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

[shoegalRN]

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?

[Virgo_RN, BSN, RN]

Let me play Devil's Advocate for just a moment here.

As a new nurse, I'm doing all I can to keep my head above water. I do not have time to answer a bunch of questions or to teach the CNA about nursing. I prefer for the CNA to do their job and let me do mine. Report abnormals to me and let me handle it. If you want to learn from me, just observe quietly and please, for the sake of the patient, don't interrupt my concentration with a bunch of questions.

Another thing to consider is that when you question the nurse's care in front of the patient or their family, this has the potential to undermine the patient's and/or family's confidence in the care they are receiving. Any such questions need to be asked out of earshot of the patient/family. If I find out the CNA is behaving in a way in front of the patient/family that undermines their confidence in the care I am providing, you bet I'm going to be ticked off. You say you just asked about the patient's BP meds, but this can have the appearance of questioning the nurse's care.

The CNA should NOT be assessing the patient, i.e. asking if they are symptomatic, what meds they normally take, etc. That is not in the CNA scope of practice, and you are basically practicing nursing without a license when you do so. Assessment is a nursing function. As a tech, you do not have a need to know what BP meds the patient is on.

When you are working as a tech, you are a tech. When you are in clinical as a student, you are a nursing student. Blurring the lines between the two can get you into trouble. Whether this particular nurse you were working with is likable or not is beside the point. You need to protect yourself and not lose your license before you even have it. Tread very carefully.

You're fortunate to work with nurses that don't mind teaching you. But as a previous poster said, be careful about who you do this with. Many nurses do not want to teach, and expect you to behave within the scope of the job you are there to do, not as a nursing student.

[bagladyrn, RN]

Let me play Devil's Advocate for just a moment here.

As a new nurse, I'm doing all I can to keep my head above water. I do not have time to answer a bunch of questions or to teach the CNA about nursing. I prefer for the CNA to do their job and let me do mine. Report abnormals to me and let me handle it. If you want to learn from me, just observe quietly and please, for the sake of the patient, don't interrupt my concentration with a bunch of questions.

Another thing to consider is that when you question the nurse's care in front of the patient or their family, this has the potential to undermine the patient's and/or family's confidence in the care they are receiving. Any such questions need to be asked out of earshot of the patient/family. If I find out the CNA is behaving in a way in front of the patient/family that undermines their confidence in the care I am providing, you bet I'm going to be ticked off. You say you just asked about the patient's BP meds, but this can have the appearance of questioning the nurse's care.

The CNA should NOT be assessing the patient, i.e. asking if they are symptomatic, what meds they normally take, etc. That is not in the CNA scope of practice, and you are basically practicing nursing without a license when you do so. Assessment is a nursing function. As a tech, you do not have a need to know what BP meds the patient is on.

When you are working as a tech, you are a tech. When you are in clinical as a student, you are a nursing student. Blurring the lines between the two can get you into trouble. Whether this particular nurse you were working with is likable or not is beside the point. You need to protect yourself and not lose your license before you even have it. Tread very carefully.

You're fortunate to work with nurses that don't mind teaching you. But as a previous poster said, be careful about who you do this with. Many nurses do not want to teach, and expect you to behave within the scope of the job you are there to do, not as a nursing student.

NancyNurse - I hope you will read back over this and take some time to rethink your attitude. To me this sounds like insecurity speaking. Asking questions is NEVER inappropriate. Neither is not knowing the answer if you are the nurse (something that seems to threaten many new nurses). Nothing wrong with saying, I'm not sure, let me find out.

The techs/CNAs you work with are your right arm and your first line of information when caring for your patients. You can't be everywhere all the time and observe everything. The information relayed by a knowlegeable experienced aide can make all the difference in the world. By answering questions and passing on info to them you are ensuring that they understand the importance of signs/symptoms you will want to know about.

Take this from an old nurse - if you project this attitude at work, you will alienate all the assistive staff and find yourself drowning with no one willing to throw you a lifeline at best, and sabotaged at worst (if one of the offended is particulary vindictive). Have respect for the person you work with if not for the position.

[leslie :-D]

i overheard a tech telling an orientee that "nurse leslie explains everything..."

in other words, i ramble.

i work with a few techs who are also nsg students.

no one has to ask questions...

i babble their ears off, whether they want to hear it or not.

(i tell myself to shut up but obviously choose not to listen.:))

nurse2be, is there any possible way the nurse could have felt you were 'questioning' her vs 'asking questions'?

leslie

[casi, ASN, RN]

I can't help but think that the nurse may have felt that you were challenging her and her skills instead of trying to learn. Some people are very sensitive.

When I try to pick my nurses brains I'm always very careful what I say. Normally there is a lead-in "The nursing student in me is very curious...."

