Me vs. the charge nurse

P_RN, ADN, RN · May 23, 2007

We need a lot more info. before even venturing a guess. How old is the patient? Is she post CVA? What is her baseline. What were the po meds? What's your facility policy? How much experience do you have? (no offense there intended), So much missing here.

CVICURN2003 · May 23, 2007

Was I wrong in what I did? I need some other perspectives. I was working a few days ago and had a conflict with my charge nurse. It was basically about whether to call the doctor about something related to my patient. She saw a blood pressure and freaked (was 180's over 80's), I saw the doctor had noted this in his progress notes just 2 hours prior and ordered some PO meds to be given, which I just had. I tried explaining this, but it was no use and she practically ordered me to call the doc. I was really upset about this because this was MY patient and I thought she had no right to tell me what to do. Or does she? Basically I am wondering that as a staff nurse, do I have to respond and do (within reason of course) what my charge nurse tells me to do regarding my patients? I am really torn about this and could use some feedback. Thanks!

I probably would have asked her if she wanted me to give her report and she could take over the care of the patient (so you have not abandoned the pt) if she thought I was not taking care of it. Or I would have told her to call the MD. As long as I felt that the MD had addressed it. Did You take the pressure in both arms? Had his BP been this high over several hours and when the md came? Or was he trending high for several days/shifts? What was his diagnosis? That would make a difference. Or if you just wanted to keep the peace, you could have called and said "MD so and so, Mr. So and So's BP remains high. I saw where you addressed it earlier in the day his po meds have been given at whatever time. Is there anything else you would like me to do? Here are his vitals for the past 2 hours...." Then you have CYA and shut your charge up.

At my hospital my charge is wonderful and any insight he gives me is usually right. But, I am comfortable with him, he is comfortable with me and it works for our unit.

RachelRN25 · May 24, 2007

We need a lot more info. before even venturing a guess. How old is the patient? Is she post CVA? What is her baseline. What were the po meds? What's your facility policy? How much experience do you have? (no offense there intended), So much missing here.

The patient was 98, with less than 24 hour old CVA. I can't remember what med I gave...sorry. I have less than 1 year experience.

GingerSue · May 24, 2007

any idea what the medication was?

bill4745, RN · May 24, 2007

The patient was 98, with less than 24 hour old CVA. I can't remember what med I gave...sorry. I have less than 1 year experience.

I really think you should have called the MD, given the age and the new CVA.

CVICURN2003 · May 24, 2007

The patient was 98, with less than 24 hour old CVA. I can't remember what med I gave...sorry. I have less than 1 year experience.

Was is a bleed or a embolic?

RachelRN25 · May 24, 2007

Was is a bleed or a embolic?

It was an ischemic stroke. I gave cozaar I think?

CritterLover, BSN, RN · May 24, 2007

what was her bp after the bp med?

if the doc knew her bp was 180/80, i can't see calling him about it unless the ordered med didn't bring the bp down.

am i correct that 2 hrs had elapsed between the time the order was written and when the med was given? could this be what the charge nurse was getting at? was the order written stat?

for most elderly patients, 180/80 isn't much to get too exiceted about. there are exceptions, though. however, if it was a stat order, and you didn't get it from pharmacy for 2 hrs, that could have been the issue (where i work, stats have to be given within 30 min; nows within 1 hr).

all that being said, if the charge nurse only wanted you to call him and remind him of what he already knew and had addressed, that is kind of silly, unless the med hadn't worked. since you probably didn't have time to know if the med had worked or not (takes about 30-60 min, for the average po med to work, right?). i'm hoping there was more behind the request than that.

since you are fairly new and still learning, there isn't anything wrong with asking the charge nurse why she was so insistent that you call the doc about the situation.

dria · May 24, 2007

maybe you could ask the charge why she felt the call to the md was warranted...i'm sure she wasn't intending to report those bp's just for the sake of reporting them....there was likely a particular concern that she had....could be a good learning experience for you...at the very least, you can get some practice in handling a sticky situation...i know it's difficult when you feel you are being second guessed.

texas_lvn · May 24, 2007

agree with critter lover and dria. I would go to the charge nurse and simply state "I am learning, can you please explain why you felt like it was warrented to call the md" Maybe there is something I missed.

Good luck.

Tweety, BSN, RN · May 24, 2007

You do not have to do what your charge nurse tells you to do. You should collaborate as a team to do what's best for the patient.

If the charge nurse wanted the doctor called that badly she/he should have done it.