Newish Nurse opinion question

[emtpbill, ASN, RN, EMT-P]

So,

  Have been a nurse since October of 2021. Worked in an ER for about 6 months and then went back to working on the ambulance , as a nurse, for about 6 months. Anyways, went back to a different ER about a month and a half ago due to being offered a salary package I couldn't refuse.

   So after being a medic on the street for 25 years prior I am still getting used to the ER hospital side.  Was on ER orientation up until a week and a half ago.  My very last shift on orientation a patient came in with Diarrhea.  ER attending do their thing. I start the IV's get all the nurse stuff going. The nurse that was preempting me was floating around. Anyway, pt goes to CT for a GI scan and the CT shows some polyps but no definitive blockage. Pt is not complaining of any nauseousness or vomitting whatsoever but he does have the beginnings of dementia. WIfe is there who says this is the patients baseline. His only deficit is that he sometimes while talking will end his sentence with something totally irrelevant. Like talking about the football game and he will end with "I'm a mason in lodge #000. " He can still make needs known and also can convey any pain.

 

   So the hospitalist comes down and briefly stops at the desk I'm at and says "he'll end up needing a NGT".  So I meander over to the preceptor.  Im done work in about an hour or so and she would be taking the patients over from me for another 6 hours when I'm done. I tell her what the hospitalist says. We talk about the patient, mental status, possible tolerations and such and that he would probably need to be restrained and fight the introduction of the NGT possible causing nasal or nasopharynx trauma. She says that since he isn't vomiting , not complaining of any nauseousness and still passing stool and flatus that to hold off the NGT. The feeling that I am getting from the different preceptors I worked with in this ER is that orders by hospitalists hold until the patient gets upstairs, unless obviously needed stat and that in that case our attending would be the one ordering. I can understand about hospitalist admission orders being done upstairs as if we were doing every single order for admission also we would be running from room to room constantly trying to get all these orders done.

 

   So, I guess what I'm asking is , what are my ER peeps thoughts on this. I want to do what's best for the patient but being a new guy in this ER I wanted to follow my preceptors leads but don't want to get jammed up cause some hospitalist Is putting a thousand orders in.

[offlabel]

Sounds like your preceptor got it right.