Hi everyone. I am a resource nurse, aka float pool. I began my career on the cardiac unit and now work 9 different areas of the hospital. The other day, I was working on the ortho floor and I began with a delightful group of patients. One patient had fallen and had a surgical knee repair. Her surgeon saw her after my assessment, he told her that she could go home that day if she "did well in physical therapy". Her appointment wasn't until that afternoon, but as it was close to Christmas, she was delighted with this news. I went into her room shortly after the surgeon left to see if she or her neighbor needed to use the bathroom or wanted to get cleaned up, because I was going to leave the floor for break and I didn't want to leave them before checking. My patient told me that she was feeling ill, she had just had a "spell" where she became diaphoretic and then felt extremely weak. She said that she had had a couple of these "spells" during the night and had forgotten to mention them to her surgeon. The following weakness seemed to last for an hour orso. I did a quick set of vitals and a spot chem (patient not diabetic). Her vitals were normal, actually BP and HR better than they had been @ 0800. Spot chem was 244, a little high but too high to be a hypoglycemic recovery. I went to her e-chart and was looking to see who her primary care doctor was when the charge nurse for the ortho floor asked why I hadn't taken my break. I explained that I was going to call the doctor with the symptoms my patient was having. She picked up the written chart and said, "this patient has discharge orders, what are her symptoms?" I explained them to her and she replied with, "did you have an order to check her blood sugar?" Ummm, no, but I'm very sure that you don't need an order to check a chem on a symptomatic patient. She then said, "this is an ortho floor, it's probably just a reaction to taking narcotics, ship her home and have her follow up with her new symptoms with her PCP." During this conversation, I was already paging her on-call PCP--it was the weekend, so not her regular doc. I explained to the charge nurse that it is my duty to make sure my patient is stable and well when she is discharged and I would be happy to take full responsibility for any flack for this situation.
The on call PCP ordered telemetry, stat EKG, CKMB's and Troponins x3, CXR, cardiac consult, and CT of chest with contrast. Charge nurse is a little on edge now, but she asks t/o the day about the results. Patient is in NSR, CXR clear, labs negative.
I accompanied my patient to her CT scan with a DASH monitor that I had to borrow from another floor because the charge nurse thought the only one they had was on the crash cart. She suggested that I take the one off the crash cart :uhoh21:(OH NO!) but I rejected that idea. When I returned to the floor, I had been reassigned due to staffing adjustments. Later, I called the floor to follow up with the charge nurse on another situation and she told me that my patient had a PE and they were now trying to figure out what to do about it.
My only thought was thank God I am such a stubborn nurse! If the patient had an ortho nurse, she may have gone home with a PE.
Has anyone else noticed that mentality in the hospitals? treat only the problem you specialize in?
