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I feel like I caused harm to pt

First Year   (4,182 Views 20 Comments)
by psmithlove psmithlove (New) New

717 Profile Views; 12 Posts

After working ltc for a yr after getting my rn. I was excited to get a position on the med surg floor at my local hospital but last night scared me so bad. I don't think I can go back. I'm still getting oriented but a pt c/o diarrhea, abdominal pain and a HA. I got my trainer and the pt started to c/o chest pain. Took vitals n bp was 100/55. Asked if we should give nitro prn and she said yes. After 5 min she has no pain after emesis. Preceptor says pt is overreacting and isn't having chest pain so no EKG is needed.

6 hrs later pt takes o2 off after getting levaquin ivpb and is sob with 02 sat in 70s n sbp drops from 94 to 82. Dr called n sent to ICU. Preceptor claimed she didn't know pt had chest pain and I was working on my own. I get a call from supervisor asking me about this plus I forgot to chart chest pain. Only diarrhea n preceptor charted emesis. My supervisor said I was unsafe for giving nitro with low bp but my preceptor said it was fine n pt was faking mi. I don't know!

I feel like I should quit acute nursing. I guess I just needed to vent but I'm probably going back to ltc job. :( supervisor said no one is in trouble n she's not pointing fingers but I need to come in to fix charting ..

Edited by psmithlove

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TheCommuter has 10 years experience as a BSN, RN and specializes in Case mgmt., rehab, (CRRN), LTC & psych.

1 Follower; 228 Articles; 27,607 Posts; 317,943 Profile Views

Your preceptor lied to cover her own behind, and in the process she made you out to be the fall guy. She blatantly lied when she claimed she didn't know about the chest pain. She lied when she said you were working alone.

It is up to you to tell the truth. Good luck to you.

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bsyrn has 20 years experience as a ASN, RN and specializes in Peds, School Nurse, clinical instructor.

795 Posts; 12,242 Profile Views

I am sorry you are in this situation. Obviously your preceptor is only looking out for herself. Unfortunately, you did not chart the chest pain and your supervisor was right, nitro with a B/P of 100/55 was not the right thing to do. Hopefully some re education will be done and you will get a new preceptor. Best of luck.

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westieluv has 26 years experience and specializes in Med/Surg, Tele, Dialysis, Hospice.

948 Posts; 19,726 Profile Views

I have been an RN for 25 years, with several years experience working Med/Surg Tele. Here is my take on this:

When the patient first complained of chest pain and her BP was 100/55, the preceptor should have had you call the doctor and report the chest pain, along with any other apparent symptoms, and that the patient's BP was that low and then ask the doctor if he wanted you to go ahead and give the Nitro and if he wanted an EKG. For a nurse to decide on her own that a patient is faking chest pain and "overreacting" and therefore does not need an EKG is incompetent and downright scary. She is not a doctor, and this was a call that a doctor should have made. An EKG would definitely have been in order in this situation. It is not up to us as nurses to decide if a patient is really experiencing a symptom or not, especially something as potentially serious as chest pain.

Yes, you should have charted the chest pain, but as a nurse who is new to acute care, I feel that your preceptor should have guided you better in how to handle this situation, and the fact that she lied about knowing about the chest pain indicates to me that she realized that she screwed up big time and was lying to cover her behind.

I hope you won't give up, because to me, this situation sounds like it could have been avoided if you had had a competent preceptor. What should you take away from this? That you never, NEVER do what your preceptor did and ignore a patient when they complain of something and chalk it up to "overreacting". That is never our call, so when in doubt, call the doctor, that's what they are there for. If they order something like an EKG and it shows nothing out of the norm and it turns out that the patient was indeed "overreacting", then no harm done. But if something cardiac is going on with the patient, you will never be sorry that you got the order and you may very possibly end up saving their life.

Go in and fix your charting, and move on, but if you continue with the same preceptor, be very, very wary of her nursing judgment and if you find yourself in another situation like this, seek out someone else and ask them what they would do.

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Barnstormin' PMHNP has 4 years experience and specializes in psychiatric.

