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?
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!).....
I didnt mention, I did take the BP manual after the dinamap. In fact, I took it manually the entire time after the fact, and it was still in the 200's over 50's-70's. I told the nurse right after I told her how high the BP was, that I was gonna do it manually.
But thanks for your advice, I will definately take heed in the future!
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! :)
Yes, I did ask the patient is her BP normally this high. She said she has high BP, but it never runs in the 200's. I told the nurse this also.
Specializes in Education, Acute, Med/Surg, Tele, etc.
You got it going on!!!!!! Awesome! Way to nurse!!!!!
Yeah, I learned the hard way about the old dyanmaps, and don't use them anymore...LOL!
And yes, although a patient may be up in the danger zone on BP...it is our jobs to try to guide the MD into getting it..LOL! You responded perfectly, and sorry about that RN giving you the old standard of "your place is....". I was just talking to a student who was told she stepped out of bounds once...and she isn't that way at all!!!!!!! I was floored infact, this gal was so appropriate, asked awesome questions (even if she felt they were stupid..LOL...I remember that so well..and well heck...still do! LOL!). But go figure, she was brought into a charge nurse office too...man it about killed her emotionally..and like nursing school doesn't give you enough of that??? Nope, I think from day one of RN school (even before) we have the test on our stress levels very well underway...LOL!
Keep with it hon...you did right on!!! I was just trying to help by playing the evil nurse role there for ya...LOL! (actually quite a good thing to think about at times...because you not only run into nurses, charge nurses, administration and MD's that will gladly and almost instinctively do this to you on a whim!).
Reminds me of yesterday going over the preceptees charting...we actually played a game of Lawyer and Nurse...I went over every single word and we joked about what they would say in a court...it was informative and fun...but real too...well, sadly this incidence for you was real and not fun! But informative yes..because YOU took the opportunity to make it so!!!!!!!!!!!! THIS is a sign of an RN!!!!!!
I just want to thank everyone who responded to my post! Thank you all for the great advice and I will surely take heed of it.
I am just a student nurse, but I love learning. I am open and receptive to growth and change and new challenges.
I am glad to know there are nurses out there like yourselves. I'm glad you all seen this from a different prospective and I feel better about it. However, I'm still a little upset about having to meet with the supervisor tonight.
This was my first time ever working with this nurse, so I will chalk it up to that's just the way she is. It just upset me so much that I was accused of trying to "do her job" because I simply questioned her about the patient's meds and BP. Not only that, why bring in the charge and supervisor when she could have just approached me like an adult? I guess some folks just love drama, I'm just not one of them.
My thing is we are working as a TEAM. I may just be a tech, but when something is not right, I will speak up on it. I will ask questions and if I am wrong, correct me and teach me the correct way. We have to work together for the PATIENT. This is not about egos.
I guess some folks dont see it that way. Oh well, what can you say?
I don't know if you can do an incident report on this but document what happened anyway, to cover your backside. It sounds like this nurse is being defensive, and stirring up the drama to cover her mistakes. (It seems constructive criticism or the possibility of commenting on her mistakes is going to "highly offend" her.) It also sounds like she has a history of this, too.
I don't know if you can do an incident report on this but document what happened anyway, to cover your backside. It sounds like this nurse is being defensive, and stirring up the drama to cover her mistakes. (It seems constructive criticism or the possibility of commenting on her mistakes is going to "highly offend" her.) It also sounds like she has a history of this, too.
Well, I guess I'll see what the nursing supervisor has to say about it. The charge nurse did tell me she will tell the nursing supervisor my part of the story and from what she's heard about me from other nurses, she didnt think I was doing anything other than asking questions since I'm in nursing school. When I told the charge to not assign me to her again in the future to nip this problem in the bud, she replied that no techs on nights wants to work with her. That told me this nurse has issues with other techs on the floor as well.
How do I document this? Would I document this in the patient's chart? I don't know if I could since I'm only a student nurse, although, I do chart all the other info (VS, blood sugars, daily wts).
I think I'm gonna play it by ear. And let me just say, I got my 90 day review with nothing but more than satisfactory marks. I have gotten several outstanding recommendations from the nurses I have worked with. So, this really threw me for a loop that this nurse would be offended because I was simply asking questions.
Specializes in Education, Acute, Med/Surg, Tele, etc.
awesome babe! Yes, play it by ear...but do make sure you documented your findings...that is all you need because...in the law, anything reported by a average nurse as part of clincial findings is just..and hi ya, we all said we would so you are good. As long as you documented your findings...and dependant on what type of charting your facility does (mine is by exception...but if you are worried about CYA we document WHOM we told...good thing always actually) you are in the clear!
Well, I guess I'll see what the nursing supervisor has to say about it. The charge nurse did tell me she will tell the nursing supervisor my part of the story and from what she's heard about me from other nurses, she didnt think I was doing anything other than asking questions since I'm in nursing school. When I told the charge to not assign me to her again in the future to nip this problem in the bud, she replied that no techs on nights wants to work with her. That told me this nurse has issues with other techs on the floor as well.
How do I document this? Would I document this in the patient's chart? I don't know if I could since I'm only a student nurse, although, I do chart all the other info (VS, blood sugars, daily wts).
I think I'm gonna play it by ear. And let me just say, I got my 90 day review with nothing but more than satisfactory marks. I have gotten several outstanding recommendations from the nurses I have worked with. So, this really threw me for a loop that this nurse would be offended because I was simply asking questions.
As far as documenting in the chart, you can ask the charge nurse if you can and how to go about it. But even if you can't, you can write down what happened and keep it in a safe place. Write down what you did and said, what the pt. family said, and your interaction with the nurse, all the facts with what time each thing happened. You did nothing wrong by asking questions, and I see no reason why the nurse would have a legitimate reason to be offended.
Number one you are not just a student nurse and you are not just a tech. Don't cut yourself down.
As far as documenting the incident, I keep a personal journal with the date, shift, who was involved, what was said, what the response was and the outcome. I don't include pt names, but will use the room number if it is pertinent to do so. We also have personal improvement forms, I occasionally use those if face to face confrontation doesn't work and I keep a copy for myself. Those are just some of the things I do to document.
Good luck with your supervisor, I am sure things will go okay. Do remember this as a learning experience so when you get your license, you have this to reflect on and will not respond as this nurse did.
You are going to be a great nurse. However, I must say, I love what the other nurses have said on this site. You guys seem to be very supportive of students. In the real world, I encounter more of what this great future nurse has. Nurses that I have met look at me as a Tech and don't want me to get involved in assessing and trying to figure out what's wrong with their patient............even for learning purposes. They treat me like "You haven't passed boards yet, just clean the poop, take the vital signs and shut up!" How sad.
I wish all of my aides were as competent, caring, and interested as you. Keep up the good work. You did nothing wrong. Just consider this a lesson in learning who you can ask questions to, and who you can't.
shoegalRN, RN
1,338 Posts
I didnt mention, I did take the BP manual after the dinamap. In fact, I took it manually the entire time after the fact, and it was still in the 200's over 50's-70's. I told the nurse right after I told her how high the BP was, that I was gonna do it manually.
But thanks for your advice, I will definately take heed in the future!