I'm so mad I could SCREAM! (LONG)

[shoegalRN, RN]

Ok, here's the story. I am a nurse intern going into my 4 semester. I work on a Med-Tele floor and I work nights. I have NEVER had a problem with any of the nurses I work with. In fact, I have been requested as the "tech" by several nurses. All the nurses I have worked with know I am in nursing school.

Well, last night I work and I am doing q 4 VS. One of the patients have a BP of 215/70. I ask the patient was she on any BP meds. She tells me Clonidine. The patient's family member was in the room as well. The patient then proceeds to tell me that she had not had her meds including the Clonidine since she's been down for a MRI. I tell her that I'm quite sure the nurse heard something in report and she will be in to speak with her shortly. The family member wanted to reconfirm the BP (it was done on a dinamap).

I leave the patient room to tell the nurse about the high BP. The nurse is sitting at the nurses station and the family member comes to the door and says "I just want to make sure, what was her BP again?" as I am walking away with the dinamap. I tell her what it was and tell her I'm in the process of speaking to her nurse about it.

I ask the nurse if she knew if this patient was on Clonidine and if so, when was the last time she had it because her BP is very high. I tell her what the patient told me about not having her meds since she went for a MRI.

The nurse says she will check the orders and go in and speak with the patient.

I go about my night as usual.

The nurse ask me to keep an eye on the pt's blood pressure and to take it manually instead on a dinamap. I did. The BP was still high, despite whatever drug she was giving her and it wasnt Clonidine (because the nurse said it wasnt ordered, it was a home med). So, when I told her the BP, I asked her "is she on a beta blocker or something?" She told me "yeah, but I don't think it's working", so I asked her "does she have something else ordered?" She ignored me.

This is nothing new I do. I ask the nurses questions all the time when I'm trying to piece together the big picture. Most nurses are receptive to my questions and are eagar to teach.

Why did I get pulled into the office by the charge nurse with a complaint from this nurse? The nurse told the charge nurse I told the patient and her family member she had not been given her meds for today. How can I tell the patient anything like this when I don't even KNOW this patient's meds? This is what the patient told ME and I told the charge nurse this. Then she said the nurse told her I was "questioning her about the patient's BP meds and asking her what she is gonna do about it". I told the charge nurse what the patient's BP was and if the patient was on any BP meds and the patient stated she takes Clonidine, in which, I relied to the nurse.

The charge nurse said this nurse was highly offended that I was asking her questions and was in tears. I really don't understand when I was not rude to her, nor talking to her in a condesending tone. I worked in telecommunications for over 14 years, I know how to communicate and speak to people. The charge nurse also said that this nurse emailed the nursing supervisor, so I will most likely be having a meeting with her also.

So, I told the charge nurse I am not at work to create drama and if she felt my asking questions for knowledge was too much, then please don't assign me to her again and we can keep it at that. The charge nurse said that she understands I am in nursing school and wouldnt be offended at all that I was asking questions about abnormal vital signs. She basically told me not to worry about it and basically this nurse does not get along with any of the techs on nights.

So, I go back to the floor and address the nurses (including her) and tell them if they have a problem with me asking questions, I apologize because I'm just trying to learn. I'm not there to "take over anybody's job" or "step over boundaries" by questioning things I've been taught in nursing school and trying to apply it in the real world. The other nurses said they have no problem with me asking questions and would be kinda suspecious if I didnt ask questions, considering I am in nursing school. Of course, the other nurse just sat there staring at the floor.

I am sooo upset about this! Not only do this nurse NOT come to me directly about any issue she may have had with me personally, she got the charge nurse and nursing supervisor involved. I wanted to confront this nurse so bad, but the charge nurse decided it was best that she speak with us separately because this nurse has a hx of taking something so small and blowing it out of porportion (the whole crying thing is beyond me).

What are your thoughts? Do you think I did the right thing? What would you have done if you were the nurse or me in this situation?

[RN1982]

I think I'm offended that you go pulled into the office for that. So after the RN gave the meds and the BP was still high, did she ever contact the doctor?

[shoegalRN, RN]

I think I'm offended that you go pulled into the office for that. So after the RN gave the meds and the BP was still high, did she ever contact the doctor?

Yeah, she FINALLY called the doctor after the 3rd BP check and it was still high AFTER she had given the med.

And I asked her about that too. I asked her if maybe the doctor had ordered Clonidine and it's not on the emar?

[pagandeva2000, LPN]

Sounds to me that this nurse was unsure of herself and even though you asked her simple questions, she couldn't handle it. Anyone confident in their knowledge would not have felt that way, especially from a nursing student. I think you did the right thing and from now on, when interacting with this person, give her the information and let her be the licensed professional that she is...(IOW, let her hang on her own).

[RN1982]

Sounds to me that this nurse was unsure of herself and even though you asked her simple questions, she couldn't handle it. Anyone confident in their knowledge would not have felt that way, especially from a nursing student. I think you did the right thing and from now on, when interacting with this person, give her the information and let her be the licensed professional that she is...(IOW, let her hang on her own).

I agree.

[BlueRidgeHomeRN]

there will always be some nurses who are threatened by other's competancy...you will see this nurse again everywhere you work, with a different name and face:rolleyes:....

you did nothing wrong. the nurse should have taken a better history; or at least be glad that someone caught this. you were a patient advocate, which is what your role will ultimately be. in the process, you, a "mere tech", made this chickie look bad. of course, her feelings are much more important than saving a pt from a potential stroke!!!

roll with this, dear.....don't let anyone else drag your level of care down.

[justme1972]

Sounds like the nurse was trying to cover her butt by letting the BP get so high by shifting the focus to you.

