OMGosh...she wrote me up! Update about the Narcan!

Nurses General Nursing

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For those that didn't see my post, I had a patient come in after surgery who was very sedated, however...didn't meet the criteria for using narcan. He had serious sleep apnea so his pulse ox went from the 70-90's dependant on what part of the snore he was on, had good color, breathing about 18-20. I had called the MD, I did everything correctly...I even came on here and discussed my actions which no one said I was incorrect for holding narcan for a pt with hx of being overly sensitive to IV medications, post large back surgery, and it being near 11pm! I was of the mindset to let him sleep it off, and I will monitor closely instead of stripping his opiate receptors and leaving him in uncontrolled pain!

The nurse after me used the narcan X3!!!!!!!!! (did she wait to tritrate to effect long enough???!!!) And since she used narcan it needs to be investigated (protocol). She pointed the finger at me being at fault (just like I thought she would!). She said I didn't tell her about the pulse ox ...OMG yes I did, ad nauseum infact...and told her about the differences between breaths and I put him on 4L of O2, and that if she uses the pulse ox to wait a while and watch the trend. Guess she didn't. Also she said she couldn't wake the pt...I could...so I wonder what is up with that?

SO again...I was called into the managers office to discuss this. My boss seemed very perplexed about the pointing of fingers...and I said I was not suprised at this at all...and told her my side of the story...quoting my own documentation, people that were with me for reference..and my clincial opinion of the situation. Needless to say that my documentation was beyond efficient (two pages of details), and the managers were all on my side! The poor pt had to go through 2 days of uncontrolled pain because of the narcan...and we will start up incident reports on that soon!

Anywhooooooo they are going to talk to the nurse and get her side of the story...but in her documentation in the chart she actually wrote that I was at fault! That is not cool and I believe since it wasn't my fault...that is false documentation and proably more!

I was very professional and to the point and stood behind my choice! Everyone was so proud of me! Including me!!!!!!!!

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

I'd assume writing up would be the making of an occurrence/incident report, either naming or suggesting that triage did or didn't do something. Wouldn't something from management be more of a written/verbal warning/counseling?

Specializes in Research, ED, Critical Care.

Triage - be very careful about your situation. The actions you describe from management and between shifts may indicate a toxic environment. As a newbie, you are a threat to the status quo - both for staff and management. The behavior during this event is not reflective of you, but of what has been allowed to occur in the environment. Please assess your current situation carefully. What do you see for the future in this environment? Is reasonable, progressive, professional change possible? What is the history/tenure of staff and managment? Have you experienced "words" of one sort and seen "actions" of another? Do you feel "cognitive dissonance" - a vague internal awareness of disgreement between what you believe to be true and right versus what is occurring? Do you have a mentor with authority at this facility? If you cannot find positive responses to these queries, I would seek a new work environment, if that is not possible right now - lay low and be careful.

Specializes in M/S/Tele, Home Health, Gen ICU.
By "written up" are you talking about what she documented in her nurses notes?

Or did management give you a written warning that is in your personnel file?

I'm sorry this happened.

(What about Bipap for the apnea? Was the MD aware?)

I was going to ask about Bipap, that is certainly much more appropriate than narcan for someone with sleep apnea, and Noc shift nurses should be well aware of that. I think your night shift cutie needs some classes on documentation, one never assigns blame or voices an opinion in the nurses notes. i expect there is a lot of inssecurity here as you are doing all the right things and are a great assessor, patient care provider and patient advocate too. Glad the supoort is on your side, where it should be.

Good luck.

Celia

Specializes in Education, Acute, Med/Surg, Tele, etc.

Thanks guys!!!!!!!!!!!

Actually we did want a bi-pap but the MD was being "MR. I can't be bothered" guy and wasn't really behind us..."it can wait till morning!". UHG!!!!!!!! So I kept my pulse ox on him (it was our spare), and was in the room doing my charting and what not so I could notice any change. Again, I was lucky I had that time...my other patients were stable and sleeping.

