Need your opinion about my situation

Hellllllo Nurse, BSN, RN · Sep 21, 2005

I think you were totally correct in what you did. An excellent nurse. Document everything well, make it short and concise, as you did in your post. Bring copies of your notes. And yes, I would ask to go the cardiac unit. Your post is a good example of why working in med surg sucks.

RN12345656 · Sep 21, 2005

Hello everyone
I've been working as an RN since June in a 600 + bed hospital. My original plan was to go through a cardiac program, because I have always loved cardiac and have worked as a Tech on telemetry floor. For reasons I'm not going to spend my time on, I decided to work on med-surg for a year. I am on neuro-vascular unit with overflow from GI unit.
Right away I am finding myself not handling a 6 patient load. I am told I spend too much time with my patients. My assessments and documentations are very in detail. The goal is apparently to cycle from patient to patient spending only 10-15 minutes with each. At my last meeting with cords I received some constructive criticism, I got my stuff together, untill..last weekend.
Friday I got a right hemi CVA in hypertensive crisis. She had a video swallow, which cleared her for diet. She choked x 4 when I attempted to give her PO, cracles the next day in lungs, sats OK. BP out of control ( 190-200 sbp), no meds po. MDs notified continuously - no x-ray. no NG tube. Ordered her some vasotec and labetolol IV , which did nothing. Saturday I came in, the saga continutes. At this point she is vomiting, lateral pain in head and neck, bp 204/108, positive babinsky. Daughter at bedside freaking out, I am spending all my time with this pt, trying to convince MDs she is not appropriate for this unit. MDs kept increasing her doses, which again did nothing. 2 other nurses working with me felt i was overreacting and that since this pt already has a hx of HTN, I should just stop obsessing over it. Finally, at 6 pm daughter was crying, insisted to talk to MD. Said to him " if you don't get my mother some drugs, I will take you to court" Pt to ICU on nitride and another drip - HTN resolved in 1 hour ( after 2-3 days of us/me begging MDs for help). As for me, my coordinators are aware that I spent the whole day with this pt only handling 4 pts all together instead of 6. I'm going to have a meeting on friday to defend myself.
I felt that I was right in all respects and that I am probably not designed to be a med-surg nurse. I am considering asking my super to allow me to leave into cardiac program in January. What do you think?
thanks. Natalia

Natalia,

Good for you for being the patient's advocate and an awesome nurse. Unfortunately, you DO NOT have the support of the staff and the doctors. Sometimes, the doctors do not listen to you and it is frustrating. But, I tell what....the doctors you were trying to convince of the seriousness of your pt...will listen to you next time. It sounds like you work at a relatively large hospital. Were you talking to the residents? The Attending? If something like this happens again and you do not get the response that you like..call the attending. (And who cares if you work the night shift). At the same time, talk with your charge nurse. She needs to be communicating to the appropriate people. If you don't like what she is doing..call the nurse supervisor for the hospital.

It sounds like to me...no one was doing their job except for you!!! You were an ICU nurse those days. If you have to spend more than 30 mins in a room at one time OR if you are always in the room--you are playing ICU nurse. She was unstable and no one (except for you) did anything about it. This needs to be documented and the appropriate people need to be written up. Good...go to the coordinators and let them know you have no support from the staff. Let them know you are writting it up. I wouldn't want to stay there. Give me a break, who cares if you spend to much time in other pts rooms and document well. Is there anything wrong with that? If your pts are taken care of and the work is done--there shouldn't be a problem. If they are more concerned that you are clocking out late or that you are going into OT--move on--they don't care about you anyway.

I work cardiac and I love it. Make the change now.

