Do I do something wrong in this situation?

DusktilDawn · Oct 1, 2005

Thanks for responding Nurseinthemaking,

Since the Med Nurse was apprised of the situation, yes he should have prioritized here, what was he thinking :smackingf If there was nothing else of equal importance going on, this should have been his first priority, most definately. He also had the option of sending one of the PCTs congregating in the back to get a nurse to come back from lunch, if necessary.

(let's think about this, when you walk on the floor, as a nurse, you assume responsibility for every patient on that floor

Absolutely agree with you on this one. You may be assigned patients you will be primarily caring for, but each LPN, RN, CNA/PCT owes a duty of care to ALL patients on the unit that they work on. It makes me balistic when I hear the phrase "That's not my patient," :angryfire :angryfire :angryfire

Like I stated, the CNA and Med Nurse carrying on about VS being documented incorrect, despite the fact the dynamap has a display, is probably an attempt to CTA (T as in Their butt). For whatever reason the Med Nurse choose not to prioritize this patient and both were making excuses after the fact.

Now I can see why you were paired with a CNA, to become familiar with the equipment. I hope you specified the reasons why you requested not to be paired with her. Sleeping on the job :nono: Speaking another language in front of patients/other staff, could be considered rude.

I hope this situation was handled appropriately after.

Dialysis may be your niche, Nurseinthemaking, but have you tried to get into the Dialysis Center you spent clinical time at? I don't like the sounds of this place, it doesn't sound like too much team work goes on here.

TNRNMAN · Oct 1, 2005

I posted this in the Renal Nursing Section, but think I should have maybe put it here since more people will see it. I really need some help thinking all this through.
I have a little situation that happened yesterday and with me being a newbie I am not sure if I handled it right or not.
As a GVN who has not taken her boards yet, I cover for PCT's while they are at lunch, have patients that are assigned to me and am also being trained with the caths (take off is very easy as far as cath care by the way, but put on I am still nervous about) anyhow. Here is the scenario:
Lunch time coverage is taking place. I have 6 additional patients to cover plus the 2 that currently I am caring for. 7 of them were doing fine, no problems to mention, one I noticed he was sweating and started yawning, so I do a BP on him, (when he arrived it was 140/86) this was almost 2 hours into his Dialysis, his BP started dropping and was at 88/64, I asked him how he felt he said he felt fine, but new it was dropping, I laid him back and gave him a damp cloth, 5 minutes later it had dropped to 76/56, so I gave him 200cc's NS, the patients eyes started watering, but he really was not complaining, I wasn't for sure if he was being tough or felt like doo doo and couldn't muster up the energy to talk. Amongst all these 5 minute BP's, I am adjusting the cuff and making for sure I am getting a right reading. 5 more minutes later it had dropped to 66/44. I requested a Hypertonic from the Med Nurse, who was on the floor, his response was "he is not my patient, I have another hypertonic to give, plus Immodium to one patient and another Med to give to another patient." I am thinking OK, maybe he will give the Hypertonic and be over here after that. 10 Minutes later the pt's BP was down to 55/35, Charge Nurse was gone to lunch and Med Nurse still had not come over there. The whole time I am documenting my 5 and 10, minute BP's, pt's symptoms, request for Hypertonic yada yada. This is where hell breaks loose, Correct me if I was wrong. I documented with the 55/35 "Hypertonic was pending Med Nurse Arrival".
I never left the pt's side, I stayed with him and finally a tech came by and I asked her to get either the charge or the Med Nurse now, she got the Med Nurse and he walked up with a pissed off look on his face and I showed him my VS on the Screen, informed him once again of everything I did. I told him, I needed to go and check on my 7 other pt's and I would return. Done, I thought, oh heck no, I got jumped by the PCT who was/is my preceptor (mind you these both are of an International origin and they do stick together, they also speak in their language on the floor while caring for patients who do not speak their language) anyhoo. She told me that I was documenting wrong BP's and why would I Take BP's every minute and document I was taking them every 5 mintues, she felt like I was trying to get the nurse in trouble and we don't document like this, we cover for our Nurses. I told her that as a GVN, I have a legal obligation to document what I do and the time that I do it, she told me know I don't. She told me that I should never, ever of wrote that and that I was wrong for doing it, I then got the rath from the Med Nurse, stating that if I had looked at his previous BP's I would have noticed that he came in with a low BP. He told me that the PCT who was taking care of this patient falsified BP's on Paper but if I had looked at the machine, I would have realized that. NOT because what he was looking at was the BP's that the Monitor was showing, he didn't scroll up and so I told him that if he would scroll up on the screen he would see that the patients original BP was what the PCT had documented. He told me I was trying to make him look like a bad nurse and I promptly replied, "you know what, I am not here for your license, I am here for mine and for these patients and if you don't like that, you know where you can put it."
So now that I have had time to breath and reflect, did I do something wrong here, should I not have documented what I did?
Before I give you my Charges response to all of this, I want to here what everyone has to say. I don't want to sway anyone. I want a God's honest truth.