BUT...I did run into a karma deal yesterday! The same nurse turned down the PCA I had for another pt, and he was in pain screaming all night and it took her a lot of time to get him contolled painwise! The wife was with the pt (stayed) and was in tears. The family told me this when they saw me during my inital assessment of a patient, and I told them I would be their nurse again...they were very happy!!!!!! I had them explain what happened and WROTE HER UP under patient/family complaint (not a personal one by me, that would be too obvious that I was trying to make a stink! LOL!)...and management will handle it..in fact, management told me to do it!

Lets see how it goes...she'll proably find out it was me that filled the report, but...my manager is going to say she found out and had to take action.

This gal needs a lesson in pain management specific to nocs! Us during the day handle the weening so we can closely monitor...but keep our patients up in pain all night...no way can we even ween them because they spent all their energy at night painful and trying to sleep! I know she wanted to start the weening process...but first..get to know the patient and the day they had...this one too was a fresh late night post op! Poor guy!

Specializes in Junior Year of BSN.
Thanks guys!!!!!!!!!!!

Actually we did want a bi-pap but the MD was being "MR. I can't be bothered" guy and wasn't really behind us..."it can wait till morning!". UHG!!!!!!!! So I kept my pulse ox on him (it was our spare), and was in the room doing my charting and what not so I could notice any change. Again, I was lucky I had that time...my other patients were stable and sleeping.

BUT...I did run into a karma deal yesterday! The same nurse turned down the PCA I had for another pt, and he was in pain screaming all night and it took her a lot of time to get him contolled painwise! The wife was with the pt (stayed) and was in tears. The family told me this when they saw me during my inital assessment of a patient, and I told them I would be their nurse again...they were very happy!!!!!! I had them explain what happened and WROTE HER UP under patient/family complaint (not a personal one by me, that would be too obvious that I was trying to make a stink! LOL!)...and management will handle it..in fact, management told me to do it!

Lets see how it goes...she'll proably find out it was me that filled the report, but...my manager is going to say she found out and had to take action.

This gal needs a lesson in pain management specific to nocs! Us during the day handle the weening so we can closely monitor...but keep our patients up in pain all night...no way can we even ween them because they spent all their energy at night painful and trying to sleep! I know she wanted to start the weening process...but first..get to know the patient and the day they had...this one too was a fresh late night post op! Poor guy!

WOW ....OUCH...does that nurse wear black and walk around with a scythe geesh (just being sarcastic people) :uhoh3: . If managements telling you to write her up more obviously they know she's not that competant. I mean we don't know her side of the story yes but still...WOW!!!

Specializes in Trauma ICU, MICU/SICU.

I'm sorry to hear you had to go through this. Glad you doc'd so well and that mgmt is on your side.

Poor patient - Narcan x3. I cannot even begin to imagine what that feels like.

Specializes in med/surg, ortho, rehab, ltc.

This gal needs a lesson in pain management specific to nocs! Us during the day handle the weening so we can closely monitor...but keep our patients up in pain all night...no way can we even ween them because they spent all their energy at night painful and trying to sleep! I know she wanted to start the weening process...but first..get to know the patient and the day they had...this one too was a fresh late night post op! Poor guy!

A LESSON IN PAIN MNGT SPECIFIC TO NOC.....EGGGGXACTLY!

I onced worked worked a floor they called Ortho/Trauma/med/surg where we did a lot of those "huge back surgeries" (Ant/Posterior spinals with hardware). Anyway one of the noc RN's was VERY stingy and judgemental about the use of pain meds. She kept complaining that "all we do on this floor is give narcotics." Hello! These are fresh post-ops......we're not getting them hooked on opiates for life.

The day RN that followed this night RN would often hear from the pt about how much pain they had been forced to suffer. Sadly the day RN's would turn the pt complaint over to the Nurse Manager & she never bothered to tell this night shift nurse about proper pain control/night. (I think maybe the NM was more afraid of upsetting this staff nurse because she was one of the few experienced staff we had on nights. Our night shift was only able to attract travelers.)

Luckily a pt finally c/o uncontrolled pain/noc to his doc & the doc was able to get this RN to understand the use of opiates in the management of short-term pain. Funny thing was a yr later this same RN had a difficult delivery with C-section & I remember her telling me how "The percocet saved my life."

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