Did I handle this situation wrong?

Specialties Urology

Published

I have a little situation that happened yesterday and with me being a newbie I am not sure if I handled it right or not.

As a GVN who has not taken her boards yet, I cover for PCT's while they are at lunch, have patients that are assigned to me and am also being trained with the caths (take off is very easy as far as cath care by the way, but put on I am still nervous about) anyhow. Here is the scenario:

Lunch time coverage is taking place. I have 6 additional patients to cover plus the 2 that currently I am caring for. 7 of them were doing fine, no problems to mention, one I noticed he was sweating and started yawning, so I do a BP on him, (when he arrived it was 140/86) this was almost 2 hours into his Dialysis, his BP started dropping and was at 88/64, I asked him how he felt he said he felt fine, but new it was dropping, I laid him back and gave him a damp cloth, 5 minutes later it had dropped to 76/56, so I gave him 200cc's NS, the patients eyes started watering, but he really was not complaining, I wasn't for sure if he was being tough or felt like doo doo and couldn't muster up the energy to talk. Amongst all these 5 minute BP's, I am adjusting the cuff and making for sure I am getting a right reading. 5 more minutes later it had dropped to 66/44. I requested a Hypertonic from the Med Nurse, who was on the floor, his response was "he is not my patient, I have another hypertonic to give, plus Immodium to one patient and another Med to give to another patient." I am thinking OK, maybe he will give the Hypertonic and be over here after that. 10 Minutes later the pt's BP was down to 55/35, Charge Nurse was gone to lunch and Med Nurse still had not come over there. The whole time I am documenting my 5 and 10, minute BP's, pt's symptoms, request for Hypertonic yada yada. This is where hell breaks loose, Correct me if I was wrong. I documented with the 55/35 "Hypertonic was pending Med Nurse Arrival".

I never left the pt's side, I stayed with him and finally a tech came by and I asked her to get either the charge or the Med Nurse now, she got the Med Nurse and he walked up with a pissed off look on his face and I showed him my VS on the Screen, informed him once again of everything I did. I told him, I needed to go and check on my 7 other pt's and I would return. Done, I thought, oh heck no, I got jumped by the PCT who was/is my preceptor (mind you these both are of an International origin and they do stick together, they also speak in their language on the floor while caring for patients who do not speak their language) anyhoo. She told me that I was documenting wrong BP's and why would I Take BP's every minute and document I was taking them every 5 mintues, she felt like I was trying to get the nurse in trouble and we don't document like this, we cover for our Nurses. I told her that as a GVN, I have a legal obligation to document what I do and the time that I do it, she told me know I don't. She told me that I should never, ever of wrote that and that I was wrong for doing it, I then got the rath from the Med Nurse, stating that if I had looked at his previous BP's I would have noticed that he came in with a low BP. He told me that the PCT who was taking care of this patient falsified BP's on Paper but if I had looked at the machine, I would have realized that. NOT because what he was looking at was the BP's that the Monitor was showing, he didn't scroll up and so I told him that if he would scroll up on the screen he would see that the patients original BP was what the PCT had documented. He told me I was trying to make him look like a bad nurse and I promptly replied, "you know what, I am not here for your license, I am here for mine and for these patients and if you don't like that, you know where you can put it."

So now that I have had time to breath and reflect, did I do something wrong here, should I not have documented what I did?

Before I give you my Charges response to all of this, I want to here what everyone has to say. I don't want to sway anyone. I want a God's honest truth.

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Specializes in RN, BSN, CHDN.

I cant believe what i am reading, in fact I had to read it twice. MMM I wonder what the trained nurse would have done if the patient had arrested, that would have stopped her in her tracks. Is it normal to have one person looking after so many on dialysis? even during a lunch break. I really do not know what to say except I read many horrendous stories on here and your's is one of them. Sorry i am not much help but you have done nothing wrong

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Specializes in RN, BSN, CHDN.

Ps what does PCT stand for

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Ps what does PCT stand for

At my hospital it is Patient Care Tech

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Ps what does PCT stand for

yup, that is what it stands for. It has taken the place of what is otherwise know as a CNA which is a Certified Nurses Aide.

Waiting to here more comments.

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Specializes in Geriatrics, Cardiac, ICU.

I'm not a nurse yet, but as far as I can tell you were just doing your job and the others were being lazy. You are there to take care of the patients. Did the gentleman ever get any care? Is he ok?

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I'm not a nurse yet, but as far as I can tell you were just doing your job and the others were being lazy. You are there to take care of the patients. Did the gentleman ever get any care? Is he ok?

Yes we were able to get his BP up after being given the hypertonic. As we all know, BP's do drop during Dialysis but when we have the meens to get them back up, we should not make these pt's wait. They feel like crap, the cramp and can crash FAST.