Editorial Team / Admin · Sep 21, 2005

Hello everyone
I've been working as an RN since June in a 600 + bed hospital. My original plan was to go through a cardiac program, because I have always loved cardiac and have worked as a Tech on telemetry floor. For reasons I'm not going to spend my time on, I decided to work on med-surg for a year. I am on neuro-vascular unit with overflow from GI unit.
Right away I am finding myself not handling a 6 patient load. I am told I spend too much time with my patients. My assessments and documentations are very in detail. The goal is apparently to cycle from patient to patient spending only 10-15 minutes with each. At my last meeting with cords I received some constructive criticism, I got my stuff together, untill..last weekend.
Friday I got a right hemi CVA in hypertensive crisis. She had a video swallow, which cleared her for diet. She choked x 4 when I attempted to give her PO, cracles the next day in lungs, sats OK. BP out of control ( 190-200 sbp), no meds po. MDs notified continuously - no x-ray. no NG tube. Ordered her some vasotec and labetolol IV , which did nothing. Saturday I came in, the saga continutes. At this point she is vomiting, lateral pain in head and neck, bp 204/108, positive babinsky. Daughter at bedside freaking out, I am spending all my time with this pt, trying to convince MDs she is not appropriate for this unit. MDs kept increasing her doses, which again did nothing. 2 other nurses working with me felt i was overreacting and that since this pt already has a hx of HTN, I should just stop obsessing over it. Finally, at 6 pm daughter was crying, insisted to talk to MD. Said to him " if you don't get my mother some drugs, I will take you to court" Pt to ICU on nitride and another drip - HTN resolved in 1 hour ( after 2-3 days of us/me begging MDs for help). As for me, my coordinators are aware that I spent the whole day with this pt only handling 4 pts all together instead of 6. I'm going to have a meeting on friday to defend myself.
I felt that I was right in all respects and that I am probably not designed to be a med-surg nurse. I am considering asking my super to allow me to leave into cardiac program in January. What do you think?
thanks. Natalia

:balloons: Hello and Welcome to Allnurses.com:balloons:

After reading about the above events, I think you do not belong in Med-Surg. You most definitely belong in the cardiac unit. You most assuredly served your patient well. The nurses in that area were remiss to discount your findings.

Kudos to you for being a most excellent patient advocate. With your eye for detail and relentless approach to a critical matter, you might even consider the NP role. I think you are certainly cut out for this.

I hope you get to go to the cardiac arena. You have got what it takes.

grannynurse FNP student · Sep 21, 2005

Hello everyone
I've been working as an RN since June in a 600 + bed hospital. My original plan was to go through a cardiac program, because I have always loved cardiac and have worked as a Tech on telemetry floor. For reasons I'm not going to spend my time on, I decided to work on med-surg for a year. I am on neuro-vascular unit with overflow from GI unit.
Right away I am finding myself not handling a 6 patient load. I am told I spend too much time with my patients. My assessments and documentations are very in detail. The goal is apparently to cycle from patient to patient spending only 10-15 minutes with each. At my last meeting with cords I received some constructive criticism, I got my stuff together, untill..last weekend.
Friday I got a right hemi CVA in hypertensive crisis. She had a video swallow, which cleared her for diet. She choked x 4 when I attempted to give her PO, cracles the next day in lungs, sats OK. BP out of control ( 190-200 sbp), no meds po. MDs notified continuously - no x-ray. no NG tube. Ordered her some vasotec and labetolol IV , which did nothing. Saturday I came in, the saga continutes. At this point she is vomiting, lateral pain in head and neck, bp 204/108, positive babinsky. Daughter at bedside freaking out, I am spending all my time with this pt, trying to convince MDs she is not appropriate for this unit. MDs kept increasing her doses, which again did nothing. 2 other nurses working with me felt i was overreacting and that since this pt already has a hx of HTN, I should just stop obsessing over it. Finally, at 6 pm daughter was crying, insisted to talk to MD. Said to him " if you don't get my mother some drugs, I will take you to court" Pt to ICU on nitride and another drip - HTN resolved in 1 hour ( after 2-3 days of us/me begging MDs for help). As for me, my coordinators are aware that I spent the whole day with this pt only handling 4 pts all together instead of 6. I'm going to have a meeting on friday to defend myself.
I felt that I was right in all respects and that I am probably not designed to be a med-surg nurse. I am considering asking my super to allow me to leave into cardiac program in January. What do you think?
thanks. Natalia

A question or two. Is your facility a teaching one? Was the physician a resident or an attending? The orientation of a med/surg unit is different from a cardiac unit and more patients are expected to be handled. I would ask for a transfer. And I would defend myself by pointing out the mistakes made in the patient's treatment and the aniunt of time necessary to obtain proper treatmeny.

Good luck

Grannynurse :balloons:

Karen · Sep 21, 2005

Sounds like you are an awesome nurse that any unit would be lucky to have....unfortunately that patient did not belong on that unit. Where was the charge nurse, nursing supervisor, and risk management in all of this?? If doctors aren't responding to abnormal patient conditions I call in the mentioned above right away. Hypertension is not a normal condition even if the patient has a history of it and especially if the patient had a stroke for heaven's sake! Also, you mentioned you worked at a 600+ bed hospital...Is it a teaching hospital? If you are working with interns and residents and not getting a response keep in mind these are new grad drs. When I worked at a teaching hospital and had issues where the interns and res. were not addressing things calling the fellow or attending gets things happening.

