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Need to rant

CCU   (2,524 Views 7 Comments)
by Stormy8 Stormy8 (Member)

3,718 Visitors; 56 Posts

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So....need to let off a little steam. I work in a CVSICU. Had a patient who was dying. In liver/renal failure...lactate >20, acidotic, full support. Family plan to come in the AM to say goodbye. Brief picture for you. I take on care of pt. currently maxed on VASO and very high dose of Levo. My pressure sudden started softening. She's been labile all day. Checking my Aline, ran a cuff pressure to check. Previous iCal was low so I grabbed a CaCl stick and gave it to the patient. BP improved.

Mind you before all this, I called my NP to ask her if she could give me the plan for the patient when she could and she replied with attitude :)...I'm busy with two bleeding patients. Totally understandable.

Once she was able to come see me, I told her what happened and she yelled at me and told me to write myself up for giving the CaCl without an order.

I see where she is coming from. Just wanted to get that off my chest and maybe get some feedback.

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4,617 Visitors; 324 Posts

Was their someone else you could have gone to to get an order? A chain of command? Someone above the NP to escalate your concerns about your patient to?

Did you express your concern to the NP and ask for direction as to what you should do if she wasn't coming to review? "I understand your stuck with 2 critical patients, who would you like me to contact to review my critical patient?"

Did you seek guidance from your charge nurse or a more senior nurse? "What do you think I should do in this situation?"

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16,471 Visitors; 2,438 Posts

Giving cacl without there being an order of some sort? You practiced medicine without a license. End of story.

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Ruby Vee has 40 years experience as a BSN and specializes in CCU, SICU, CVSICU, Precepting & Teaching.

11 Followers; 65 Articles; 170,450 Visitors; 13,938 Posts

There should have been a chain of command . . . someone else you could go to if that NP was too busy to help you. Unless you had a prn order for calcium OR had a protocol in place to cover you, you should have had an order. But you know that. Next time, ask the NP if someone is covering for her. Or when you call, give her a quick summary of the scenerio and ask "Is it OK to give Calcium?" It's easier for a distracted provider to answer a yes/no question than to come up with an order from scratch.

I hope the NP didn't actually raise her voice to you -- but asking you to write yourself up for giving meds without an order is reasonable, if maddening.

I hope your next day at work goes better than this one!

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3,718 Visitors; 56 Posts

Well said. Thank you for your input!

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chillnurse has 6 years experience as a BSN, RN, NP and specializes in Internal medicine/critical care/FP.

1 Article; 7,340 Visitors; 208 Posts

call and ask me for something specific and 99% of the time ill say sure. i prolly woudlnt write somebody up for that but id tell them call me first next time. no sense in write ups for anything that just happens once. i also dont know why providers get mad when called. I've been called about stuff thats perfectly normal "just to let me know" which is dumb, but i still dont get mouthy with people. No sense in that stuff.

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travelea has 8 years experience and specializes in Critical Care.

1,571 Visitors; 26 Posts

No nurse wants their patient to crash at the expense of a provider that's too busy. In hindsight, you could have phoned the attending for the order before the drug was administered... (in many circumstances, I firmly believe the word "no" really means "Go one step higher").

Taking matters into your own hands -while appearing beneficial for the patient that may or may not have made it- could have put your license at serious risk. What would have protected you if the patient crashed at that moment (whether or not the Calcium had anything to do with it)?

Regarding the NP, this is a testament to how much easier it is to write somebody up than utilize good communication and conflict resolution skills. Sorry it had to happen, and hopefully nothing too serious came out of it.

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