Good judgement skills or not?

[nevergonnagiveup]

I work on a very busy medical floor. I had a patient admitted to floor with a dx of hypoxia. This woman's previous med hx included asthma with use of continious O2 at home. She was to originally be admitted to ICU but the MD stated in his admit orders that if patient's O2 sats were greater than 93% on nasal O2 she could be admitted to a regular medical floor (she needed 6L of O2 via a hi flow n/c to maintain that O2 sat...to me she should have went straight to ICU to be monitored more closely). Upon making my final rounds, I found her doing pursed lip breathing, gasping for air, labored resp with use of accessory muscles and sweating. I checked her O2 sat and she was only 82% with 6L. I placed a non-rebreather mask on her while I attempted to call respiratory to adminster a neb treatment because you could hear the wheezing without a stethoscope. I made two calls and the line was busy. Knowing that time was of the essence, I directed the unit clerk to call a rapid response code (the policy in the hospital is to call a rapid response if their is any change in the patient's condition). The entire code team responded. The patient received treatment after treatment with very little change in her O2 sat. The pulmonologist was called, assessed the patient and decided to transfer her to ICU. After it was all over, I went to the bathroom and overheard outside the door my charge discussing me to another nurse. Her statements were I should not have called a rapid response but should have called respiratory stat to adminster a treatment because I had the whole hospital respond to a code unnecessarily (last time I checked-airway was a priority). I was so upset that my nursing judgement was questioned and even started questioning if I did the right thing. Can anyone offer any advice on how they would have handled the situation and did I do the right thing? Just need some reassurance.

[AlabamaBelle]

You made a very appropriate use of your resources. We have Rapid Response Teams in our hospital (PERT = Pediatric Emergency Response Team). Your situation fits into the parameters we have set in place.

The only thing wrong with your situation would be the actions of your charge nurse. Her comments should have been addressed to you and you alone. Definitely discuss this her and your manager.

Way to go!

Cindy

[Super Nurf]

Isn't Rapid Response the first choice in line to avoid the costs of a code? To get there before an actual code is needed? We are encouraged to call RR if we feel we need it, and it has come in handy many a time. I think it's one of the best ideas to come down the pike in a long time.

You did the absolute RIGHT thing. Here again, document, document document.

I would go to that person and say "I overheard this..." Your judgement should NOT have been discussed with anyone but you, it's this kind of backbiting that really doesn't get us anywhere, and promotes the idea of "nurses eating their young". There is a better way, and it's called communication --appropriately and professionally. You did what you felt you had to do, we all do in any situation. What one might do may be different from someone else, but hey, as long as the pt is okay, isn't that what we are there for?

[CRNI-ICU20]

your charge nurse is a ding-dong....you did the absolute RIGHT thing...first response AIRWAY....didn't she take a BLS class for crying out loud??

Calling a rapid response team was the absolute correct thing to do...it advocated for your patient....it put her airway and breathing first....

I would be curious to know what her C02 levels were after admission to the ICU....betcha they were in the 60's...or more....wave that one in your charge nurse's face...ABG's tell the truth of a patient's inner world condition. A respiratory therapist can only give a treatment, they can only "milk" along a patient's DECLINING condition....they cannot reverse C02 levels with an inhaler....she needed postive pressure 02, ie either ventilatory support, or high flow (15L) nasal cannula or bi-pap with maybe some bicarb IV solutions.....not the kind of patient for a busy med surg unit....

Maybe your charge nurse would like to step up to the bedside and recommend alternative treatments for this patient...I am sure she's just got a pocket full! ugh.

[Daytonite, BSN, RN]

the bottom line is that you do what you have to do for the patient first.

where was the charge nurse when this was going on? part of her responsibility is to help guide the other staff nurses when problems like respiratory therapy not responding to calls for a patient in crisis arise. as the charge nurse, she should have been aware that you had a patient who could go bad at any moment. someone needs to go over her job description with her. charge nurse is a leadership position. part of what you heard is her blaming you for her failed performance in this. guess she has a problem accepting responsibility.

now, that the whole situation is over, discuss it with the manager and charge nurse and find out how you could have done this differently, if at all, so the next time you'll be ready. i was a supervisor on the off-shifts. when a patient was in crisis like this, i would have expected a staff nurse having the kinds of dead ends you were running into to have paged me immediately. (i would also have been aware of this admission and her status anyway and be periodically checking with you about her.) i would have been up to your unit by your side helping you out with this in seconds. part of the supervisor's job is to do that. on the day shift, the nurse manager, assistant manager, and next the charge nurse are responsible for those duties. when it's your first time at something like this, you can't be expected to know exactly what to do. that's part of why these management positions exist. you did for the patient and if anyone wants to discipline you, i'd keep repeating that as my reason for what i did.

and, one more thing. i just re-read your post. write the charge nurse up for overhearing her discuss your performance with another nurse while you were in the john. she deserves it and your manager needs to know what kind of a gossiping troublemaker she put into a leadership position. write so it's documented and let the manager decide if she wants to address it with the charge nurse and keep it in her personnel file. for now, this charge nurse doesn't need to be going any farther up the career ladder for this kind of behavior. you can turn the tables on her, but in the appropriate way. hope you feel better about this now.

[reesern63, RN]

Ditto what everyone else said. Rapid response teams are meant for the situation you described.

[anniev]

I have had a few that thought I go over board with my nursing , my reply has always been,,"I have never been called to the office for doing too much" You had no other choice RT's line was busy, on to plan B...

[MS._Jen_RN, ASN, RN]

As others said, you made the right call. Now call the charge on her unprofessional, backbiting behavior. If she had a question about/problem with your jugement it should have been addressed to you and you alone. Let us not judge others lest we ourselves be judged.

~Jen