical-in fact it is fairly normal for a diabetic correct? If that's the case, what would have caused the blood sugar to have been the issue? Thank you for any answers given!
Any decreased LOC is an appropriate time to check a bed side blood glucose. The number "123" was simply given to indicate that it was not what was causing the issue.
At my hospital, the ICU nurses lead the rapid response teams and the doctors may or may not show up. We are able to order tests, imaging, give certain medications under protocols, and transfer / admit to ICU. Even if the patient doesn't quite need it we will stick around and reassure the floor nurse what to look for and what to do if the patient suddenly changes. At my hospital nurses actually get in a lot of trouble for NOT calling a rapid response. Had a physician recently decide to intubate on the floor before transferring to ICU, he got in a lot of trouble for not calling us and allowing us to assist in what we do best.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
I am a nursing student and was wondering if you could explain the glucose. It is my understanding that a glucose of 123 is not critical-in fact it is fairly normal for a diabetic, correct? If that's the case, what would have caused the blood sugar to have been the issue? Your post said insulin was not given, so the bg would not have dropped. What was the purpose of rechecking the sugar? Thank you for any answers given!
It would not have been inappropriate to have checked the glucose, just to make sure it wasn't causing the issue. However, in this case I think it was trotted out mainly to second-guess the nurse.
Is it possible for the bg to have gotten so critical in 2 hours? I'm just trying to understand the reasoning for taking the extra 5 minutes to check it knowing the information from the 6:00am check. Thanks
Is it possible for the bg to have gotten so critical in 2 hours? I'm just trying to understand the reasoning for taking the extra 5 minutes to check it knowing the information from the 6:00am check. Thanks
It wouldn't take 5 minutes to check a blood sugar. That's something that the CNAs do at my facility, so at my place it would have been delegated. The CNAs on my unit will automatically take a blood sugar if there is a mental status change or s/s of hypo/hyperglycemia. I didn't even have to ask when I had to call a RR on an unresponsive patient in May. In my facility a blood glucose of 123 doesn't typically warrant insulin, typically with sliding scale insulin anything less than 150 means no insulin (unless it's the extremely high coverage scale).
OP- Have these mangers not seen Josie's Story? If something had happened and you hadn't called the CAT you would have been called out for failure to rescue. I would have called a rapid and it sounds like CAT is what your facility uses. This sounds like a place where you are damned if you do and damned if you don't. I agree with what others are saying- get out!
So, to me, the bottom line is, you asked your charge nurse, she told you to call the CAT, you did as you were told. If you had not called the CAT it frankly would have been insubordination on your part at that point. You are getting flack from supervisors that don't know how to stick up for their nurses when it comes to bratty residents. Sounds like the resident complained and they are scared of him for whatever reason.
I had an ER doc write an email to my director once regarding both me and another home care nurse. We had, at two separate times, advised one of our home care patients to go to the ER for COPD exacerbation. Apparently in each scenario with different family members we were asked by them what could be done for the patient there that could not be done in the home at that very moment, to which we replied "breathing treatments and IV steroids". The doctor was mad that we mentioned IV steroids saying we "telling him what to do" I guess because the family asked about it once they came in to the ER (never mind that both times he ordered both IV steroids and breathing treatments). My director basically told him to go pound sand though she did share the emails with us, wanting us to know they had occurred but that we had done nothing wrong. These people should have listened to the doctors complaint, said, "Of sure, we will deal with her" and then privately supported you for caring for the patient properly.
midgeypoo, LPN
26 Posts
where I worked a code blue is when your patient has stopped breathing, a rapid response usually is when the patient's vitals or anything alarming but short of not breathing is going on. Yet some places may call the rapid response instead of using code blue (sounds better overhead announcements) I guess ??