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 ..
Specializes in Mental Health, Gerontology, Palliative.
Glad you are getting a change.
Sorry if it seems like an old harp however document, document, document. If someone tells you something, write it in the patients notes what was said, and what you did. Far lmore difficult for them to throw you under the bus if its documented.
I had a situation about a month ago, I was told to take a fentanyl patch from one patient to use it for another patient whose patch had been increased but not come from the pharmacy yet. Very much not offay with policy however did not have alot of choice, patient needed the increase
I wrote in the patients notes "After consultation with RN X, 25mcg fentanyl patch taken from patient A's supply to give to patient B as needed for increased dose. RN X to remedy this on Monday". Also wrote similar in the controlled drugs register.
I'm really sorry this happened to you too, and I sincerely hope your manager investigates this 'preceptor'.
As far as I know, ya CAN'T work independently IF you have a preceptor LOL. I have a suspicion your manager saw right through your preceptor's pathetic excuses, whether or not she/he said anything to you about it. Even if you do all the nursing work, the preceptor is responsible to FIND OUT what the heck is going on with your patients, even if it's just to ask you.
Anyway . . . don't let a lovely effed up learning experience like this pass you by! Unfortunately some of the best 'lessons learned' are initiated by a mistake, hopefully not a costly one.
Now you know the (UNIVERSAL I must say!) protocol for how a nurse should respond to a complaint of chest pain. You will never be in this situation again :) no matter how incompetent your preceptor or charge nurse may be. The preceptor made so many juicy 'lesson learned' mistakes I could write a whole paragraph on them. Suffice it to say chest pain is always a big deal, always reportable no matter WHO says what, even if it turns out to be heartburn from the tomato sauce. Your preceptor's attitude is basically a highway to Hell in a handbasket -- no one fakes chest pain and if they do, they're gonna get a cardiac work up for their troubles .
And never, NEVER throw another nurse under the bus. It is very bad karma. It is the worst karma, I think.
Look up the definition of "preceptor". It means "teacher, instructor". I'm still trying to wrap my head around the fact that this "preceptor" was teaching another nurse to ignore chest pain and assume that the patient was "overreacting". That almost gives me chills. Thank God this patient lived to tell about it. The next patient may not be so lucky.
One of the cardinal rules of nursing 101: Pain (or any other symptom) is ALWAYS what the patient says it is. If it's nothing, testing will show that. If it's something, you will never be sorry that you listened to your patient.
What your preceptor was deplorable. I precept a lot I take complete responsibility of the nurse I am orienting. She needed to be a teacher and mentor to you not throw you under the bus. You did the right thing calling your preceptor when patient complained of chest pain from there she did not handle the situation right. Glad you are getting a new one. That said sounds like your facility needs to have a process in place for handling chest pain. Where I work if a patient complains of chest pain no matter how mild we call a chest pain rapid response and the ccu charge nurse , a respiratory therapist, ekg tech, lab tech and a dr all come. There is a protocol they follow including nitro if appropriate, aspirin and morphine if appropriate and an ekg. We caught a lot of MI's this way and its takes the pressure off of the nurse since she does not have to try to handle the situation on his/her own.
OP - just to make it all more confusing ... Not all cardiac pain is the classic crushing substernal chest pain, especially in women. Back pain, nausea, diarrhea, especially if accompanied by anxiety or diaphoresis can all signal badness. I had one patient whose massive MI was signaled by pain in her jaw. My partner's best friend died of an MI when she laid down to relieve her back pain. My partner's fatal MI caused no pain at all - just n/v/d and cold sweats.
Your preceptor's index of suspicion should have been way higher than it was.
Specializes in Adult and Pediatric Vascular Access, Paramedic.
#1 if a patient complains of chest pain DO A 12 lead EKG, even you think they are crying wolf, because that one time that you don't do it!
Time is heart muscle, so it is not worth the risk... The patient having an MI that goes unrecognized for hours is at high risk for
cardiac arrest and long term sequelae, including CHF.
#2 Vomiting and diarrhea can be a symptom of an inferior MI, look it up, and in inferior MI the patient can have right ventricular MI. In
the case of right ventricular MI, administering Nitro can be detrimental and cause a precipitous drop in BP which they
may not recover from, although is is a very small percentage.
#3 Your preceptor sounds like she or he does not know what they are doing, or they are lacking common sense. I would sit, talk to the nurse manager about what happened, and ask for a new preceptor.
#4 When your patient complains of pain, NEVER assume they are faking, actually when it comes to anything having to do with medicine
and a patient don't assume!
#5 From this you may learn to speak up if your preceptor, a doctor, or anyone else is doing something you are uncomfortable with.
Good luck and glad to see you are getting a better preceptor!
OP - just to make it all more confusing ... Not all cardiac pain is the classic crushing substernal chest pain, especially in women. Back pain, nausea, diarrhea, especially if accompanied by anxiety or diaphoresis can all signal badness. I had one patient whose massive MI was signaled by pain in her jaw. My partner's best friend died of an MI when she laid down to relieve her back pain. My partner's fatal MI caused no pain at all - just n/v/d and cold sweats.
Your preceptor's index of suspicion should have been way higher than it was.
Heron, I'm very sorry for your loss!
My mother-in-law didn't die from hers thankfully, but leading up to it (she'd had a 90% occlusion of her LAD) she was crabby and anxious a lot, and had acid reflux type discomfort. Then when it happened, she said she just felt strange, then she vomited and arrested.
supervisor said no one is in trouble n she's not pointing fingers but I need to come in to fix charting ..
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Tenebrae, BSN, RN
2,021 Posts
Glad you are getting a change.
Sorry if it seems like an old harp however document, document, document. If someone tells you something, write it in the patients notes what was said, and what you did. Far lmore difficult for them to throw you under the bus if its documented.
I had a situation about a month ago, I was told to take a fentanyl patch from one patient to use it for another patient whose patch had been increased but not come from the pharmacy yet. Very much not offay with policy however did not have alot of choice, patient needed the increase
I wrote in the patients notes "After consultation with RN X, 25mcg fentanyl patch taken from patient A's supply to give to patient B as needed for increased dose. RN X to remedy this on Monday". Also wrote similar in the controlled drugs register.