WOW, How many applications did you fill out the day after this, you need to get out of this situation, take it from someone who knows you are setting your self up for trouble this type of healthcare workers, ( notice I did not say professionals ) are very dangerous to a new license. GET OUT OF THERE. The fact that these techs are speaking to you or anyone else that is truly responsible for the patients, and telling what you should and should not do is inappropriate, you have the right to document any finding that you encounter as long as it is the truth. The med-nurse is obviously incompetent, and should be brought into question, as we write new questions for the NCLEX this is the type of things we are trying to find out, can you prioritize and handle diversions in an appropriate manner for the safety of the patient and obviously this person can not. Careful with your words and your description of people they are irrelevent when you have such a strong case of facts. Be professional at all times and climb that ladder, the chain of command. Be sure that this is reported and if or not you are blown off GET OUT OF THERE!!!!!!!! :uhoh3: :uhoh3:

barefootlady, ADN, RN · Oct 1, 2005

1. Sounds like you did the right thing with this patient.

2. Sounds like you need to look for another job with a facility that has adequate staff and more modern methods of care.

3. Sounds like you are a well prepared, alert, caring nurse.

Nurseinthemaking · Oct 1, 2005

This has got to be a Fresenius unit. Is it in Lubbock?
Giving hypertonic for hypotension while on dialysis is an old, outdated intervention, and consisered dangerous by DQI. But, many Fresenius units still do this.
Anyway, you might have also turned off the UF on the machine.
Sounds like a unit where I used to work, notice I say used to.
Also, chronic dialysis is totally different from ICU. Any agency that tells you they consider 6 mos of chronic dialysis as a year of ICU experience has no idea what they are talking about. In chronic dialysis, cardiac meds, vasopressors, heart moniters, vents, etc are not used. We're talking apples and oranges.
I am a dialysis nurse, and I live in TX. but the dialysis situation is so bad here (staffing, insubordinate techs, poor standards of care) that I am now a traveler, and work in other states. I won't do dialysis in TX.

The first thing I did was turn off the UF. That's always the first step when they start dropping.

Actually no, we are in the Dallas Ft. Worth area. We are not Fresenius, but it seems as though they do try and mock themselves after Fresenius as far as TX goes. From what I understand, our unit is not as much of a stickler about pt. care as Fresenius does.

What does a Unit do if they don't use the Hypertonic? What is the next intervention after you have taken all measures prior to that. Broth? We use Broth post TX for Orthostatic HTN. Or do they call 911?

I wondered if they really new what they were talking about as far as ICU goes. It sounded good to me at the time.

Hellllllo Nurse, BSN, RN · Oct 1, 2005

1. Sounds like you did the right thing with this patient.
2. Sounds like you need to look for another job with a facility that has adequate staff and more modern methods of care.
3. Sounds like you are a well prepared, alert, caring nurse.

ITA.

Nurseinthemaking · Oct 1, 2005

Thanks for responding Nurseinthemaking,
Since the Med Nurse was apprised of the situation, yes he should have prioritized here, what was he thinking :smackingf If there was nothing else of equal importance going on, this should have been his first priority, most definately. He also had the option of sending one of the PCTs congregating in the back to get a nurse to come back from lunch, if necessary.
Absolutely agree with you on this one. You may be assigned patients you will be primarily caring for, but each LPN, RN, CNA/PCT owes a duty of care to ALL patients on the unit that they work on. It makes me balistic when I hear the phrase "That's not my patient," :angryfire :angryfire :angryfire
Like I stated, the CNA and Med Nurse carrying on about VS being documented incorrect, despite the fact the dynamap has a display, is probably an attempt to CTA (T as in Their butt). For whatever reason the Med Nurse choose not to prioritize this patient and both were making excuses after the fact.
Now I can see why you were paired with a CNA, to become familiar with the equipment. I hope you specified the reasons why you requested not to be paired with her. Sleeping on the job Speaking another language in front of patients/other staff, could be considered rude.
I hope this situation was handled appropriately after.
Dialysis may be your niche, Nurseinthemaking, but have you tried to get into the Dialysis Center you spent clinical time at? I don't like the sounds of this place, it doesn't sound like too much team work goes on here.

