made MD angry, and resources on unit

[keepingalive]

I have been caring for a patient who was admitted for post menopausal bleeding and hydroneprosis. History of hypertension and diabetic. Patient is 3 day post d & c, and has a nephrostomy tube/bag.

On my shift, she starts to complain of headache and her temperature is 100.2. My charge nurse gave Norco because it will help with the elevated temperature and pain. Not 5 minutes goes by. Coincidentally, right after she swallows the pills, I ran her vitals (again) and her respirations are increased, and her o2 saturation dips into the 80s with hr at around 130-140ish.

I tell my charge nurse and she told me the abnormal vitals were because of pain and temperature.

I returned to check the peri-pad and the patient is actively now bleeding. I thought it was rectal because I have no idea how to distinguish between lady partsl and rectal bleeding. So I tell my charge nurse. "The patient is rectally bleeding."

She asks "Are you sure."

I replied "I'm not sure. I do not know how to check. Can you assist me?" And then she ignores me. And reiterates the abnormal vitals were because of pain and temperature.

At this point, I realize she is not going to check with me. I get on the phone and dial the MD. I told him about the rectal bleed, the vitals, etc...

Turns outs, the patient was bleeding lady partslly and needed a couple of units of blood. MD was angry I told him "rectal bleed." Oh well.

Anyway, when you (YOU) were a new nurse, who were/was your resource on your shift? What would you have done differently?

[jadelpn, LPN, EMT-B]

After a d&c there is usually not a ton a bleeding. So I can see how you could perhaps think that the bleeding could be coming from somewhere else. That coupled with the other signs/symptoms of impending distress, and yes, a call to the MD to assess would be warranted. As in some instances a rapid response.

Charge should have taken this more seriously, and curious as to what the response was after the MD was called and blood was ordered. Take away the "where the blood was coming from" thing for a moment--literally, what happened when MD was "2 units of PRBC's" and the charge realized that you made a good catch?

Hopefully, this patient was sent to a higher level of care, as if there was still bleeding, giving blood would be like my gramma who was a nurse would say "spitting in the breeze".

As a newer nurse you are still learning. But good on you to realize something was amiss, and to react accordingly. If there's a meeting regarding this, make sure that you really stress that you were taught it good practice to update the charge nurse not only every couple of hours, but on a PRN basis. And that if the policy is different, you need to know the proper procedure.

And in communication, make sure that you are to the point "room 233 is s/p D&C and is actively bleeding with bright red blood. Also she is c/o 7/10 pain. I medicated per order with____________. Her vitals are increasingly unstable, and I am concerned about the amount of blood I am seeing that is bright red. I would like to call the MD for further assistance."

If you are still being ignored this is a patient safety issue, and needs to be brought up the chain of command. For no other reason other than it is a patient safety risk.

Let us know how it goes

[Nursynursenurse, ADN, RN]

To determine the source of blood, couldn't you ask the patient? If there was a rectal bleed, surely she would feel a gush of what would probably feel like uncontrollable watery diarrhea. For some who is AOx3 and continent, this is something out of the ordinary.

[SnowShoeRN]

This is +4 times I have asked for her set of experienced eyes and she has neglected me. She is always reading reports when I need her most.

If you're that concerned about the safety situation, why not go to your nursing supervisor or manager and have a talk with them? You don't have to be all like "so-and-so is terrible and super unapproachable and super unsafe," but you could say something along the lines of "May I speak to you confidentially? As a new grad, I don't always feel like I'm getting the support I need from my charge nurse. This concerns me because xy and z. For example, the other day when I had a patient who was bleeding lady partslly..."

Your manager may clarify charge nurse roles you haven't noticed before or point you in the direction of other resources you weren't aware of. Or they could do nothing and that may signify that you need to consider leaving your work environment.

In any event, nothing will change about the situation until you do what you can on your end. Best of luck with things.

[imintrouble, BSN, RN]

As everyone else has already said, the OP did fine for her patient.

If I'd called an MD and said "I don't know" about the bleeding, I would have been slaughtered. All places are different.