Did you happen to look at the chart? I am wondering if the CHART stated that the med were to be ordered post MRI and the nurse missed it.

I just happened to notice that you post didn't say said that that nurse reviewed the chart for changes...but just ran to the supervisor crying a river saying you were rude to her...so no one would think to pick up the chart to check.

To me, that would have been a natural response as soon as you told her that she hadn't had her meds, her BP was high, is to pick up the chart first thing to see if an order was there or if the physician omitted it.

I'm a student, not a nurse..I'm just kind of throwing it out there...

[cupcake25]

I want you to know that you have done nothing wrong. You did everything you could to help the patient. I don't think the nurse was doing her job. You don't just sit on a high BP. You sound like you are going to be an excellant nurse. Just realize that some nurses are better than others and there are alot of nurses out there that will stab you in the back.

[Beary-nice]

First and foremost, I applaud you in wanting to learn by asking questions. I would enjoy working with someone like you and would encourage your learning and growing experience. It sounds as if this nurse was unsure what to do and couldn't see the big picture and maybe doesn't care to be told that directly or indirectly by anyone. Gonna be a rough time for this person.

My only concern out of what you said was telling the family member that you were quite sure the nurse had heard something about it in report. I guess I would have told the family member that I would report the blood pressure and the information given to me about the Clonidine. Then I would have followed up with the family member and said that I had reported the info to nurse so and so. I had an experience once where a tech had something similar to a family member and the patient, when that wasn't at all how it went down, then there was a mess to straighten out.

It also seems to me that this nurse doesn't have confrontational skills and has to go gnashing teeth into a supervisor rather than catching you on the spot and verbalizing her concern. Again, gonna be a rough ride for this person.

Good job and keep pressing on!

[Antikigirl, ASN, RN]

There is such good advice and support here...I will try to be the devils advocate (although hard)....

Okay...hmm...my only advice is to always remember, TREAT the patient not the machine...and along with this comes doing an immediate MANUAL BP and pulse then report to the nurse. Cause frankly...my first question would be..."Did you do this on the machine? What is the manual????". If that wasn't done, I make you go back! (and if I am not up to my eyeballs in stuff...I go with you, or have you wait till I can...not going to leave ya hanging, but that is me!).

So lesson one, always do manual on any odd readings! You would not believe how many times things are solved this way by machines not working correctly or simple anatomy not meching with the machines limited diameters! :) (I take all MANUAL...I don't trust dinamaps or even pulse ox...9 times out of 10 they are incorrect and cause undo panic!).

Okay the biggie in this case must have been FAMILY! Want a bad situation 50 times worse...have a family member in the room! LOL! (you students will learn this...). So oops, family member getting anxious...now we have a situation! That could very well be what set your nurse off. Many nurses are awesome with patient care, but not as good with family dynamics and communication...and this would tweek them out (especially on a busy day, and I don't mean running as much as mentally busy!). So we started with a MACHINE saying a high bp...no manual checked...and now an overly anxious family member..all from a VS check...okay high gear time with complications!

ALSO! A MD may have NOT wanted the patient on their home meds because they were not working and wanted to check baseline without them to be able to prescribe something more appropriate...so don't assume that that med given by the nurse was a wrong one clinically...we run by the whim of the MD my dear...and we don't prescribe. Plus many MD's get very egosentric if you question or give suggestions...and will actually STOP where they are an order nothing! Another pearl of wisdom...KNOW your MD's and their little personality tid bits...she may have known this Doc better than you and had to approach it slowly as not to screw up the works!

So okay..lets see where we are now...high bp on a MACHINE, no manual taken, anxious family member, and the social dynamics of dealing with the MD and still...get things done to satisfy the patient, family, MD, and you!

I think I can safely stop here...just think about these dynamics because they happen ALL the time! Another part of the art of nursing you will learn as you go along (especially the fact that FAMILY PANIC over ANY medical term or vital sign, and expect instant results from the RN to correct it!!!!!! They don't know the hurdles we have to jump through to get a simple order!)....

HOWEVER...you did excellent in reporting that BP in a timely mannor! AWESOME! Just next time take a manual then report!

Being called in however...your a student...what good is that??? Oh yeah...it scared you, made you doubt yourself...not appropriate or pro learning!!!!! I think that was a catty thing to do...it isn't like you aren't stressed enough learning...shoot! I would talk to you after and during actually I did my implementations to solve the issue to teach you...so next time you know what is involved in solving a probelm on many levels! That would have been much more proactive!!!!!!

Take it as a learning experience because this not only happens in school...but in the job arena as well! Learn how you deal with this personally and professionally...that would be the greatest thing to take from this!!!!!

Good job! I would have totally understood your reaction and guided you through the process with a few laughs along the way (cause that is how I teach!).....

[Antikigirl, ASN, RN]

Oh yeah...just a learning thing here, when it comes to odd VS...always ask two things right off after getting a manual.

1. Are they symptomatic?

2. Is this out of their norm?

Chances are the first thing the MD will ask you are these two questions...have those answers ready (for your RN when your are a student too!). Saves time and may just answer some of the puzzle of an odd VS!

Hope that is helpful too! :)

[mesaray]

It sounds so odd to me that a nurse who is suppose to be a model and teacher to you would get offended by asking that question. Shame on her!!!!!!!!!!!!! I think that you absolutely did nothing wrong my dear..... You don't let those kind of nurses get to you and bring your spirits down. You have every right to question if this med was given especially when this patient's b/p was that high. If I was that nurse, I would think that I have a smart student on my hands and I would totally appreciate and invite the investigation. I wonder if she did something wrong and was trying to turn the tables here. Take a DEEP breath and just move on. Cheers to you for being a good nurse!:heartbeat