what would you have done?(long)

[southernnursern8407]

Im just wondering how others would have handled this situation.

I work nights on a med-surg floor,have been a nurse for almost a year. I have 6 pts and my charge nurse has 6pts and we have one nurse aid(no techs or anybody else). I get out of report and immediately im very busy with two pts who had critical problems.however,I was able to assess all of my pts in a timely manner and get most of my meds passes to all pts on time,in the meantime the nurseaid had been getting vitals.Now normally I like to read the h/p on my pts but being that we were short handed and really busy,i just read over the last couple days of md orders/progress notes. So,2300 comes around and our nurse aid gets pulled to another floor.So,I now have to take 0000(which actually were more like 0100 vitals by the time i got a chance to do them),I went to take vitals on one pt who was post abd.surgery.It turns out her b/p is 180/100.I think this cant be,she has no history of htn and she isnt even on b/p meds or anything. So,i get a manual cuff and check it again..ok its really that high.I go to her chart and there in the h/p is hx of htn,mi,cad,etc.Now none of that had been told to me in report,but I should have read the h/p in the first place.I look at the graphic sheet of her b/p for the last 2wks..her b/p had been low 110/50 Until that day when it started out at 140/70 and continued to rise.The nurse aid from earlier had failed to tell me about the 2000 b/p being 167/?,but then again i should have looked for myself.Basically,the md had this pt npo because of her ng tube and he didnt continue any of her po bp meds(no bp meds ordered at all). I asked my charge nurse what to do,she said call the md.I paged the md,the md on call calls me back.I tell him" pt xyz had a b/p of 180/100,there is no med ordered for b/p,would you like to order something. he begins to yell and cuss me out,tells me that I should call other md(he was the admitting,attending,and primary md,there was one other md that had been consulted but hadnt seen the pt yet) he ends up giving me a now dose of something and hanging up on me.neway to make a looong story short,he comes up there the next day looking for me..talks to the house supervisor and my manager..about all the things I did wrong(mainly waking him up) he looks at the b/p graphic sheet and says look the b/p had been high all %&&*^* day! and I get called in the middle of the night!,he is still yelling and cussing...and the house supervisor sided with the md.,...ok sorry so long..what would you have done? thanks

[Sully, RN]

You did the best thing for the patient! I would have done the same thing. You did the best you could with the information that you had. It sucks getting yelled at when other people have dropped the ball and the blame lands on you.

[Melinurse]

You did the best thing for the patient! I would have done the same thing. You did the best you could with the information that you had. It sucks getting yelled at when other people have dropped the ball and the blame lands on you.

I agree with Sully, RN. You did your job. This is something that will happen again unfortunately. Just keep advocating for your patient. I would have done the same thing too. You did the right thing for your patient.

[SuesquatchRN, BSN, RN]

You did everything right.

[highlandlass1592, BSN, RN]

Im just wondering how others would have handled this situation.

I work nights on a med-surg floor,have been a nurse for almost a year. I have 6 pts and my charge nurse has 6pts and we have one nurse aid(no techs or anybody else). I get out of report and immediately im very busy with two pts who had critical problems.however,I was able to assess all of my pts in a timely manner and get most of my meds passes to all pts on time,in the meantime the nurseaid had been getting vitals.Now normally I like to read the h/p on my pts but being that we were short handed and really busy,i just read over the last couple days of md orders/progress notes. So,2300 comes around and our nurse aid gets pulled to another floor.So,I now have to take 0000(which actually were more like 0100 vitals by the time i got a chance to do them),I went to take vitals on one pt who was post abd.surgery.It turns out her b/p is 180/100.I think this cant be,she has no history of htn and she isnt even on b/p meds or anything. So,i get a manual cuff and check it again..ok its really that high.I go to her chart and there in the h/p is hx of htn,mi,cad,etc.Now none of that had been told to me in report,but I should have read the h/p in the first place.I look at the graphic sheet of her b/p for the last 2wks..her b/p had been low 110/50 Until that day when it started out at 140/70 and continued to rise.The nurse aid from earlier had failed to tell me about the 2000 b/p being 167/?,but then again i should have looked for myself.Basically,the md had this pt npo because of her ng tube and he didnt continue any of her po bp meds(no bp meds ordered at all). I asked my charge nurse what to do,she said call the md.I paged the md,the md on call calls me back.I tell him" pt xyz had a b/p of 180/100,there is no med ordered for b/p,would you like to order something. he begins to yell and cuss me out,tells me that I should call other md(he was the admitting,attending,and primary md,there was one other md that had been consulted but hadnt seen the pt yet) he ends up giving me a now dose of something and hanging up on me.neway to make a looong story short,he comes up there the next day looking for me..talks to the house supervisor and my manager..about all the things I did wrong(mainly waking him up) he looks at the b/p graphic sheet and says look the b/p had been high all %&&*^* day! and I get called in the middle of the night!,he is still yelling and cussing...and the house supervisor sided with the md.,...ok sorry so long..what would you have done? thanks

You did the right thing. I'd talk to my supervisor about it and see if you can't get them to see your side of the story. No one should have to take that nonsense from a physician. It is hard to learn to stand up for yourself but it is a skill you will need to develop. Some docs get off on throwing their weight around..if the abuse were to continue, I'd report his butt up the chain of command. JCAHO has made lateral workplace violence a huge priority for 2009...keep that in mind. Your facility should have some type of plan in place to deal with that kind of behavior. Stay strong..and remember: you can't be in 4 places at once.

PS: Hey, forgot to add: I commend you for trying to read your pt's H&P's. That's a good habit to get into. But don't beat yourself up if you can't. Sometimes you do the best you can with what you've got. Good job.

[canoehead, BSN, RN]

I would have called the doc at the same time you did and asked for the same thing. Bloody hell, you can't win sometimes, eh?

[Valerie Salva, BSN, RN]

You did the right thing. MDs will continue to behave like idiots, and spineless traitor NMs will continue to side with them when a nurse is just trying to do the right thing for her pt.

Welcome to nursing.

[dorselm]

This is one of the things I dread the most about preparing to graduate and enter the world of nursing. I can't understand how it is permissible for the md to talk down to you b/c you woke him from his beauty sleep. If I were you before I excused myself from the oneway conversation with the md I would have said " I understand you are upset but I refuse to be degraded b/c I advocated for my patient." I'm glad you posted this b/c I can see how important it is to read the H&P to get a better understanding about the patient. I think you should be proud of yourself.

[southernnursern8407]

Thanks for the input :)

[blaaveispiken]

Basically,the md had this pt npo because of her ng tube and he didnt continue any of her po bp meds(no bp meds ordered at all).

house supervisor and my manager..about all the things I did wrong(mainly waking him up) he looks at the b/p graphic sheet and says look the b/p had been high all %&&*^* day! and I get called in the middle of the night!,he is still yelling and cussing...and the house supervisor sided with the md.,...ok sorry so long..what would you have done? thanks

Sounds like he was transferring blame when it was really his error in the first place! Pt should have been getting something for BP control with her HTN history.

I don't get how doctors can rant and rave and get away with it. It isn't tolerated where I work and there have been a few docs who were asked to leave because of their rude behavior to staff.

You did the right thing -- the patient always comes first and the house supervisor should have backed you up!