[shoegalRN, RN]

Let me play Devil's Advocate for just a moment here.

As a new nurse, I'm doing all I can to keep my head above water. I do not have time to answer a bunch of questions or to teach the CNA about nursing. I prefer for the CNA to do their job and let me do mine. Report abnormals to me and let me handle it. If you want to learn from me, just observe quietly and please, for the sake of the patient, don't interrupt my concentration with a bunch of questions.

Another thing to consider is that when you question the nurse's care in front of the patient or their family, this has the potential to undermine the patient's and/or family's confidence in the care they are receiving. Any such questions need to be asked out of earshot of the patient/family. If I find out the CNA is behaving in a way in front of the patient/family that undermines their confidence in the care I am providing, you bet I'm going to be ticked off. You say you just asked about the patient's BP meds, but this can have the appearance of questioning the nurse's care.

The CNA should NOT be assessing the patient, i.e. asking if they are symptomatic, what meds they normally take, etc. That is not in the CNA scope of practice, and you are basically practicing nursing without a license when you do so. Assessment is a nursing function. As a tech, you do not have a need to know what BP meds the patient is on.

When you are working as a tech, you are a tech. When you are in clinical as a student, you are a nursing student. Blurring the lines between the two can get you into trouble. Whether this particular nurse you were working with is likable or not is beside the point. You need to protect yourself and not lose your license before you even have it. Tread very carefully.

You're fortunate to work with nurses that don't mind teaching you. But as a previous poster said, be careful about who you do this with. Many nurses do not want to teach, and expect you to behave within the scope of the job you are there to do, not as a nursing student.

First of all, we are all entitled to our opinion. And for the record, I did not question the nurse infront of the patient, I questioned the nurse AT THE NURSE'S station. I know BETTER than that and I'm more professional than that. And I did NOT question the nurse in a way that was questioning her ability, I asked her in a way I was curious, and this nurse knows I am in nursing school as well, because she was in my orientation when I got hired. We got hired at the same time.

And my title is techincally, a NURSE INTERN II, where I was told by the nursing manager I would be doing nursing duties under the care of the nurse. I was told I could answer questions during my orientation and that's what I intended on doing. This was clearly outlined in my job description.

I did NOT do a head to toe assessment on the patient, but I am observant when I take vitals signs. No, I don't listen to lung or heart sounds, but if the patient is symtomatic, you bet I am going to report that. If an IV is infiltrated, I'm gonna tell the nurse. If the urine output is less than 50 ml in 12 hrs, I'm gonna tell the nurse. If I take a blood sugar and it's 59, yes, I'm gonna report it to the nurse. At the same time, I'm gonna observe if the patient is sweating or shaking. I will tell the nurse the results and what I observed. When I get patients out of bed, the first thing I ask them is are they dizzy. If so, I let them sit for a while. I ask if they are in pain, when taking VS, because it is something I was told I have to ask them. And if they are, I will report it to the RN. I just can't see "doing as I am told by the RN" and not asking a question, especially if it relates to the care of the patient.

And you are right, I will cover my azz. If I get an abnormal reading on a VS, or observe something that's not right, I will let the RN know, and I will document I advised the RN of such.

And if you have this type of attitude as new grad, I sure wouldnt want to be a student in the clinical setting asking you a thing, let alone being your CNA. How soon does one forget?

[shoegalRN, RN]

I can't help but think that the nurse may have felt that you were challenging her and her skills instead of trying to learn. Some people are very sensitive.

When I try to pick my nurses brains I'm always very careful what I say. Normally there is a lead-in "The nursing student in me is very curious...."

No, I asked her simply: "Can I ask you something?" I also told her, "well you know I am in school and I'm trying to remember exactly what to look for when a beta blocker is given". I also told her: "I remember having a test question in Pharm about hypertensive meds". Things of that nature. Plus, I'm sitting there with a NCLEX book as well. I even ask this nurse did she take Kaplan because I planned on taking it and we were talking about school and courses and such. This is WAAAY after the BP reading thing. In fact, I keep asking her if her new admit was up yet so I can get zero out the bed and get the new admit care kit in the room, as well as get the dinamap in there to take the vitals.

So, in my mind we were having a regular conversation, and I had no idea she was even slightly offended by what I had asked her earlier.

[shoegalRN, RN]

i overheard a tech telling an orientee that "nurse leslie explains everything..."

in other words, i ramble.

i work with a few techs who are also nsg students.

no one has to ask questions...

i babble their ears off, whether they want to hear it or not.

