Just when you think you have it together...

[dee78]

This week celebrates my 1 year anniversary as a working RN. I believe that I finally have it together, people come to me with questions (though I still have some of my own). My time management is where I excel. Then yesterday hits...

The night nurse tells me that she is worried about my patient. I had my first "real" rapid. I suppose the others were but this was the first one with a cardiac rhythm issue. I didn't call it, I called the doctor immediately. I had patients with this rhythm before but they usually come out. This is a doctor that I work with daily but he was asking for drugs that we didn't have. Thankfully my charge was walking behind him when he called it so she was there to run it for me. I felt helpless. I did what others told me to do. We get the patient to the unit, they were still trying to stabilize her when I left them. Could I have done anything to prevent this one? No, they came back from surgery, my tech went right in to hook up the monitor, and I was sitting at the desk charting on the patient when I heard the alarms the moment she was hooked up.

So I get back from ICU and monitor room calls me again. The patient in the next room is having the OPPOSITE rhythm. I page the doctor. Doctor asks if everything else is stable, it is. Okay. The rhythm keeps trending the wrong way. I call again, I ask her at what point she would like me to call her. She asks for an EKG. I call her again when her bp is also trending in the wrong direction. I made a suggestion and was just told that she would be down in a little while. This went on for 3 hours before she came to see the patient, the only orders were to hold certain meds that weren't due for 7-19 hours. I thought I was going to call a rapid but I was trying to trust the doctor. Should I have called a rapid? Without a doubt, they would have swept her to the unit. I know I bugged the fool out of the doctor and I felt bad about it but I didn't feel she was treating the situation urgently enough. Maybe it was my adrenaline still pumping, making me more anxious than I normally would have been or maybe it was my coworkers walking by asking if I knew about the rhythm, calling me when they walk by and see it, etc.

Oh well, I know that in both situations I did what I knew to do. That really is all that I can do, I'm not going to second guess myself.

[HouTx, BSN, MSN, EdD]

Seems like you have done a good job of reflecting on the event - analyzing what happened, how you reacted, and what you would do differently if/when it happens again. This is exactly how you develop into an expert clinician. Good Job!!

FWIW, I always advise our nurses to always follow the RRT protocol as it is written. This means that no one, including the physician who is not at the bedside, can over-ride the decision to trigger the rapid response team. If anyone tried to second guess your decision, you can just refer them to the RRT protocol.

[smbradley87]

Hi dee! I am new to this site, so I hope you receive this comment, even know your post was back in August. I ran across you on all nurses.com and I saw you completed the LPN/RN program; congratulations to you! I am in my second semester of the LPN program. So far, second semester has been good. We have had no complaints or lost anyone. (We did loose 9 people first semester for either grades or ATI) but other than that, we have had new teachers this year who have really worked with us. Definitely worried about the med surg ATI. Do you have any reccomendations on that on how to study? And the RN program, quick question, for the transition, I made all A's and B's, except for a C in micro. Will that C in micro prevent me from getting into the transition RN? Would you recommend me taking it over? I don't mind to retake classes, but before that, I graduated at utc with a degree in rehab science so I am beyond needing a break with school, but if you personally think I may need to take it over I will. or is the TEAS the most important? Thank you!!