Did I do the wrong thing? Advice needed. (Long)

Nurses General Nursing

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Hi all. I'm a new grad, and have been working on a medical oncology floor for about a month now. Our floor gets anyone who has a medical issue, as long as they were diagnosed with cancer at one point or another in their past.

Recently I was on a night shift. The hospital I'm at does obs at about 8pm, then policy is not to do any more until 6am. I have some reservations about this, because a lot of these people are not all that well, and I would like to know about any potential problems more than an hour before I am due to go home.

That said, I took obs on one guy. Old, about 78, hx lung cancer, admitted with SOB. O2 @ 2L via NPs. Obs at 8pm fine, no problems. He slept well all night, observed to be settled on all rounds, O2 in situ.

By 6am, his heart rate was 161 and his BP was 98/64. He had a low BP historically, but this was a little bit lower than usual. I knew he had a history of AF, and was on digoxin. He didn't feel dizzy, sick, hot, cold or anything unusual; in fact, he felt fine and wanted to stand up for a shower. I asked him not to stand up until I came back. Because I am new and still quite unsure about my judgement skills, I checked with my mentor. She basically said "If you think he's OK, then he is, it's not unusual for AF pts to have HRs that high". She' an awesome nurse, she knows EVERYTHING (or so it seems!). Fair enough, thought I.

I found out today that the oncoming shift decided to make a MET call (rapid response team/Medical Emergency Team) call on him. The team just gave him some MgSO4 and trundled off again, so he was fine.

But... and here's the point... do you think I should have called a MET myself? Our criteria say you can call a MET for a pulse >140. I didn't feel it was warranted. Did I miss a GIANT red flag? Could this guy have died if the next shift didn't make the call? I'm looking up stuff about AF now to see if I can find some info about appropriate management, but I want your opinions, too.

Thanks.

Specializes in Med onc, med, surg, now in ICU!.

Thanks, everyone. I had come to the conclusion that I did make a mistake not calling the rapid response team after I did some research, but I really appreciate your input and experience. Next time I see something funny I will definitely call the docs - I'd rather look stupid for worrying too much than too little.

In answer to some questions, I am only 5 weeks into my new grad year. I am 'off orientation' officially; I got three WHOLE days as official orientation, but I am part of a new grad program whereby everyone knows I am a new grad and so are willing to help out if I have problems, questions or skills I am not allowed to perform without accreditation from the facility (inserting IVs, doing PICC dressings, accessing or de-accessing portacaths etc - I'm in Australia, we do things a little bit differently to you guys. I think you have a better system in many ways for training nurses.) I do take my own patient load, and that night I had eight. I did verify those obs (errr..... vitals? Is that what you call them?) manually, because my BP machine is dodgy at the best of times, and I know that our pulse oximeter doesn't handle odd rhythms well.

I am trying not to beat myself up; what happened, happened, and I (and my patient!) was lucky that nothing serious went wrong. I feel stupid, in retrospect, that I even had to ask about this. I am DEFINITELY learning from my mistake. Anyone whose heart rate is unusual to me will be getting at least a call to their doctor.

Thanks for being so supportive to me, everyone. I am so glad there's a place I can come to ask experienced nurses questions like this without fear of embarrassment!

Specializes in pediatrics.

It's a tough call and made even tougher by the fact that your mentor wasn't very helpful. I precept all the new night shift nurses that work on my unit and the first thing I tell them is don't be afraid to ask questions!! You did the right thing asking your mentor, but did she even assess this man? So she said that if you think he's ok,then he's ok? If you thought he was ok, would you have asked her in the first place? Probably not. She should have at least taken a look at him.

So does obs means that you check your patients at 8pm and don't check them again until 6am? Wow. That's a long time for something to go wrong. I'd have reservations about that as well....

Specializes in Med-Surg, Wound Care.
And what does "obs" mean? Observation? Obstetricians?

I was going to ask the same thing! Not an abbreviation I've ever heard of.

Specializes in Case Management.

If their "obs" is the same as our "obs" some hospitals have observation rates in their contracts, where a pt has had op surgery and stayed overnight, the hospital does not bill for a full admit. It used to be called "short stay".

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