Did I get "too excited" too soon?

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I'm a new nurse orienting for my 2nd job--casual night shift in a nursing home. Last night about 5am, when I tried to wake up a resident for her morning pills, I found her drowsier than the night before. She does respond briefly to sternal rub, but she barely could take her pills. I went to get the Ox machine and her O2 sat was 85%. This is not usual for her, she usually rans mid 90s, and she usually wake up and take her pills with no problem. I told my preceptor that her Ox was 85%, first she said the Ox machine is not acurate. When another machine shows 86%, she said "oh, see, she is getting better, and it is normal for her. You never get away from your med pass for something like this". I disagreed with her. We put the breathing treatment on her and at first I request to leave the Ox machine in the room so we can monitor her, my preceptor said we are not allowed for infection control purposes. Then when I was going to recheck her after five minutes, she stopped me and basically I have to argue with her to go and check my resident again. My preceptor said " You shouldn't get too excited over this fake emergency!"

I just want everyone's opinion on what had happened. Why it's such a big deal to take one second to check Ox of the pt?

One week ago when a resident c/o dry heave, a nurse brushed her off by saying " she's just playing tricks so she doesn't need to eat in the dinning room", "she ate all her lunch in her room", I shadowed her all day, I didn't recall where she got that information from. I was orienting with her and I didn't find time to go and assess that pt. The pt passed away 4am same day. I blamed myself and wished that i could go assessing her, maybe I can do something. My lesson is you don't trust anyone unless you assessed the pt.

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Specializes in Progressive, Intermediate Care, and Stepdown.

I would say go with your gut instincts. Your intuition. If you feel you need to assess your patient more often, say q2h VS as opposed to q4h, do it. Maybe your preceptor has previous knowledge of this patient's condition or knows certain oxygenation issues or medical history you aren't aware of. Hence, why she said don't worry. But, again, if I were in your shoes, and felt that intuition or that gut feeling, assess more often. You are covering your butt. And, you making sure patients are staying safe. I've done extra assessments because of that intuition we develop and because of it, the patient had recovered quicker with quicker medical intervention. Good luck!

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Specializes in LTC and School Health.

Keep Covering your butt. That is my only advice. You did the right thing advocating for your pt.

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It takes 30 seconds to check someones oxygen level. I don't see the big deal. I say better safe than sorry. I'm pretty sure if the pt arrested and you went to court they would not think the med pass was more important than making sure your patient was getting enough oxygen. ABC's people.

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Specializes in hospice, HH, LTC, ER,OR.

Sounds like your preceptor is there for a check only.. Always go with your gut instinct. Yes the patient should have been monitored more closely and had an intervention

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Specializes in Trauma, Teaching.

I fail to see how leaving a machine in a room that it has already been taken into, is an infection control issue.

It doesn't matter if she has a history of this problem or not, her sats were below norm and needed to be addressed. Is she hiding pills and then taking them all at once? Is she stroking and you can't tell because of the meds sedating effects? What is the big deal about applying O2 as needed? You should definitely have a protocol covering you for this.

Sounds to me like the other nurse is not willing to interupt her "routine" way of getting everything done for everyone, at the expense of an individual. Not good in my book. Frankly, I'd have ignored her and gone in to check on the patient.

So, no, you did not get excited too soon. Maybe you didn't get excited enough.

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Specializes in OB (with a history of cardiac).

You never get away from your med pass for this....? Let us see how this would sound in my workplace: "Oh, I am so sorry Mr. Jones, your wife went into v-tach, then fib, then croaked...well, yes I saw it on the monitor, but I never get away from passing my patients meds for such fake runs of v-tach" (And we do get a LOT of false alarms, I'm telling you). Your preceptor is a....um...silly goose and I sure hope any patient in her care doesn't desat or have any flash pulmonary edema occur...because heaven forbid she divert from her med passes.

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thank you thank you everyone. I found out today that my preceptor was so cocky because she is some administrator's wife. Experience doesn't necessarily make a nurse a good nurse. Whoever she is, it's not about her, no one give a **** about her. It's all about the pt. I feel good about myself :)

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The"preceptor" sounds dangerous.

Learn to ignore her and do what needs to be done. An 85% sat is priority! Why is she allowing inaccurate equipment to stay in use?

You should label it as such and take it out of commission.

Your resident sounds like she may have had a little Co2 narcosis... did you try having her take a few fast deep breaths?

Keep up the good work!

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Specializes in Hospital Education Coordinator.

sounds like a bad nurse is "hiding" in a lesser supervised work environment. Stick to your instincts. It's your license

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You did the right thing. When I was a new nurse, I was jumpy over things like that as well. However, I remember one of my professors said that "always do what makes you sleep at night." Whenever I feel uneasy about something, I always get a second opinion from an experience nurse, then I go check it out myself so I can have a peace of mind.

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Specializes in Rehab, critical care.

You did the right thing, and your preceptor sounded like she was more concerned about getting out on time (i.e 5 am you mention) than caring about her patients. Either that, or she just doesn't know that an 85% sat combined with having a hard time waking the patient up is a priority. If your resident required a sternal rub to wake up, and she's normally great, she's your priority, and you assess all vitals, and quickly assess the situation. Could the AMS be d/t oxygenation issues? etc. Good for you to double check the sat machine, too, with another one. Keep up the good work!

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