My Charge nurse got wind of what was going on and came back out on the floor and after the pt had been taken care of, he talked to eveyone and I was told by him and 2 other Nurses, I did the right thing, I documented the right thing and that they needed this kind of new blood in this facility. He backed me on this. The pt asked the tech, "what? does she not know what she is doing", the tech told him yes she did everything she was supposed to and when the Charge heard this, he talked to the pt to and reassured him he was lucky to have had me there. It made me proud.

Nurseinthemaking · Oct 1, 2005

WOW, How many applications did you fill out the day after this, you need to get out of this situation, take it from someone who knows you are setting your self up for trouble this type of healthcare workers, ( notice I did not say professionals ) are very dangerous to a new license. GET OUT OF THERE. The fact that these techs are speaking to you or anyone else that is truly responsible for the patients, and telling what you should and should not do is inappropriate, you have the right to document any finding that you encounter as long as it is the truth. The med-nurse is obviously incompetent, and should be brought into question, as we write new questions for the NCLEX this is the type of things we are trying to find out, can you prioritize and handle diversions in an appropriate manner for the safety of the patient and obviously this person can not. Careful with your words and your description of people they are irrelevent when you have such a strong case of facts. Be professional at all times and climb that ladder, the chain of command. Be sure that this is reported and if or not you are blown off GET OUT OF THERE!!!!!!!! :uhoh3:

You know you are right, I said to him something ugly and God has haunted me about that ever since. It is so hard to act Christian and Professional when you have 2 people coming at you like that. But I am 34 and I know better. I appreciate the reminder and also what you said.

That Nclex word makes my tummy do flip flops, ugh, I want to get that over with. October 12th is my test date. Cross your fingers for me.

TNRNMAN · Oct 1, 2005

You know you are right, I said to him something ugly and God has haunted me about that ever since. It is so hard to act Christian and Professional when you have 2 people coming at you like that. But I am 34 and I know better. I appreciate the reminder and also what you said.
That Nclex word makes my tummy do flip flops, ugh, I want to get that over with. October 12th is my test date. Cross your fingers for me.

You will do fine, that is obvious

talaxandra · Oct 1, 2005

I am not trying to prove a case, I am stating the facts. I asked for help in determing if my documentation was wrong or the patient care I gave was wrong. I am not racist and the only thing I am biased about is my kids. What they do is what they do. They stick together like glue and I promise you, if you would have seen it with your own eyes you would know exactly what I am talking about. It is hard to relay the message via internet.

I'm sorry, I don't think I expressed myself clearly enough. I certainly didn't mean to sound as though I think that you're racist or biased; what I meant to convey was that including remarks like that, although they may well be accurate, dilute what you're saying because they can make you sound as though you have another agenda (be in racism, previous clash, personal dislike etc).

I made a point of this because i think that what you said and did were right, and would hate to have the impact of that diminished.

DusktilDawn · Oct 1, 2005

My Charge nurse got wind of what was going on and came back out on the floor and after the pt had been taken care of, he talked to eveyone and I was told by him and 2 other Nurses, I did the right thing, I documented the right thing and that they needed this kind of new blood in this facility. He backed me on this. The pt asked the tech, "what? does she not know what she is doing", the tech told him yes she did everything she was supposed to and when the Charge heard this, he talked to the pt to and reassured him he was lucky to have had me there. It made me proud.

Kudos to the Charge Nurse. Maybe this facility is looking for to infuse "new blood" and a better attitude here.

BTW I think you'll do well on your NCLEX, Nurseinthemaking.

Best of luck,

DusktilDawn

KatieBell · Oct 1, 2005

I'm so so glad your charge supported you. That has got to feel GREAT!!! Still, you might think about another job.

I'd also agree with Hellllllo Nurse. 6 months doing dialysis does not an ICU nurse make. There is a lot to learn doing dialysis, but it is not ICU.

Just as a word of friendly advice. The recruiters for agency are NOT (usually) nurses. Sometimes they know nothing about nursing. I went one time to an agency, was doing the forms and the person said "Is Emergency Nursing considered acute care? We're only looking for acute care here, and I think Emergency Nursing must be some other kind of nursing" So, be well informed yourself, and do not rely on the agency's opinions.

Best Wishes for NCLEX!

barefootlady, ADN, RN · Oct 1, 2005

Thanks for completing the story. Your charge nurse knows just how lucky the unit is to have a new nurse who is already doing critical thinking and acting in a competent, patient safety orientated manner. I may have to rethink your getting another job is you continue to get support and encouragement from most of the staff.

God understands our human feelings and only asks us to do our best. If you continue to put His teachings into practice everyday, you will be a great nurse.

I am sure you will do well on the NCLEX. I wish you continued success in your life and in nursing. Have a blessed day.