continuity of care

[Tele_Nurse4u]

so..i am a newer nurse and am maybe still 'in the clouds with nursing' but, here is my dilema:

i work midnights and during the night a normally oriented and alert 92 yr old man became very confused and combative. now, i admitted this man and was his nurse for the next 12 hrs, so i know this WAS NOT HIS NORMAL behavior. the only thing i could think was that he had gotten an ambien and it made him goofy. so i did everything...called the daughter to come sit with him let the doc know...etc...

he was scared (due to his confusion) and obviously upset when staff came in. whenever this happened he got all riled up again. SO...it was my idea to try to limit the number of visits in the room if possible. normally on our unit the tech does vitals, nurse does as't, then breakfast comes, the meds passed....

well, i mentioned to the day nurse that we should really try to do 'cluster care' as he got obviously upset when staff kept entering...(at least until he was completely oriented again). She acted like it was an absurd idea!:angryfire She then proceeded to TELL me AT THE NURSES station how stupid of an idea it was and how i had put her 'in a difficult position' and would make her 'look like a liar' if she had to keep gping in there. I said 'i know you are busy, i used to work days. but i think it is better for the patient if you could just take vitals and give meds while you are in there doing your ast.' well, she just kept going on and on. SHe said 'just give him some ativan.' The MD had said unless he remained extremely combative not to give it to him d/t his age. he didnt wanna 'knock him out.' well, this just infuriated her even more. Honestly, i didnt really feel comfortable giving ativan to a 92yr old man, so i didnt.

so...after this long drawn out story

what would you have said? was this NOT a good idea? he WAS coming down and within a few hrs probably wouldnt remember anything and be completely 'with it'.

is continuity of care such a hard thing to do?? i know it is busy...but what happened to the betterment of the patient??????

thanks everyone

[oramar]

Sorry you had to deal with a person that gave you an attitude. Sounds like a very good idea to me.

[whipping girl in 07, RN]

Maybe it's my background of ICU, but I've always tried to cluster my care. Even more so for a confused and/or agitated patient. And when worked the floor I had to, as I couldn't get all those 9pm meds given on time if I didn't pass them as I was doing my initial assessment.

The nurse could have always listened to what you said and then not did it, but she didn't have to berate you about it. That was just b*tchy.

[leslie :-D]

it sounds like poor judgment from the day nurse...

giving an ativan to an elderly pt who had a paradoxical reaction to the ambien, is probably not very smart.

and common sense and courtesy, would dictate clustering care to an agitated, confused pt.

sorry she was being so short-sighted and obstinate.

everything you did, was right on the mark.

leslie