My nursing judgement call.....thoughts?

[knittingfan283]

I had a patient that complained of sharp stabbing chest pain that started in his left pectoral area, then moved from there to his sternum and then back. I called the doctor and obtained orders, but before I could do so, his brother ran out of the room and told me that i was needed in the room right away. When I got back into the room, he was sheet white and told me it felt like someone was sitting on his chest. Naturally I called a rapid response (like a code, but is called when immediate help is needed. It's my hospital's way of trying to prevent code.) We transfered him down to the ICU in order to be treated. Did I do the right thing? Should I have called it sooner? I was wondering, since my charge nurse seemed more annoyed than anything else. What do you think?

[Old.Timer]

This was new onset chest pain, and if it weren't for the RRT I wouldn't have gotten any help, because the charge nurse didn't help me, just ordered me around. We'd been having personality conflicts lately, which was partly my fault as well as hers. She told me later on that she didn't know what to do, and was glad I was able to make that judgement call. She has a BSN (nothing wrong with a BSN but she constantly rubs it in my face) and looks down on me because I have an LPN degree even though I am in school to complete ADN. So not only does she get ****** off when I am able to make sound nursing judgements, but gets ****** off because I am able to perform under pressure better than her. *sigh* Sorry for the immature rant.

I have absolutely no patience with any BSN nurse flaunting her credentials and/or "rubbing it in someone's face" as if it makes her better. Doing so usually indicates insecurity which appears to be the case in this instance.

I obtained my BSN years ago when it was not as common as it is now. Luckily, I had a professor who made sure we understood that it didn't make us particularly special and in fact, initially, we were less prepared clinically than others.

Two of the best nurses under pressure on my unit were LPN's. Trust me, even once I was very experienced and confident, they were who I frequently called for when I wanted back up or a second opinion. It was not necessarily another RN.

I just had to chime in. It annoys the heck out of me when I hear BSN nurses acting above others.

Having said all that, I do happen to be an advocate of BSN as entry level for nursing. That is for no other reason than I don't believe we stand a chance of being considered professional without it.

[Anna Flaxis, BSN, RN]

I think you did the right thing. Cardiac chest pain is *almost never* sharp and stabbing in nature. This combined with the sudden onset makes me think PE. PEs are frequently fatal, and until PE has been ruled out, ICU is the best place for this patient.

Too bad your CN was irritated, but you may very well have saved a life. Good job, and good job for the brother coming out to get you!

[noahsmama]

During my orientation as a new nurse, it was emphasized to me over and over again that it is better to call the RRT and not need it, than to not call and need it. We were told that no one should ever give us a hard time about calling the RRT, and if anyone ever did, the person responsible for training us wanted to know about it, so she could personally chew them out.

My understanding is that the whole reason most or all hospitals now have "rapid response" teams in addition to code blue teams is that studies have shown that patients who are (or may be) heading downhill benefit from having the intervention of the code team sooner rather than later. At the hospital where I used to work, the code blue team and the rapid response team were the exact same people -- it's better for the patient to have their intervention before they go into cardiac arrest, not after!

In other words, you did the right thing, and your charge nurse needs to get over herself! I hope you won't hesitate to do the exact same thing in the future!

[Spritenurse1210, BSN, RN]

I won't let her sway my judgement, since she freezes during true emergencies. Someone has to take charge.

[Esme12, ASN, BSN, RN]

Whether PE or MI......the Rapid Response was the right choice......good for you for recognizing a problem and acting on it.....I was going to add that the charge nurse is probably insecure and jealous that she may not know what to do herself.......then you answered the why yourself.....wel done!

[Roy Fokker, BSN, RN]

You did the right thing.

For future reference - it's ALWAYS better to call RRT than to call a Code Blue! It stems from the old maxim "an ounce of prevention is worth a pound of cure" ... i.e. preventing a code is better than running a code!

Don't let anyone else tell you otherwise: When in doubt, call RRT - that's exactly what they're there for! :)

cheers,