new nurse advice. screwed up? - page 4

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   Ddestiny
    Quote from Rumana1983

    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

    Somewhere along the line in nursing school we get taught that MDs are Gods that are constantly in a bad mood and don't want to hear about their patient status. This is not true. Stop believing this.

    I've been working in a hospital for 3 years. The only time I had a doctor raise his voice at me over the phone, I held firm and told him he was wrong (he was), and he backed down. I've had doctors that sound annoyed on the phone but are just sweet as pie in person. The most common theme is that they just want the required info and no fluff -- patient name, what you are requesting and why. Don't go through the full SBAR, especially in a hospital where the doctors are acutely aware of these people. If you need to give some history to back up your request, that's fine, but don't give a full history up front. Do an appropriate assessment before you call and have your information available to you when you call. Eventually the doctors get to know you and you them, so you can learn their preferred communication methods (i.e. we have one doctor that prefers to be emailed sent to him rather than a phone call if the concern isn't urgent).

    But never forget that MDs are human. They have good days and they have days where they can let stress get the worst of them. They are not infallible. You are not less worthy of respect simply for not having those letters behind your name. Stop looking at them as gods and think of calling the MDs are a short conversation with another human that just needs to know the facts. They have many more patients than nurses do, so they need us to be their eyes and ears. Neither of us can do our job without the other.
  2. by   BurnedoutICURN
    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?
    You said your charge nurse said she'd be OK, so I assume you spoke to the charge about the patient's condition. Either way, I would have made the call. I definitely would have documented any time I spoke to someone about the patient's condition. However, any time the patient's post-op condition is like this, err on the side of caution and make the call.
  3. by   BurnedoutICURN
    Don't be scared. Yes, you can say "I did my job, I was concerned for the patient." Management should be pleased that you're concerned over your patient's condition. After all, you're saving them the expensive costs of the legal department defending litigation brought on by negligence.

    Now, at some point, you will learn what these doctors expect. You will learn what is more emergent or urgent and what can wait until morning. For instance, an order for colace because a patient is constipated can wait until morning. That's an easy example. A drastic or uncharacteristic change in heart rate with subjective symptoms is a change that needs to be addressed.

    Please don't be afraid. Hopefully, you'll have mentors or preceptors available when you get that first job and they'll be able to help guide you.