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Nurse vs respiratory

Nurses   (1,261 Views | 27 Replies)

347 Profile Views; 8 Posts

Hey everyone. Quick question 

So just recently I had a patient with a neb treatment that was due at 2100. Hours later and it's now a quarter to 0100. The room is right next to the nurses station and I never saw the respiratory therapist go in to administer the treatment. It is now outstandingly late on the emar and has not been documented that it's been given or refused. The patient tells me that they're short of breath and claims they never got a breathing treatment. At this point it's 0100 and the patient had another treatment due at 0200 so rather then letting the patient suffer I gave the breathing treatment and it looks as if the patient got the 0200 dose early. 20 mins later the respiratory therapist comes in pissed because I gave it and tries to start an argument with me while I was carrying for another patient in another room. I tried to avoid the conversation at that time because it was very unprofessional to try to discuss one patient in front of another patient and also HIPAA. The respiratory therapist said "you don't give my neb treatments", then walks out of the room.  The current patient I was with made a comment of that being rude which put a bad taste the patient's mouth about the professionalism of the hospital. After I finished what I was doing with that patient I Left the room to confront the respiratory therapist. She then tries to tell me that she already gave the 2100 neb treatment and that the patient got double dosed. Once again I remind you that the patient claim to never have got it. But I told her that you didn't documented anything and in this world when don't document it you didn't do it. Was I wrong?

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Sour Lemon has 9 years experience.

3 Followers; 4,310 Posts; 31,660 Profile Views

Is this RT a person you've had past conflict with? What you're describing sounds very personal. I'm in and out of rooms all night and would have no idea if they'd been through or not unless I just happen to see them. Patients are not always reliable sources of information, either.

I think you probably could have handled this better unless there was no way for you to contact RT for advice/conformation and the patient was in a clear distress.

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8 Posts; 347 Profile Views

No, I have never had conflict this person and it caught me off guard. She claimed she gave at 2130 after the fact. But at 2300 when It wasn't scanned I called to ask for the breathing treatment and she stated "ok", never confirmed or denied it was already given. And yes I know patients are unreliable, but at a quarter to one the patient was in clear distress. I would have more respect if she had pulled me aside to ask me about it rather then trying to argue with me in front of another patient which I tried avoid. Now when I say I confronted her afterwards the word confront was bit strong. Because i approached her calmly to explain. I'm 1 of three travelers working at this hospital and couldn't find the policy so we ask 3 people and other nurses who work there permentally and was told yes nurses can give the neb treatment. The respiratory therapist never let me finish talking and walked off. So it's not personal from my side. I don't even know her.

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adventure_rn is a BSN and specializes in NICU, PICU.

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Unfortunately, in my experience, some RTs tend to be less diligent about scanning meds at the time they're administered than RNs tend to be. It shouldn't be that way, but that's the way it is. Next time, before giving a missed treatment, I'd double-check with the RT that it was actually missed.

Nebs fall into a weird category--they are a med, and can be given by RNs, but I understand why the RT had a meltdown. Just because you can give a neb doesn't mean that it's considered to be within the nursing role at that facility. If it's expected that only the RTs give the nebs, then it can create confusion and lead to double-dosing if RNs are giving them as well (especially if RTs aren't using the MAR appropriately).

I'm not saying that you were in the wrong, but it sounds like this is a facility where the RTs expect that they're the only ones who should be doing the nebs--now you know.

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1,138 Posts; 7,807 Profile Views

Why did you not call RT?  I never administer breathing treatments. Our RTs often scan them later.  If my patient is having issues breathing, I do my nursing interventions and call RT.  That’s why they are there.  I love the RTs on my unit.  

You were wrong in my opinion.

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8 Posts; 347 Profile Views

Well a this particular hospital your allowed gives and 1 hour before due. I didn't give the past dose I scan the 0200 at 0100 so it wasn't technically a double dose

I did call the rt, as mentioned earlier. She never came or told me it was given. 

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8 Posts; 347 Profile Views

Also I've worked at other hospitals where nurses give the treatments. Also asked the staff who work here who tell me nurses can give the treatments.

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12 Followers; 3,912 Posts; 29,782 Profile Views

When you called earlier it would have been good to find out specifically if the 2100 neb had been administered. Also if your patient needs a neb communicate about that, as you did--but don't leave out the part where you offer the option for them to come and give it or you to give it yourself; then you'll find out their attitude about it in advance.

These are the things that would've prevented this. The RT didn't communicate any better.

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8 Posts; 347 Profile Views

Thank you, but I did ask initially and she wouldn't give me straight answer. This where my frustrating comes from.  Its easy to say yes or no. Also I recently ask another respiratory therapist who gives treatments who's response was I guess it depends on whose working. So apparently no here know what the policy is.  Thanks for the feedback!

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3 Followers; 37,134 Posts; 98,843 Profile Views

1 hour ago, TheSixFootThree said:

Thank you, but I did ask initially and she wouldn't give me straight answer. This where my frustrating comes from.  Its easy to say yes or no. Also I recently ask another respiratory therapist who gives treatments who's response was I guess it depends on whose working. So apparently no here know what the policy is.  Thanks for the feedback!

Based on my understanding of this post, I believe she did not give you a straight answer because in fact, she had not given the treatment and was trying to obfuscate that fact. She pounced on you because she was trying to put it on you.

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96 Posts; 1,733 Profile Views

On 1/26/2020 at 9:14 PM, TheSixFootThree said:

...it's now a quarter to 0100...

I’m sorry, but I really liked this part. What was the dose of the neb you gave? Half of 2 mg? 😀

Most places I’ve worked respiratory document their meds late. Sometimes they’ll sit on the MAR as not given/late, etc. right til the end of shift. They normally grab all their nebs for the shift right at the beginning and carry them around with them (and leave the empties on the bed—bastards). I would not give this neb without first checking with the RT. 

If the patient’s saying she didn’t get it, ask respiratory. If respiratory doesn’t give you a straight answer and the patient’s short of breath, ask respiratory to come and give a prn (I imagine if the patient is on scheduled nebs, they have prns). 

If respiratory wouldn’t give me a yes or no answer as to whether they administered a breathing treatment, I’d call the respiratory supervisor and ask them. They’re usually pretty good at pulling their troops into line. 

The worst part about nursing is trying to get other people to do their job while trying not to bruise anyone’s precious ego and creating an unpleasant work environment for yourself. 
 

You’re all a team. You have to work together. There will be a day when you’ll need respiratory big time, and you’ll be so grateful for them. Don’t throw anyone under the bus, but definitely be persistent when asking whether or not a patient had a breathing treatment and someone’s giving you the runaround. 

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8 Posts; 347 Profile Views

As mentioned earlier there are hospitals where nurses give treatments. But it has recently come to light she never gave the first treatment. Spoke to managment and I'm not the only nurse who has not had certain respiratory therapist give treatments on the floor not throw anyone under the bus because The previous hospital I was at had amazing respiratory therapist so thats not what this was about. However nurses are allowed to give treatments here and I was told it was fine that I had gave the treatment by the manager. Thanks problem solved

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