My thinking about this nurse is, I sure hope to heck that he doesn't end up working in a hospital someday and one of my family members work on his floor. Becuase if they need something stat and they are not his patient they will not get it. :angryfire

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I wish you worked with me! Everything you did was MORALLY and LEGALLY CORRECT! Do not EVER let another nurse or tech tell you to FALSE DOCUMENT! EVER!

If they are doing that... their jobs should be gone. If a patient with a chronically low bp is in your clinic... YOU GET DR ORDERS THAT it is OK! I have a gal who has a written MD order that a 70 systolic standing is OK to leave.

Actually, I just went thru a situation today about my admin. wanting me to work Monday with just me and 1 tech.. 12 patients. I told her NO WAY! No reuse, no water person, just 2 people there.. PERIOD!NO WAY!

Hugs... keep up the GREAT work! Your patients are VERY lucky to have you! (7 years this December as a dialysis carge nurse!)

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I wish you worked with me! Everything you did was MORALLY and LEGALLY CORRECT! Do not EVER let another nurse or tech tell you to FALSE DOCUMENT! EVER!

If they are doing that... their jobs should be gone. If a patient with a chronically low bp is in your clinic... YOU GET DR ORDERS THAT it is OK! I have a gal who has a written MD order that a 70 systolic standing is OK to leave.

Actually, I just went thru a situation today about my admin. wanting me to work Monday with just me and 1 tech.. 12 patients. I told her NO WAY! No reuse, no water person, just 2 people there.. PERIOD!NO WAY!

Hugs... keep up the GREAT work! Your patients are VERY lucky to have you! (7 years this December as a dialysis carge nurse!)

Thank you so much for your very kind words. This is exactly what my Charge told me. He told me everything I did was right and to not ever let anyone sway my better judgement.

I love Dialysis and I love the patients, this has really shook me up though.

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You are a good nurse and will be throughout your career. Do not let those who do not care about patients sway you or influence you. They should be reported. keep your documentation of what happens in your unit in case something happens you have who said what to whno. I was told to keep a journal when I am told different things from different staff whoa re teaching me. Your own personal journal for your protection. Keep up the good work and get those others out of patient contact. They are putting patients in danger

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Good for the charge nurse for covering you! It could have potentially been very nasty for you.

Absolutely the med nurse was in the wrong. The patient could have coded on her and what then? Would she have continued giving the Lomotil or Imodium or whatever NONEMERGENCY drug she was giving rather than take care of a crashing patient?

Hey - just think. Soon you'll pass your boards and YOU can run and grab that hypertonic yourself.

As for the documentation - you CYA'd. You didn't do it in an accusatory or unprofessional manner, you simply documented the situation. If something happened to the patient and you got pulled into court, you're covered. The med nurse is screwed. Nurses should cover for each other and help each other out, this is true - meaning simply that they shouldn't hang each other out to dry but NOT by falsifying anything. That med nurse left you - and the patient - out to dry. She apparently doesn't know how to prioritize care. I hope an incident report was written because that nurse needs to be dealt with either with a corrective action or with education or both.

And it sounds like you have a great (thinking) charge nurse. That will carry you a long way.

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Specializes in Hemodialysis, Home Health.
Thank you so much for your very kind words. This is exactly what my Charge told me. He told me everything I did was right and to not ever let anyone sway my better judgement.

I love Dialysis and I love the patients, this has really shook me up though.

WOW. I, too, am shocked.

If this patient had a reasonable BP to begin with and began dropping, you did the right things by documenting, giving a NS bolus of 200 ml, and continuing to recheck and redocument. All those things were perfectly correct.

Personally, I would have also dropped the patient's goal by 500 if the above did not help bring his pressure up, and you were having a hard time getting the hypertonic you needed. Or, give another 200 ml NS... and then another...whatever it takes. We cannot allow the BP to just CONTINUE to drop.

I think there is a major attitude problem where you work, and it is an unhealthy one for both staff and patients.

While our unit gets hectic and crazy, too, I can at least be grateful that we ALL work as a team... nurses and techs alike. We cover each other's patients look out for what our colleagues might need in the way of assistance. This would have been unheard of at my unit.

The med nurse was way out of line in that situation. Anytime a patient starts crashing, it is time to ACT. The other meds could have waited until this was dealt with. Shame on the med nurse !

Are you not allowed to give meds yet? If you are, I'd have certainly begun drawing up that hypertonic rather than wating on him/her !

Just keep giving a slow NS bolus in the future, or drop the goal in increments of 500 until that patient's BP comes back up.

Never EVER falsify ANYTHING.

You did well. Stand tall. Continue to provide the competent care your patients deserve. :icon_hug:

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