Anagray, BSN · Sep 21, 2005

Thank you so very much for your support. It means SO much. I am already feeling self-conscious being fresh out of school, it so good to have someone who understands me.

The charge nurse was one of the people who was not supportive, but later appologized for not understaning my concerns. The MDs were actually attending docs, one of them with cardiac training, which blew me away. My hospital has very few residents, therefore most MDs should know what they are doing.

I've actually now decided to indeed go to CCU and even before this incident happened I have made plans to go to school and get my pre-med. Having the background in nursing, will hopefully help me to become a holistic MD at some point in my life. It was my life's dream to be MD and when I became a nurse I realized how constricted I am by my scope of practice. In Russia, where i'm from, MDs are similar in attitude to nurses here, very holistic. Sorry to see not many MDs in the states are this way.

Thanks again. I will write an update on what happened when i get back to work. :balloons:

DianeS, RN · Sep 25, 2005

Hello everyone
I've been working as an RN since June in a 600 + bed hospital. My original plan was to go through a cardiac program, because I have always loved cardiac and have worked as a Tech on telemetry floor. For reasons I'm not going to spend my time on, I decided to work on med-surg for a year. I am on neuro-vascular unit with overflow from GI unit.
Right away I am finding myself not handling a 6 patient load. I am told I spend too much time with my patients. My assessments and documentations are very in detail. The goal is apparently to cycle from patient to patient spending only 10-15 minutes with each. At my last meeting with cords I received some constructive criticism, I got my stuff together, untill..last weekend.
Friday I got a right hemi CVA in hypertensive crisis. She had a video swallow, which cleared her for diet. She choked x 4 when I attempted to give her PO, cracles the next day in lungs, sats OK. BP out of control ( 190-200 sbp), no meds po. MDs notified continuously - no x-ray. no NG tube. Ordered her some vasotec and labetolol IV , which did nothing. Saturday I came in, the saga continutes. At this point she is vomiting, lateral pain in head and neck, bp 204/108, positive babinsky. Daughter at bedside freaking out, I am spending all my time with this pt, trying to convince MDs she is not appropriate for this unit. MDs kept increasing her doses, which again did nothing. 2 other nurses working with me felt i was overreacting and that since this pt already has a hx of HTN, I should just stop obsessing over it. Finally, at 6 pm daughter was crying, insisted to talk to MD. Said to him " if you don't get my mother some drugs, I will take you to court" Pt to ICU on nitride and another drip - HTN resolved in 1 hour ( after 2-3 days of us/me begging MDs for help). As for me, my coordinators are aware that I spent the whole day with this pt only handling 4 pts all together instead of 6. I'm going to have a meeting on friday to defend myself.
I felt that I was right in all respects and that I am probably not designed to be a med-surg nurse. I am considering asking my super to allow me to leave into cardiac program in January. What do you think?
thanks. Natalia

Definitely, head for cardiac. I also did med-surg for a year and am now in cardiac and love it. It sounds like you had no support from the doctor or your co-workers but WAY TO GO for the patient. Head for the heart, and good luck with whatever you decide to do.

TexasgirlRN · Sep 27, 2005

After reading your story, I realize I'm not alone. It's SO frustrating when you can see something coming, and you warn the M.D., but they do nothing, and- WOW- cause & effect, what you saw coming HAPPENS. :banghead:

All I can say, is keep on doing what you're doing. You've got some great nursing/assessment skills!

Anagray, BSN · Sep 29, 2005

Hi again!

How is everyone? Hope you all had some good days at work :)

I had a meeting with one of the cords. They sort of made it look like I didn't tell my Charge Nurse clearly that I need help that day. But, whatever - I didn't really get in trouble and I did not want to rat enyone out, so I left it at that - just nidded my head and insisted that i did everything right.

As for my patient... As it turns out, that faithful Saturday she had a massive brain bleed. She came back to my floor after ICU in a different state neurologicly than before the incident. Now, 2 weeks later, she is dying in Hospice 1 floor below us, because there is nothing that could be done at this point. Her daughter thanked me many times for everything I've done, but she is considering filing a lawsuit against the attending MDs.

Very sad.

Thank you for your support.

dan_haifa · Sep 30, 2005

Have you idea, colleagues, why don't MD's responses to our opinion? What is it? Pride, may be? Or, may be, Prejudice? :)

Editorial Team / Admin · Sep 30, 2005

Have you idea, colleagues, why don't MD's responses to our opinion? What is it? Pride, may be? Or, may be, Prejudice? :)

Hello, dan_haifa,:balloons:

Yes. A little bit of both. And, this at the expense of our patients.