What to do if you disagree with the care of another nurse's pt?

[Erythropoietin]

I am a new nurse working on a medical floor. There was recently a situation at work where another nurse's patient had a sudden change in condition that seemed alarming enough to me to warrant calling a rapid response, but this was not done. I witnessed the pt's condition because I was at the pt's bedside assisting in his care while his RN paged/called the MD and did other things outside the room. I asked the pt's nurse more than once if we should just call a rapid response, but I was basically ignored.

After much delay, the pt was transferred to ICU, but I do not know the outcome after that. Had we called a rapid response, I do know the pt would have been assessed/treated by the MD and rapid response team immediately and the transfer would have occurred without delay.

I do not want to be a busybody who interferes with how other nurses care for their patients, I don't want to step on the toes of my coworkers, and I don't want to be a "know it all" that questions the actions of more experienced nurses. That said, I am very disturbed by the situation I witnessed because I honestly feel that the patient received poor care. I am also very confused about what my role is in such situations since I was not the patient's nurse.

Has anyone been in a situation like this, and if so, how do you handle it?

[wooh, BSN, RN]

And I did note that in another post I made where I said my floor generally relied on each other and not RRT when a patient was questionable :)

My point was basically not to confront her about the situation, but to be aware. I did wind up being the nurse who "was talked to" because I was unwilling to ask for help and would call RRT before looking to my colleagues. I learned a valuable lesson from those conversations which made me a much stronger team mate, but no one jumped on me the first time they saw it happen, it was gradual.

Mostly I quoted you so it would be seen twice, because it was a good post, not because I disagreed. :)

[Tait, MSN, RN]

Mostly I quoted you so it would be seen twice, because it was a good post, not because I disagreed. :)

Oh :)

[canoehead, BSN, RN]

Just in a general sense, if another nurse is sinking, and may be doing something wrong or missing something I mention it to her. "Would you like me to ...?" or "Do you think... is OK?" I might go ahead and get the EKG myself acting as a helper, or put in an extra IV. Usually the nurse has a good explanation for things, or is grateful for the help. I know myself, I can airlock when too many things are happening at once. It's not neglect or lack of knowledge, just a need to stand still for 10 seconds and reassess.

If a nurse is sinking, an not responding to verbal cues or offers of help, I would go to the charge nurse and clue them in. Let them assess the situation and deal with it. Let them know you are available to give a hand when they need it. Someone with more time in nursing will be received better than a young person (just human nature) and if they have worked together for years, they will have better communication. Hang out for the learning experience if you can. Watch how they negotiate the situation, and you may have questions afterwards.

Once you go to the charge nurse it's in their hands. If the whole thing goes to pot, it's on them. As a new nurse, you will bring too much pressure on yourself if you try to jump in. BUT you can talk to someone afterwards and go through why they did this or that, and what if we...? If it's a total mess, go to your manager or educator and say you witnessed a situation that you couldn't make sense of, and run it by them. They will explain or follow up, if need be.

The fact that you're asking this question means you're a good nurse and looking to learn. There may be factors you don't know about, like someone on the RRT is a cowboy and intubates everyone within 5 minutes, but that patient has responded to xx med in the past, and they wanted to give him a chance. Or that nurse was counselled about calling rapid response too often the day before. If someone has been a good nurse in the past, they probably have a reason when they do something funky.

[sbfairy]

Depends on the nurse and how much experience they have as to how s/he would react in this situation. I have some critical care experience so the situation you described would not have alarmed me and I would have dealt with it very calmly. Unless my hospital's protocal stated to call the RRT, I probably would have done exactly what you saw the primary nurse doing, getting in touch with the MD and going from there. As others have stated calling the RRT does not move the Pt along to ICU any quicker. At my hospital the RRT would have arrived and most likely have been mad because the patient wasn't in the middle of coding (yes, I realize that the purpose of this team is to assess a patient who has a change in status). The RRT team, at least at my facility, will not draw blood or start IVs (know this from personal experience), and all of the necessary orders would have to come from the Doc anyway. They would, however, help hook the pt up to the monitor on the crash cart to check for any arrythmias. I can do that without them. Depending on how well you know this nurse you may ask her why but you have to be very careful how you approach this nurse. If this is someone that you have a good rapport with then by all means ask away. If not then either leave it alone or ask very respectfully. You do not want to the be the new "know it all" that all the other nurses avoid. Remember all nurses do things differently but we aim for the same ending. In a few years you may very well not call the RRT when you are in this exact situation.