If I'd called and said "I did this, and this, and this, and I don't know, he/she wouldn't have liked it, but my butt would be intact.

"I don't know" is possible, but you have to qualify it with everything you did to try and find out.

All responders have been very kind and understanding, and I don't want to be the odd man out. But I'll admit to wondering how even a new nurse didn't know how to determine a source of bleeding.

[KatieMI, BSN, MSN, RN]

As everyone else has already said, the OP did fine for her patient.

If I'd called an MD and said "I don't know" about the bleeding, I would have been slaughtered. All places are different.

If I'd called and said "I did this, and this, and this, and I don't know, he/she wouldn't have liked it, but my butt would be intact.

"I don't know" is possible, but you have to qualify it with everything you did to try and find out.

All responders have been very kind and understanding, and I don't want to be the odd man out. But I'll admit to wondering how even a new nurse didn't know how to determine a source of bleeding.

I kinda understand not finding the source down below, there can be "circumstances" making that digging into bleeding flesh really difficult. But treating "fever and pain" with Norco while saturation drops and heart is pounding 140 times/min is just about textbook example of chapter on "How to stop imagining yourself as a clinical thinker, or The shortest cheatlist of how to avoid license loss and murder charges".

[neuron]

I assure you her duties as charge are far more numerous than what you're thinking/describing here.

So that makes it ok to ignore the pt. in decline and new nurse who needed her assistance?

[VANurse2010]

So that makes it ok to ignore the pt. in decline and new nurse who needed her assistance?

Where, oh where, did I say that? Stop projecting.

[TheCommuter, BSN, RN]

All responders have been very kind and understanding, and I don't want to be the odd man out. But I'll admit to wondering how even a new nurse didn't know how to determine a source of bleeding.

If there's lots of blood, I'll concede that determining the source of hemorrhage 'downtown' can be challenging. However, it is possible and necessary to find out.

[Kooky Korky, BSN, RN]

You did well OP. Charge Nurse is dangerous. IF you report her, she will, of course, try to turn the story around to blame you.

[Wrench Party]

I agree, your charge nurse is special. You may not have had all the info, but you were correct to escalate the situation.

Random thought: even if there is excessive bleeding after a D and C, you're not likely to catch it on the pad. Oftentimes clots will develop in the uterus, "clog up", and send the patient into a lot of cramping and pain. This may have been covered up by the Norco. Your VS may or may not also reveal this, but an ultrasound might.

[Ruby Vee, BSN]

The reason I knew she was bleeding lady partslly was a coworker told me how to check (as "TheCommuter" specifies). After the fact, I had already told the MD. My charge went ballistic, however. Because I was not 100% certain. I believe I emphasized that to her so she would go into the room with me, at least.

A week ago, we had another patient on the decline. This charge dialed up a different floor to get assistance from another charge. I am irritated that slipped her mind as I stood helplessly in clear need of assistance.

She DOES NOT receive patients. She was adjusting the schedule when I approached her. Seems her only duty on the floor is to read MD reports and pass-on information we might missed during change-of-shift report. Though I have no idea. This is +4 times I have asked for her set of experienced eyes and she has neglected me. She is always reading reports when I need her most.

I have a couple of experienced coworkers. 1/5 nurses are +3 years. We're all new graduates, with the exception of my charge nurse.

I can promise you that your charge nurse has far more duties than that -- you just aren't seeing them. If all of the nurses except the charge are new grads, she's probably being run ragged keeping up with everyone's patients. You may be too busy or overwhelmed to see that.

[Guest849204]

This is a good example of the benefit of having a peer mentor, something a lot of residency programs offer new grads.

The only thing I would have done differently (assuming I could not tell where the bleed was coming from by looking) would have been to tell the MD on the phone that there was new blood on the pad but I could not tell if it was rectal or lady partsl.

Either way, a mentor would be a good resource for you to have, someone you are comfortable going to with anything and who you can trust to give you honest advice. I think a lot of new grads end up developing bad habits and/or progressing more slowly simply because they don't have someone they are comfortable confiding in on the unit.