I need advice!

[AryaJames]

Hi. I'm a new nurse. I just graduated in Dec '11 and have only been an RN for about 10 months. I work in a nursing home. We just hired a new DON and two new floor managers - all of whom are friends with our COO - and a couple things have happened that I just don't know what to think. I don't have years of experience to rely on, and I feel like I have no one to ask advice for.

One thing that just happened over the weekend was that I was the charge nurse. Our "manager on duty" was the head of activities - great for when there's nursing-related emergencies, right? Right before change of shift I got a stat page to go up to a floor. I had never worked on the floor before, didn't know the residents at all. I ran up to find a resident lying on the floor, her wheelchair a few feet away. Her nurse was already there, getting vital signs and assessing her. They had found her like that. They hadn't moved her wheelchair. She was lying on her side. The fall was not witnessed, so we don't know what happened. She has severe dementia and is unable to tell us if she's in pain - so we carefully rolled her on her back and I did range of motion. She was lying on her left side. Her right side I was able to do ROM just fine; her left side she was resistance and was fighting me. She wasn't crying out or grimacing at all, though. Her eyes were tightly shut, I had to have the other nurse hold the flashlight while I practically pried her eyes open. Her pupils were equal and reactive, although she was already getting a nice bump on her head. Her hip didn't seem like it was beginning to bruise or swell. The nurse told me that a few years before, she had fallen, broken a hip, and was actually walking on it before it was found. I wasn't sure what to think. She didn't appear to be in pain, but what if she has a high pain tolerance and we just couldn't tell? I felt like something was a little off, but had no idea what. Maybe she had broken the hip and wasn't showing any pain. I told the nurse to call the on-call doctor (who happened to be the resident's normal doctor) and she asked for x-rays here in the building. The doctor responded, "no, no! Let's just send her out!" So we sent her out. After everything calmed down, I learned that one of our managers was actually in the building but hadn't bothered to show up for the stat page. I called the on-call manager and had to leave a message, as she didn't answer. By this time it was change of shift and I was so behind I had to stay and finish charting. The manager called back about a half hour later (oh, and she was the manager of the floor we sent the res out on) and started asking, "Why did you send her out? Didn't you do ROM? Didn't you straighten her legs to see if one was shorter than the other?" Of course I did. Forty minutes later, the DON calls. She says, "Why did you send her out? Didn't you perform ROM?" YES I DID! I felt like they were calling me incompetent and not believing me! My manager went on to say, "you should have gotten x-rays here in the building. You should have been the one to call the doctor." She barely let me explain. She also said, "now we have an ambulance bill to contend with." Seriously? She said I should have called the doctor back and asked for the x-rays here. So, I should have questioned the doctor's order to send her out when the x-rays were asked for and the doctor said no? I felt like that was definitely wrong. Well, it turns out that the resident didn't have a broken hip - but she did have a head bleed. So if I had listened to the DON, and questioned the doctor's order, IF I didn't get chewed out, we would never have found the head bleed, she would have died, the coroner would have gotten called and I would have been at fault!

I felt so alone. I felt like there was no one there to ask advice. I think what I did was right, but then why are my managers, who have more experience and education than me, questioning my assessments and my competence? Maybe I 'm overreacting. I don't know. I don't know what to think. Did I do something wrong? Even my mom says I'm overreacting. I don't know what to do or think anymore! Augh! This is driving me insane and I'm starting to think maybe I am incompetent!

[CrunchRN, ADN, RN]

You did right. Sometimes you just have to nod your head and then when the situation happens go with your gut. Also, you cannot go against an MD order and it is the MD's call ultimately.

[monkeybug]

"Where were you when I paged you?" You did the right thing. MD was notified, orders were given and followed, end of story.

[kreed]

You did the right thing!! Similar thing happened to me in my first LTC position I had only been there 2 weeks. I was written up the next day. When they found out the extent of the pts injuries they removed the write up from my file and apologized. Always go with you gut!!

[blugreeneyez]

you did the right thing. I worked at a LTC facility at one time. I worked on a vent unit which consisted of 24 vent dependent patients most of which had GTs and it was myself two CNA's and a Resp therapist. I understand what you are talking about most DONs at those facilities are worried about thier bills getting paid and not really patient care or quality of life. You are a RN and you must take the MDs orders as they are given. The only problem I see is that they should have questioned the RN that actually took the order from the MD. Most MDs get very upset if a nurse questions the order they have given unless its and error that could cause the patient death etc... With my experience I was expecting a patient to return from the hospital and that was ok what I wasn't expecting was the patient that showed up in an ambulance bagged on her trach with three CVC lines running and no vent, room or pump available for her. I called the owner of the facility and she said oh yeah I ok'd her go ahead and admit her. She failed to inform me that this patient was coming. Needless to say I gave my two week notice and moved on. My license was on the line not the owners. Owners forget about patient care and quality of care and see $ signs before anything else. I know its a sad situation, but as the others above me said go with your gut you know what you are doing don't let them make you feel any different. ALWAYS CYA don't depend on them to do it for you.