Just a Question

Is the charge nurse a RN? Are there any other RNs on the floor? In my opinion, start with notifying the person directly above you. If they say it is no big deal, you can chart who you notified and what the outcome was. You can always assess the pt. More often if you are still worried and then notify the physician when they see the pt. But charting that you took it up the ladder and nothing was done will protect you and more frequent assessments will help the pt. If during a later assessment you find further pt. deterioration, make sure you notify someone again. If you really feel that your patient is in trouble, make a suggestion when you notify the charge of the problem. For example say pt. A has been having these new symptoms and I don't have a good feeling about it, what do you think about putting some oxygen on or contacting the physician? If they say it is fine and you are still really worried, ask the charge to come and assess the pt. with you.

Hi emenhiseramRN,

Yes the charge nurse is an RN, and generally a good one as well. I just wonder if I was really getting my point across but I don't think I could have made it any more clear than saying " I am really concerned about this patient. Looking through her graphics record, there is no other entries of her having O2 levels below 92% and this patient is quite somnolent". I feel my assessment was not taken seriously and I sure hope I charted accordingly!!

I guess may have dealt with the problem accordingly but I still feel as though there was something else I could have done.

Did you count and record the respirations rate? There is a protocol for Narcan orders in these events

Ok.

So if a patient has an increase in their narcotic dosage it is not unusual to have some respiratory depression. We know this.

You say the patient's saturations went below 92%, this in itself is not ominous, you do not mention the respiratory rate. Now, if a patient is actually having a serious respiratory depression post narcotic analgesia Fiona is correct and the narcan protocol (if your workplace has one) should be followed.

Even if you don't have such a protocol, you as the bedside nurse should be able to start a little O2 therapy and continuous sat monitoring if you are really concerned.

If, however, the patient's saturations remained above 90% and the respiratory rate was adequate, it probably was appropriate to wait until the MD was rounding.

Again, I don't have the details, but there are actions to take as the bedside nurse in this situation besides charting values, take matters into your own hands.

Ok, I did a little closer read on this thread and have a couple additional comments in regards to the role of the charge nurse.

In your original post you put forth the premise that as the bedside nurse and LPN your job is to report status and it is the role of the charge to basically tell you what to do. While it is true that a charge nurse or clinician is present as a resource on the unit it is not true that she should be telling you what to do in this situation.

I see that you work in Alberta, and as any of our lovely and talented Albertan LPN posters will tell you, you are filling the same role as an RN in the inpatient hospital setting. You are 100% accountable for your own assessments and actions towards your patients, so let's take LPN vs. RN out of the picture here.

When the bedside nurse reports to the charge s/he should be able to report a thorough assessment, what interventions have been implemented and the results thereof, and what further interventions (ie: those requiring MD orders) are felt to be needed.

In a situation where you truly have no idea where to start (eg: your first big MI/code) the Charge will probably be giving a lot more guidance. In the situation you describe I feel like most nurses should be pretty capable of thinking through the next steps, and this is probably an expectation that your charge has as well. If you truly don't know what to do in a situation and the Charge seems to be unconcerned admit this, and ask why she is not worried. You may learn something new, or you may have an opportunity to clarify your concerns, and convince her that she should be more concerned.

I also disagree with the premise that you are reporting to Charge to cover your butt. This is a huge misconception. Reporting to Charge does not in any way absolve you of what happens next. Reporting to charge serves the purpose of a) keeping her informed of what is happening on the unit, b) soliciting extra support as needed, c) accessing the appropriate person to contact further staff (eg: MDs) as necessary.

Anyhow, just a few thoughts on how you could approach future happenings on your unit.

I think the OP might have been labouring under the misconception that the Charge would reassign the patient. You know the old 'LPNs only care for stable patients' mantra. The patient stays with you until the code team takes over or the RRT finds them a bed elsewhere has been my experience

It is your responsibility to report to the charge nurse that the patient is becoming unstable and let her know clearly that you need to transfer to an RN. If you feel based on your assessment that the patient needs an RN then you need to stand up and advocate.

It is also your responsibility to let the doctor know if the patient is deteriorating. I feel there is info missing from this story. I always have an RN not necessarily the charge go and assess the patient with me and then if the patient is no longer LPN appropriate the charge nurse is notified and we switch out a patient. I have coworkers who have done this before and its not an issue.

There are always protocols to be followed, but you are accountable for your patient's outcome following your assessments, not the charge nurse.

I have had physicians tell me "It's no big deal." When in fact the patient was deteriorating. We need to advocate for ourselves and our patients whenever the situation warrants it, and ensure that care is provided. Sometimes that means contacting nurses and physicians and telling them, "This is what I've observed and you need to assess ASAP. I need orders."

Documenting alone is not sufficient, especially if the reader can see that your patient was deteriorating. What were your interventions?

Thanks for all the replies :)