new nurse advice. screwed up? - page 3

Patient: 40 something year old Jane-Doe. No medical history. Is post operative. Underwent general anesthesia. Had a ureter stent placement and stone removal. BP 80/50 HR 41 100% on 2L... Read More

  1. by   AlabamaBelle
    Always, always, follow your gut. Don't listen to a charge nurse or anybody else. I'll take the chewing, which I had recently. The NP and MD (who has standing orders that we call the NP, not him) complained about my call, but my glutes were covered, just in case. And later, a couple hours after the treatment, there was a problem, not a big one, but my considerable hiney was covered as I had charted and filled out some paperwork on the problem with that particular treatment.

    It's your license, protect it. Nobody else will.
    Last edit by AlabamaBelle on Jun 14 : Reason: grammar, clarity
  2. by   ShantelH
    Always follow your gut when you feel something is wrong.Never think someone else will make that call for you. Sometimes you have to trust yourself.
  3. by   Kooky Korky
    It's so aggravating when OP's don't come back.
  4. by   NurseBlaq
    Quote from Kooky Korky
    It's so aggravating when OP's don't come back.
    Exactly! This is a learning moment for everyone. I want to know what happened.
  5. by   zoidberg
    We can only assume the worst
    Just kidding.
    No, but really. What happened?!
  6. by   flonightingale2
    It may seem scary to call the MD when you are unsure if you have to or not but I have learned that it is always better to be safe than sorry. This patient's BP is way too low and it seems like a bolus should be infused, however she has other issues including edema, bradycardia and pallor. These are not regular symptoms of a post op patient who is stable, as I see post op pts every shift. For the sake of your patient's safety, the best choice would have been to call the MD.
  7. by   Here.I.Stand
    Symptomatic bradycardia -- def. warrants a call.
  8. by   Rumana1983
    Quote from introuble7
    Patient: 40 something year old Jane-Doe. No medical history.

    Is post operative. Underwent general anesthesia. Had a ureter stent placement and stone removal.

    BP 80/50 HR 41 100% on 2L cannula.

    subjective: Looks pale. She said she looks pale, also. Feels groggy. A bit swollen/edematous in the arms.

    States "was an athlete BACK IN THE DAYS. My blood pressure runs low, but not that low. I never had my heart rate measured." In the ER, base line was 100s/60s and her HR was 70s. Maybe because of pain?

    Should this warrant a "Hello Doctor! Explain above. That's it." Or should I have left it alone? I ask because the patient was OK when I left a couple days ago. My Charge Nurse said she'll be OK. Don't need the MD. But my director wants to talk to me about this. So I think something happened to the patient. I go back in tomorrow.
    Thanks. Should I have made the call?
    ii

    After reading this post, I feel very scared. I am currently a nursing student. I have already read all the comments on this post and I got that she should have called the doctor or NP.
    BUT, I just need to know what if a new nurse feel intimidated by a charged nurse or her preceptors. what if she already called the doctor before for other patients. what if she feels embarrassed for calling the doctor again and again. what if she does not want to be seen as an annoying nurse. I know everyone talking about how important to act as a patient's advocate and preserve nursing license. But, what if the situation was different and she called the doctor and got yelled because nothing happened to the patient;! is this the way always goes, that she has to bite the bullet of bossy doctors and bullied-workers ? !! what will be the solution in this situation? what if the patient was okay and she got yelled, could she defend it by saying that "I just did my job for client's safety or remind the doctor his/ her part in patient care !!?" Can We Defend our position at work or we get fired

  9. by   Here.I.Stand
    Symptomatic bradycardia -- def. warrants a call. Plus the hypotension, which she even reports is not her norm. It's true some people run lower... I actually had an 88/45 in my employee health file in mid-2000s. However this pt is having a mental status change; in light of that BP I'm concerned her brain isn't being adequately perfused.

    Sometimes we call for things that end up being false alarms. But it's always better to be safe and err on the side of caution.
  10. by   AlabamaBelle
    Dear youngling...

