I'm a little unsure of how to handle this.....

twinmommy+2, ADN, BSN, MSN · Mar 8, 2007

I think I would have done the exact same thing. Did he end up getting moved? I know you said that he died the next night but not if they moved him or not.

Trauma Columnist · Mar 8, 2007

How upsetting for you - on several levels! I'm so sorry for this loss. I think as long as nothing is in your personnel file I would let it go. However, if this is punitive, then I would certainly want to set things straight.

crb613, BSN, RN · Mar 8, 2007

He did not get moved, and yes it is upsetting. Nothing in my file that I know of. I just got my eval, & not on it...got a great one btw! Is it unsual for a charge on a different shift to take such an interest? He was 26 years old came in w/pneumonia, ended up on a vent....ARDS & then had a MI. So very sad.

twinmommy+2, ADN, BSN, MSN · Mar 8, 2007

I would think that they took an interest because they took over his care after your shift. Essentially this was their patient too, so when the parents asked (or just had questions about) moving him, the charge on days was probably involved.

I'm so sorry you had such a difficult night. I pray things go well for you.

muffie, RN · Mar 8, 2007

the parents were fortunate that you provided support during a most difficult time

AnnieOaklyRN, BSN, RN, EMT-P · Mar 8, 2007

what made him code, do they know???

Swtooth

TazziRN, RN · Mar 8, 2007

If I were you I would write it up in detail and hang on to it, just in case something is said later on. The longer you wait to write it up, the greater the chance of forgetting something crucial.

You did nothing wrong. You were directed to talk with the parents by a superior, and you had a more experienced nurse with you. The ideal person to talk with them would have been the doc, but he was a bit occupied at that moment.

People under duress do not hear (or remember wrongly) the things said to them. That's why having another nurse there is a good thing, and you did that. Good for her for standing up to you. It sounds like the day charge thinks something happened and just wants to get involved in it. Protect yourself by writing it down, but don't worry about it.

vamedic4, EMT-P · Mar 8, 2007

crb...I'm so very sorry for what you have gone thru, but let me assure you that you have done the right thing. The following is something that your day charge nurse is missing, and it's pretty blatant.

The parents deserve to be kept informed about everything that is happening with their child. Thank you for doing this.

We all know that you don't need 20 people in the room to code someone ...and unless you're putting them on ECMO or actively involved in CPR/giving meds or bagging...perhaps your time is better spent keeping the family in touch with what is probably the most traumatic experience they've ever had. Just about EVERY person I orient seems to forget this.

While we all have a responsibility to provide the best care, when it comes down to the code - someone has to keep the family informed. It can't be the physician...he's a little busy. It can't be the person bagging the patient....so who should it be?? Anyone who can accurately describe what is happening and why. It's simple. "Right now we are breathing for your son because he can't breathe adequately enough on his own. They are going to give him some medicine and put a tube into his trachea to allow us to breathe for him." IF you are unsure of questions that you are asked, find someone who can help you, or wait to have them talk to the physician...just as you did.

I'm sorry this happened to you. The parents probably went to the day charge and said "but the nurse this morning told us".... People will say just about anything to get what is perceived "better" care for thier loved ones. They'll also forget who said what EXACTLY, because, again...this is a very stressful experience for them.

Good for you. I hope it all works out.

vamedic4

The sun is back!!

crb613, BSN, RN · Mar 8, 2007

Thanks so much to all of you! He had also coded the night before....I was off so I don't know what happened then. This time his sats dropped to the 30's...his mom was at the bedside. The charge said his cuff had de-flated...I just know when I was there, his doctor & the pulmonoligst were called. The nurse that made the call came back & said, both of them had refused to come...the pulmonoligst said he wasn't on call, don't know why his doctor refused. In the meantime the ER doctor was there preparing to re-intubate him, all the time he was being bagged. This doctor was nervous & said..I don't know if I can do this or not. My charge nurse said...I know you can do it, we are here for ya....and if you can't I can. When she got the news that the other two doctors refused to come in....she went off. Sent word to his doctor to either get his a@@ in now or she would ship him....she said tell him this kid is on his way out. It was crazy but a controlled crazy.

The doctors both appear, stand there, all the time the charge is giving orders for labs, xrays, sats, bagging & suctioning. They do not re-intubate, put him back on the vent,& just tell us to keep re inflating his cuff....that's when I left & went to talk to the family. I do not know if they even spoke to any doctors that night.....his dad did come & find me later, hugged & thanked me. I felt so bad for them, & thought if you only knew.....but that I kept to my self. I was off the next night when he died.

meandragonbrett · Mar 8, 2007

Was there a reason given for not reintubating? Is there not an intensivist in house?

RosesAreBlue · Mar 9, 2007

Responded to a code (1st one). Get there & it was a childhood friends son. Bad, bad shape. When I left the code the 1st people I see are the parents. There had not been anyone out to talk to them yet, & they were beside themselves. I gave them a update, but they had so many questions that I could not answer. I went back to my charge that was also at the code, & passed on the questions. She told me to take their son's nurse, & go talk to them.
Together w/their nurse we tried to answer questions. They asked about transfering him to a larger hospital. We both told them we could & would not say if he should/should not be moved....this should be discussed w/the doctor. We explained, (the other nurse mainly) the benifits of a larger hospital, but also how unstable he was, & it would have to be their call. He died the next noc.
Now....all of a sudden it is being said that I told the family he should be moved. My charge & this other nurse both stood up for me, & said I did not do this....that I did nothing wrong. For some reason a day charge nurse ( I work nocs) decided I needed to be talked to.....and have hospital policies explained to me. Seems like everybody knew about this but me. She did come to my unit & stand around but never said anything. My night shift charge is the one who told me about the whole thing. I read enough between the lines to tell they had a pretty heated conversation about this.
So what is your advice....should I just let it alone, or set the record straight? Dang what a bunch of crap!

Sounds to me that the daytime charge might have something against you, to be spreading lies like that. Maybe you did something to offend her and she wants you fired? But personally I don't think you should have handled that particular case, considering you knew the family well. It could rattle anyone's judgement. You did the right thing though. If the kiddo was unstable, he surely would have died in transport, even in a Flight For Life copter. Maybe something that could have been done was to call a specialist from a larger hospital to see him, but then again the doctor may have gotten there too late to do anything anyhow. You did what you were trained to do and what felt right. Be proud of that and don't let that other nurse get to you. She's just being mean.