(i tell myself to shut up but obviously choose not to listen.:))

nurse2be, is there any possible way the nurse could have felt you were 'questioning' her vs 'asking questions'?

leslie

Leslie, I didnt even know she was upset, because she kept right on talking to me after I asked her about the BP thing. I even asked her about would she recommend Kaplan and she told me she had taken it herself.

I dont know. Maybe she just don't like teaching and that's fine. I know that now and I won't ask her a thing if I have to work with her again.

[UM Review RN, ASN, RN]

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 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.

OK, let me get my flameproof suit on here, because while I think you did mostly everything correctly, I also think it's important for you to understand what could be considered a little outside of your scope and why.

So bear with me, take it slow, and please understand that I am offering a potential rationale for the nurse's upset and an explanation for what you might have seen, and questions that she might not have been able to answer (whatever the reason). My apologies for such a long answer.

This is a tough business because so much information that we process is subjective. How much more so for the patients and their families! I've seen patients' BPs go up as much as 10 points just talking about an upcoming test, as I'm sure you have as well.

Anyhow.

The quoted sections in bold are possible reasons that this nurse felt you were challenging her care. If I was that nurse, I would certainly not expect you to volunteer information about what I heard or did not hear in report.

As a tech, you did not get the same type of report that I got and therefore, cannot know if the doc has DC'd Clonidine due to being worried that because the patient's DBP is so low, she has to run a high systolic or she crashes into syncope. If that patient was admitted for syncope, she could also be a rule-out stroke patient, which is why the MRI would've been ordered.

As a tech, if the patient is a rule out stroke patient, believe it or not, the docs want the patient to run a little high and our protocols call for only calling the doc if the SBP is equal to/over 220 and/or the DBP is equal to/over 110. This is because if a patient has already had a brain infarct, the higher BP will actually help the brain be better perfused.

Then there's always the HIPAA thing. As I said, I don't know the complete situation, but the patient may or may not have wanted her personal info shared with the family member in the room. I'm sure you've seen a lot of cases like that. I realize that in your case, it was most likely OK, but that was another potential area you could've gotten yourself into trouble with.

Even as a nurse, I'm reluctant to tell a fellow nurse how to treat her patients because she has information that I have not been privy to. It's beyond a matter of professional courtesy and respect, it is truly a matter of having all the available information. You may've had some valuable input to that, but there's no way possible that you had the whole picture unless you were the nurse for that patient. That's why we work together.

Anyhow, that's my:twocents:. Your situation may be completely different, I don't know, but as I said, that's one possible explanation of that nurse's behavior that I have personally run into as a nurse. Has nothing to do with being intimidated or insecure professionally, just has to do with that particular patient's peculiar problem.

Best wishes in your studies. I'm sure you'll make an excellent nurse someday soon.

[shoegalRN, RN]

OK, let me get my flameproof suit on here, because while I think you did mostly everything correctly, I also think it's important for you to understand what could be considered a little outside of your scope and why.

So bear with me, take it slow, and please understand that I am offering a potential rationale for the nurse's upset and an explanation for what you might have seen, and questions that she might not have been able to answer (whatever the reason). My apologies for such a long answer.

This is a tough business because so much information that we process is subjective. How much more so for the patients and their families! I've seen patients' BPs go up as much as 10 points just talking about an upcoming test, as I'm sure you have as well.

Anyhow.

The quoted sections in bold are possible reasons that this nurse felt you were challenging her care. If I was that nurse, I would certainly not expect you to volunteer information about what I heard or did not hear in report.

As a tech, you did not get the same type of report that I got and therefore, cannot know if the doc has DC'd Clonidine due to being worried that because the patient's DBP (sorry, this is the error I edited) is so low, she has to run a high systolic or she crashes into syncope. If that patient was admitted for syncope, she could also be a rule-out stroke patient, which is why the MRI would've been ordered.

As a tech, if the patient is a rule out stroke patient, believe it or not, the docs want the patient to run a little high and our protocols call for only calling the doc if the SBP is equal to/over 220 and/or the DBP is equal to/over 110. This is because if a patient has already had a brain infarct, the higher BP will actually help the brain will be better perfused.

Then there's always the HIPAA thing. As I said, I don't know the complete situation, but the patient may or may not have wanted her personal info shared with the family member in the room. I'm sure you've seen a lot of cases like that. I realize that in your case, it was most likely OK, but that was another potential area you could've gotten yourself into trouble with.

Even as a nurse, I'm reluctant to tell a fellow nurse how to treat her patients because she has information that I have not been privy to. It's beyond a matter of professional courtesy and respect, it is truly a matter of having all the available information. You may've had some valuable input to that, but there's no way possible that you had the whole picture unless you were the nurse for that patient. That's why we work together.