349 Posts; 14,980 Profile Views

Do what ever you have to do to get a new preceptor. That preceptor should not be allowed anywhere near patients, she is incompetent, period. I would not be able to trust a single thing she would tell me from now on, and I'll bet you dollars to donuts that the supervisor knows she is incompetent so getting a new one might not be as difficult as you think. Also, charting is a pain but it is your best friend in situations like this. You should chart everything, med surg is a very different ballgame than LTC. Refreshing your memory about acute care with a book or pocket guide can help you to deal with emergent situations.

I don't know how old you are or how outgoing, but I personally would not be able to keep my mouth shut about her, UNLESS the unit culture is so warped it would do no good. Then I would look for another unit.

Sorry this happened to you.

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101 Posts; 3,658 Profile Views

Your preceptor has no business being a preceptor.

As for giving NTG with that BP, I would have been comfortable doing so and I probably would have. However, any time a nurse has a patient complaining of chest pain, NTG given or not, the physician should be notified. Use this as a learning experience. Always be aware of unit protocols involving situations like this. Also, keep in mind that even if the EKG had been done and doctor notified, that doesn't mean the patient would not have needed transfer to the ICU. Things can happen quickly.

Don't quit! :)

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12 Posts; 717 Profile Views

Thanks! I feel better a little uneasy but I'm not even out of orientation yet. But the pt is being discharged today so that makes me feel better. I'm getting another preceptor also! My old one told me not to follow up on prn meds unless they are pain meds and I told my supervisor that and she was not too happy obviously.

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Barnstormin' PMHNP has 4 years experience and specializes in psychiatric.

349 Posts; 14,980 Profile Views

Excellent! So glad to hear that!

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flyersfan88 specializes in Trauma, Orthopedics.

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Chin up, deep breath. You're going to be fine.

I've learned in my few short months as a nurse to just do the EKG no matter what. It takes 5 minutes to be better safe than sorry. The doctors always appreciate it that I initiate the EKG before calling them so that they can look it up on the computer while we're on the phone.

That preceptor is a whack job. Glad you're getting a new one.

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westieluv has 26 years experience and specializes in Med/Surg, Tele, Dialysis, Hospice.

948 Posts; 19,726 Profile Views

Thanks! I feel better a little uneasy but I'm not even out of orientation yet. But the pt is being discharged today so that makes me feel better. I'm getting another preceptor also! My old one told me not to follow up on prn meds unless they are pain meds and I told my supervisor that and she was not too happy obviously.

Yikes! She doesn't follow up on PRN meds and she assumes that a patient with chest pain is faking and blows it off. It makes me wonder how many other nurses there are out there who are this incompetent and get away with it, especially since someone in that facility deemed her qualified to precept a new nurse. I'm so glad that you got a new preceptor. Hopefully your old one is close to retiring if they don't fire her first.

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Farawyn has 25 years experience and specializes in A little bit of everything..

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I'm sorry this happened. Please don't let it discourage you. Always check med parameters, and if you are unsure ask a doctor to clarify.

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NickiLaughs has 10 years experience as a ADN, BSN, RN and specializes in Emergency, Trauma, Critical Care.

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Your new, mistakes are likely to happen regardless. Experience and safe practice helps. Realizing how serious a med error can be helps. A better preceptor will definitely help.

The point of a preceptor is to teach safe practice and she wasnt.

ANy c/o chest pain should have an EKG. Nitro dependent on BP and if not on meds that might interact. I usually put on a couple liters of oxygen for the patient because if nothing else it decreases their anxiety. Morphine if the doc orders and theyre mentating ok with stable BP.

PRN meds should be checked for effectiveness or else how does one know if they are working?

With time and giving yourself a chance, things get better. It took me 6 months to not be scared at work. Another 6 months to feel not completely stupid. Now 6 years on im not scared goong to work, im confident in patients rooms and I know when I need to ask for help. All nurses regardless of skill level have times where they need help and its best to know when to ask. Earlier is better.

Good luck and just breathe and keep learning.

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