I did a semester at a cardiac Unit so im totally OCD about taking vitals at least an hour after giving ANY blood pressure meds...
so.....
on the med surg floor my patients bp was unstable. had an MI on the OR table. has floated btw CCU and ICU for a week because of risk of an acute MI. Post op day 8 and has NOT moved from bed...too much pain... and i was being extra cautious. great pt-very likable- appreciative. took his vitals decided to share them with the nurse... bp 82/58 manual. o2sat 83!!!!! pt feeling fatigued etc....diabetic am accucheck 332!!!...not using spirometer..
Nurse says ' who told you to do that huh?.you're just bothering him. Your pt will hate you. you're being a Bad Nurse! and you dont want to do that right now. and no i do NOT want to know his vitals..i dont need them'
is it just me or was that totally unnecessary?..........
*i should add im just a student, dont know much so correct me if im wrong*
Were the docs made aware of the vital signs? What was the previous systolic BP? A low blood pressure like that and suturation levels would warrant the patient to be assessed immediatley by the medical emergency team.
Personally I find it the comments made that your being a bad nurse totally screwed up. I hope you report this nurses behaviour because she is totally out of line.
it would have been nice to have that said reason explained to me because i am LEARNING here...and from the little i know-those vitals dont look really good....
First of all, congrats on good nursing judgement by even taking his vitals after BP meds...I'm a strong believer in this as well, especially in a patient with a history like that. Not knowing the patient's basline, each one of those vitals don't look so good on thier own, much less in conjunction.
I'm sorry the nurse dismissed you like that. My first thought is that she probably realized that SHE should have picked up on this stuff, and took it out on you because she realized what she was missing by not asssessing her patient appropriately. If the reason she wasn't concerned was because these changes were not much of a deviation from baseline, she should have explained that to you.
I worked on a cardiac floor as a PCT prior to graduation, and we took vitals on everyone with a monitor Q4H, regardless of stable vitals or not. We woke them up at 11pm and 3am...obviously not ideal, but in my opinion for patients with cardiac issues serious enough to require continuous monitoring (or a history like your patient's) not "disturbing" them is less important than making sure you properly assess them. Patients can refuse having thier vitals taken during the night, just like they can refuse any other care if it's bothering them that much and they would rather take the risk.
In my opinion, taking a patient's vitals a 9:30 am is not "bothering" them. It's a necessary part of them recieving appropriate care in the hospital. It sounds like you handled the situation well. Continue to make sure that everything you did (including notifying the pts primary RN) is charted, to protect yourself, as well as your instructor's liscense.
I'm sorry for being the bad guy here, but I really just cannot picture a nurse saying to a student "you're being a bad nurse" no matter how many times I try. This just sounds so out there.
I'm sorry for being the bad guy here, but I really just cannot picture a nurse saying to a student "you're being a bad nurse" no matter how many times I try. This just sounds so out there.
its funny you should say that.(not)
Typically i dont go around making things up about what nurses say to me... and i again why would i make that up? i have nothing to gain. I was THERE when she was saying these things to me i believe i heard correctly...
and to those who have been an encouragement on this post a HEARTFELT thank you!!! I asked myself if im really cutout for this today. I mean an experinced nurse telling you something like that really puts a dent in your confidence. but one thing ive learned is to trust my instincts and my instinct w/ this pt was that things were not OKAY and i did my best to be an advocate for him....
I'm sorry for being the bad guy here, but I really just cannot picture a nurse saying to a student "you're being a bad nurse" no matter how many times I try. This just sounds so out there.
It does seem very strange but I'm taking the OP's comments at face value here.
To the OP don't let unprofessional nurses (and yes they are out there!) get in your way. I had a few of them myself when I was a student and I would just smile at them thinking that they are providing me with a good example of how not to behave as an RN.
I'm sorry for being the bad guy here, but I really just cannot picture a nurse saying to a student "you're being a bad nurse" no matter how many times I try. This just sounds so out there.
I'm glad you don't work with those kinds of nurses, but I have had the unfortunate pleasure of doing so, and I can totally see that happening. Not everywhere, but there are some toxic places to work.
As to the patient. Was he on comfort care only? I just wondered because he had a MI in surgery and was doing pretty poorly. If he was not aggressively being treated for eventual release home, then I can understand why you wouldn't take vitals as often. But if that were the case, it sounds like the nurse didn't adequately get that idea across to you. Just trying to understand why....
Specializes in Professional Development Specialist.
As to the patient. Was he on comfort care only? I just wondered because he had a MI in surgery and was doing pretty poorly. If he was not aggressively being treated for eventual release home, then I can understand why you wouldn't take vitals as often. But if that were the case, it sounds like the nurse didn't adequately get that idea across to you. Just trying to understand why....
That was exactly my thoughts, which is why I was wondering if she asked the nurse for an explanation. I've usually seen those pts only on the medical floors, but sometimes you see strange things in hospitals. Most of the hospitals I did rotations on didn't do any vitals or bs on comfort measure only pts. They do consider it disturbing the pt during the dying process. It also explains not getting him out of bed. BUT if so, how in the heck were you supposed to know, and if this was the case how did she help you learn not to do it in the future? Most of my clinical educators would have reported that RN to the charge nurse for that type of language and behavior.
I'm glad you don't work with those kinds of nurses, but I have had the unfortunate pleasure of doing so, and I can totally see that happening. Not everywhere, but there are some toxic places to work.
As to the patient. Was he on comfort care only? I just wondered because he had a MI in surgery and was doing pretty poorly. If he was not aggressively being treated for eventual release home, then I can understand why you wouldn't take vitals as often. But if that were the case, it sounds like the nurse didn't adequately get that idea across to you. Just trying to understand why....
I think that's the thing. If the vitals really were what the OP says they were, if the patient was not in a comfort care/DNR type of situation....this just does not seem feasible. Like I said, I am NOT trying to be the bad guy, OP. Honestly. When I say I can't picture it, I really can't. In almost a decade as an RN and over 14 years in healthcare, I've not seen a situation remotely close to this....not only non-responsive to obviously critical VS/O2 sat, but so inflammatory towards the person reporting them. I had a CNA on orientation report a sat in the 70's to me when giving me a set of vitals from an HOUR before...and my response was to go BOOKING to that patient's room (WHY she didn't think/know to report them to me immediately, I don't know, but my assessment didn't support a sat that low, and a recheck showed a normal one, so I think her method was in question and not the sat itself, but anyway).
My honest suspect of the telling of this is some embellishment, and that's just my impression.
EIGHT DAYS post op and still in bed?? Where are the Physios?
If you are stable enough to go to the floor from ICU and an OBS unit, we have you dangling at the minimum by supper time. Then the Physios visit and get you out.
Scrubby
1,313 Posts
Were the docs made aware of the vital signs? What was the previous systolic BP? A low blood pressure like that and suturation levels would warrant the patient to be assessed immediatley by the medical emergency team.
Personally I find it the comments made that your being a bad nurse totally screwed up. I hope you report this nurses behaviour because she is totally out of line.