Anyhow, that's my:twocents:. Your situation may be completely different, I don't know, but as I said, that's one possible explanation of that nurse's behavior that I have personally run into as a nurse. Has nothing to do with being intimidated or insecure professionally, just has to do with that particular patient's peculiar problem.

Best wishes in your studies. I'm sure you'll make an excellent nurse someday soon.

Thank you for your input, I apperciate it! And you are right, I dont know the entire picture, that's why I was asking the nurse questions to try to piece together the picture.

And you are right, maybe I should have not said anything about report.

I love the way you explained this and if this same nurse would have explained it to me this way, I would have completely understood.

I'm quite confused about taking VS with a pt's family member in the room. I have always done so, should I be asking the family member to leave the room due to HIPAA?

And for the record, I've never said this nurse was insecure or anything like that. I was more ticked off that the nurse didnt approach me if I had offended her. Instead, she went to the charge nurse and continued to talk with me for the rest of the night. If there was a problem, I would think we could resolve this as mature adults, without getting others involved.

I can see you are a great nurse to work with.

[UM Review RN, ASN, RN]

Thank you for your input, I apperciate it! And you are right, I dont know the entire picture, that's why I was asking the nurse questions to try to piece together the picture.

And you are right, maybe I should have not said anything about report.

I love the way you explained this and if this same nurse would have explained it to me this way, I would have completely understood.

I'm quite confused about taking VS with a pt's family member in the room. I have always done so, should I be asking the family member to leave the room due to HIPAA?

And for the record, I've never said this nurse was insecure or anything like that. I was more ticked off that the nurse didnt approach me if I had offended her. Instead, she went to the charge nurse and continued to talk with me for the rest of the night. If there was a problem, I would think we could resolve this as mature adults, without getting others involved.

I can see you are a great nurse to work with.

It's not that you took vitals with the family in the room so much as that you were discussing treatment options with someone who the patient might not have wanted to have all that information.

I have to be careful about that too. Had a patient who had a family member in the room and after she left, the patient got very upset and said, "Incredible! She wasn't even supposed to know I was here!!" and I came just this close to discussing her postop teaching with that family member in the room. :uhoh21:

And thanks. I don't know if I'm all that terrific to work with when I'm getting my third admit and I'm trying to get someone else sent to the unit, but .... I sure do try.

[GadgetRN71, ASN, RN]

Unfortunately, there are many people who don't like to teach, because they are insecure. Such people get defensive when you start asking questions-they fail to remember that they were students once as well. I had many kind, knowledgable nurses who helped me out while I was in school. I worked full time as a surgical tech while in NS and I was EXPECTED to ask qustions and learn while I was at my job. Even if I didn't ask too many questions on a particular day, I had people quizzing me to keep me on my toes!(nurses and sugeons).

IMHO, it should be a given that we nurses pay it foward and teach the ones coming up. How did the past way of doing things(ie the hazing, the eating of young, the backbiting etc) work for our profession? The answer is: not well. I think we all need to realize that none of us popped out of the womb a licensed nurse-we got there through hard work and we didn't do it on our own.

How sad that this nurse blew such a good teaching oppourtunity, and instead, she acted like she was in junior high. OP, you did a great job and it sounds like when your day comes, you will be a great nurse. Just remember how this twit acted and vow never to do that to a student yourself.

[Virgo_RN, BSN, RN]

NancyNurse - I hope you will read back over this and take some time to rethink your attitude. To me this sounds like insecurity speaking. Asking questions is NEVER inappropriate. Neither is not knowing the answer if you are the nurse (something that seems to threaten many new nurses). Nothing wrong with saying, I'm not sure, let me find out.

The techs/CNAs you work with are your right arm and your first line of information when caring for your patients. You can't be everywhere all the time and observe everything. The information relayed by a knowlegeable experienced aide can make all the difference in the world. By answering questions and passing on info to them you are ensuring that they understand the importance of signs/symptoms you will want to know about.

Take this from an old nurse - if you project this attitude at work, you will alienate all the assistive staff and find yourself drowning with no one willing to throw you a lifeline at best, and sabotaged at worst (if one of the offended is particulary vindictive). Have respect for the person you work with if not for the position.

I think you've misinterpreted me. First, I stated that I am playing Devil's Advocate. That means that I don't necessarily believe everything I am stating, but that I am simply offering an alternative point of view. Second, I agree that knowledgeable, experienced CNAs are a a valuable part of the health care team, and I am not opposed to answering questions. I am merely pointing out that there is a time and a place, and a way to do so, and that not all nurses are interested in teaching.

I'd also like to add that some of my least favorite nurses to work with when I was a CNA, are now some of my favorite nurses to work alongside because they are good nurses. Some of my favorite nurses to work with as a CNA, because they were so nice to me....let's just say they might be nice, but that doesn't mean they're great nurses.