Communicating with MRP

[nursinghealth]

Hello:

I'm a new nurse. Two weeks into my first job out of nursing school. I'm on a surgical unit.

I remember hearing that nursing school teaches you what you need to know, but you only learn how to actually be a nurse by working on the floor. I can attest to that!

I am finding it difficult to tease out when / how often to contact the MD. For example - my post-hemocolectomy patient was bleeding large amounts of blood from her rectum. I told the MD when it happened and he ordered a CBC and maintenance fluids. Labwork was done and her Hgb dropped from 123 to 79 in about 24 hrs. She bled a few more times the next day and was eventually given a blood transfusion.

I understand that the MD must be notified if there is a change in the patient's condition. I did that as soon as I learned of the incident. My question is: do I continue to notify the MD if there is a repeat occurrence of the same thing? He seemed really frustrated when I called the second time, and though I can handle myself because I have a thick skin, I wonder if I am calling too much? Is it safe to say that he knows she's bleeding because I told him once? I don't think so because it doesn't reflect the amount of blood loss, but surely he doesn't need to know every time?

My thoughts are that I should ask the MD for parameters regarding when HE/SHE wants to be notified. In absence of that, any other suggestions?

I've very new and very green. Please be gentle!

[Sour Lemon]

I understand that the MD must be notified if there is a change in the patient's condition. I did that as soon as I learned of the incident. My question is: do I continue to notify the MD if there is a repeat occurrence of the same thing? He seemed really frustrated when I called the second time, and though I can handle myself because I have a thick skin, I wonder if I am calling too much? Is it safe to say that he knows she's bleeding because I told him once? I don't think so because it doesn't reflect the amount of blood loss, but surely he doesn't need to know every time?

How much time passed between calls? What new orders did you anticipate? Was a CBC ordered post-transfusion? Was the patient symptomatic in any other way? What time of day/night was the call placed and when does the physician typically round?

Those are a few things I would consider when deciding whether or not to call.

[nursinghealth]

Thank you for your response.

I communicated the bleed to the MRP when it first occurred and he ordered a CBC. I communicated each subsequent bleed to the Charge Nurse. There were a total of 4 bleeds that day of large amounts of frank blood from her rectum. The patient was hypotensive (96/57), however otherwise asymptomatic (pt denied dizziness, skin was warm, no pallor or diaphoresis noted). Her normal BP averages 100/70. Her post-op hgb was 123. The subsequent CBC that day was 94.

I received the same pt the next day. Hgb was now 79. Vitals were the same, still asymptomatic. She had another large bleed from her rectum. I informed the MRP again. He seemed frustrated with me, however he ordered another CBC scheduled a few hours in advance. The pt bled out again. I wanted to inform the MRP again - her HGB was now 79 and I was worried another bleed would send her lower, but I got the feeling that he didn't want to hear it. That he knew she was bleeding already and he didn't think it was necessary that I advised him each time. But I think it was necessary because she continued to bleed when her hgb was already 79.

I advised the Charge Nurse to cover my butt, but I did not inform the MRP as he seemed to not want to hear it. However, I noticed an hour later that he finally ordered a STAT blood transfusion to be followed by a CBC.

My question is... should I have informed the MRP of the subsequent bleed? Nursing care itself is easy - insert a foley, remove a staple, etc. It's the dynamics of interprofessional communication that stump me. I don't think I'm right. As a new nurse, I have a lot to learn. But I don't want to risk my patients' safety at the same time.

I recognize that this is a grey area that is highly dependent on context, so there is no "right answer". But I would love to hear how someone else would have handled it.

Thanks!

[nursinghealth]

I think I may just be overthinking. #newnurseproblems