    Accept now that you WILL get yelled at or the MD will be extremely annoyed with you in the field of nursing. Grow a thicker skin. The Charge or Preceptor is just a cog in the wheel. You will chart that you notified your charge nurse. Then you will call the MD, as he is the only one who can give you orders. You will chart this also, as well as his orders (or lack thereof). You will carry out orders and note responses to interventions. Protect your license. Try to group questions to the MD, if at all possible. You can always ask if anyone else needs the particular doctor. This thread has given you valuable information. Use it.
  11. by   NurseBlaq
    Quote from Rumana1983
    ii

    After reading this post, I feel very scared. I am currently a nursing student. I have already read all the comments on this post and I got that she should have called the doctor or NP.
    BUT, I just need to know what if a new nurse feel intimidated by a charged nurse or her preceptors. what if she already called the doctor before for other patients. what if she feels embarrassed for calling the doctor again and again. what if she does not want to be seen as an annoying nurse. I know everyone talking about how important to act as a patient's advocate and preserve nursing license. But, what if the situation was different and she called the doctor and got yelled because nothing happened to the patient;! is this the way always goes, that she has to bite the bullet of bossy doctors and bullied-workers ? !! what will be the solution in this situation? what if the patient was okay and she got yelled, could she defend it by saying that "I just did my job for client's safety or remind the doctor his/ her part in patient care !!?" Can We Defend our position at work or we get fired

    This is where charting comes into play. Document your calls to the doctor, VS, patient symptoms, notifying charge nurse, etc. Also activate RRT or Code Team, hell any team that will come and assess this patient. Don't worry about what they think of you, always err on the side of caution. We save lives not impress coworkers.
  12. by   Triddin
    Quote from Rumana1983
    ii

    After reading this post, I feel very scared. I am currently a nursing student. I have already read all the comments on this post and I got that she should have called the doctor or NP.
    BUT, I just need to know what if a new nurse feel intimidated by a charged nurse or her preceptors. what if she already called the doctor before for other patients. what if she feels embarrassed for calling the doctor again and again. what if she does not want to be seen as an annoying nurse. I know everyone talking about how important to act as a patient's advocate and preserve nursing license. But, what if the situation was different and she called the doctor and got yelled because nothing happened to the patient;! is this the way always goes, that she has to bite the bullet of bossy doctors and bullied-workers ? !! what will be the solution in this situation? what if the patient was okay and she got yelled, could she defend it by saying that "I just did my job for client's safety or remind the doctor his/ her part in patient care !!?" Can We Defend our position at work or we get fired

    The thing is, if we don't alert the doctors, how would they know what our concerns are and how can it get fixed? Yes, sometimes doctors get pissy and annoyed, but ultimately you are protecting your patient and your license. I've lost track of the number of times I've called the doctor to give them the heads up that xyz has changed only to have them shrug and tell me just to keep watch. That's ok. They ball is in their court. And most of the time, the patient is ok. Sometimes we annoy the doctors; we try to keep it to a minimum, but patient safety always should come first. Unfortunately some times we get yelled at. We shouldn't be treated that way, but the fear of that also shouldn't prevent us from voicing concerns about a changing patient condition

    As you practice more, you'll become more confident in your judgments and more confident what other pieces of data you need
  13. by   AceOfHearts<3
    Quote from Rumana1983
    ii

    After reading this post, I feel very scared. I am currently a nursing student. I have already read all the comments on this post and I got that she should have called the doctor or NP.
    BUT, I just need to know what if a new nurse feel intimidated by a charged nurse or her preceptors. what if she already called the doctor before for other patients. what if she feels embarrassed for calling the doctor again and again. what if she does not want to be seen as an annoying nurse. I know everyone talking about how important to act as a patient's advocate and preserve nursing license. But, what if the situation was different and she called the doctor and got yelled because nothing happened to the patient;! is this the way always goes, that she has to bite the bullet of bossy doctors and bullied-workers ? !! what will be the solution in this situation? what if the patient was okay and she got yelled, could she defend it by saying that "I just did my job for client's safety or remind the doctor his/ her part in patient care !!?" Can We Defend our position at work or we get fired


    I work in the ICU and the majority of the time the provider is physically on my unit. Sometimes depending on the service they aren't on my unit, but that never stops me from paging or notifying them. I've had shifts where I'm like, "man, the resident must be sick and tired of me paging them" and I just laugh about it.

    I've had it where a resident isn't concerned and has been ignoring what I was saying and what the previous nurse was saying (we had the same concerns) and I've been on the phone with the resident (who finally called me back) who was totally unaware that the attending was standing right next to me. The attending agreeded with my concerns and assessment and chewed that resident out big time. Document your concerns and who you notified, and keep trying when you have concerns over how a patient is doing. I will bug the crap out of a provider if I feel I have to- I'm doing my job and they are getting paid, so I'm darn well making sure they're doing their job.

    I recently had a patient come to me from the OR. They were sinus rhythm when they arrived, but then dropped to the 50's (and even started dropping to the mid-40's at times). They were asymptomatic, but I still let the provider know and got an EKG right away. It was sinus brady- no type of heart block or anything so the provider wasn't concerned. It resolved without any intervention after about 24 hours. The key with this patient was that they were asymptomatic, but even so I still got an EKG and told the provider.

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