Being a nurse in clinic setting

[nurseka3na]

I am a new nurse in a clinic setting. Coming from med-surg, it is a huge adjustment as being on the floor requires more urgency than being in clinic.

I had a pt yesterday whom everyone knows well as she comes every 2-4 weeks or so for a check-up. It is usual for her to have 300+ mg/dL blood sugar and to be hypotensive 80-100/50-60. She Always ends up being sent to urgent care at the end of the day due to her vitals & BS.

Pt had n/v, dizziness, and weakness (her usual s/s) (i will not lie i have to research all her dx, i know Her pcp is aware of her hypotension and gets medications to increase it). I layed her flat on the bed, elevated her legs, gave her water. BS was 404. My charge nurse who has been in clinic >10yrs could not care less about the situation. My CN said "this is her all the time so it is upto you to check BS and sending her to urgent care."

I just feel like everyone had been desensitized by her usual s/s and it does not feel right. Only thing i learned from nursing is to never ignore s/s that could cause harm to a pt.

I guess I am just upset that I did not get enough guidance being a novice nurse and reacting to these kind of situation make me feel like i am over reacting as the clinic nurses seem to be so "chill".

[ruby_jane, BSN, RN]

You're spot on about the acuity level. Think about what you know about hyperglycemia - could some of the signs/sx be related?

At any rate - never allow another nurse to second guess your nursing judgment, especially when you're new to the practice and new to the patient. When I find myself irritated when I have a patient coming in repeatedly with the same vague s/sx I remind myself that the day I don't do a good assessment is the day I'll miss something big.

Full assessment this time, right? Sounds like the end result is going to be the same - she needs insulin for the BSG and probably urgent care for the hypotension (maybe an IV, which you can't give, right?)

It's possible both you and that other nurse are both correct....that this is just one more blip in this patient's long, blippy history.

[JKL33]

Provide prudent nursing care to the patient in front of you. It's very likely that next time this year you will know what you need to do for patients like this but the "OMG, I have to do something STAT!" feeling may have dissipated a bit. And you still need to do what is prudent for the patient in front of you. That's all there is to it.

You are adjusting to your new setting. Some of this is indeed a matter of perspective. For example, when patients come into the clinic with a sore throat, would you expect to have timers going and people running around like chickens with their heads cut off to get these people a throat swab and some motrin STAT? Because that's what we do in the ED, even though they are treated with routine handling in your clinic all day long and in fact would mostly be fine if they didn't seek care anywhere.