I was working nights, two patients had severe hypoxia issues. The RT assigned to my area was really busy. He came by and with one patient switcher her high flow NC to a face trough, and switched her forehead probe to a finger probe (there was a reason for the forehead probe AND the high flow NC)...but this RT 'knows best'. And he turned down her O2,
Not long after, she was desatting, and I couldnt get a good reading half the time. I paged, no response. The the RN at the desk said that I did get a call back...but it was from the "guy at the end of the hall" (it turned out it wasnt). I went up to him, he is an RT for other areas that arent so busy, and he chooses to sit on the computer in our area, sometimes for hours, in his downtime. He is the senior RT.
I asked him if he had another forehead probe, said my pt was desatting, and I couldn't get a good read. He said he didnt. So I went to re-use the previous one, and to turn the O2 up.
He came into the pt room a minute later, and as I was describing the problem (I thought he was here to help) he said "And youre good at being passive aggressive...". I said what? can you explain that? /what do you mean? no response but a smirk and a shrug. silence. I said you need to talk to me about that statement. That was a very mean statement. nothing. I said if you cant takl to me about that, I am filling an incidenet report out. Which 'i did.
I asked him if he had another forehead probe, said my pt was desatting, and I couldn't get a good read. He said he didnt. So I went to re-use the previous one, and to turn the O2 up.
He came into the pt room a minute later, and as I was describing the problem (I thought he was here to help) he said "And youre good at being passive aggressive...".
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I broke down your post so you might be able to see where the passive/aggressive statement is coming from.
You have stated that the patient is "desatting" but you admit to not having a good reading or probe. Your whole post focused on "the probe". When calling a Respiratory Therapist, Rapid Response team or another member of the nursing staff, it might also be a good idea to give a brief clinical picture rather than "I can't get a sat". Sometimes we get hung up on numbers and from your post we don't even know what the numbers were that you consider to be bad. Some may be running per protocol to allow SpO2 to drift to 86% if they have a baseline Hb and ABG. This RT may have been expecting you to rely on more than just numbers from a bad probe. Next time you could say "patient looks/sounds like crap and I can't get a sat" but of course only if the patient looks like crap.
At what stage of the hypoxia issue was this patient?
What protocol were you using and at what stage to where the RT had to initiate weaning?
Well, grey gull, its interesting that you joined today-- to comment on my post?
I was able to get an intermittent read, but not enough to closely monitor this patient, and to titrate her O2, which dipped into the 70's. The RT had been aware of this patient as he earlier had been hovering around an RRT that was called.
In any event, it is not the RTs job to psychologically analyze statements made by an RN, and to diagnose, particularily when a patient is in distress, and in a patient room. The focus is on the patient. And when the intent is to 'hurt', then I call thaat abuse, especially since I was doing everything in my power to help the patient in a systematic way.
I have to agree with grey. Despite it not being his patient/area he obviously did come in. Had he come in and the situation been that of all hell breaking loose he would have been legally obligated to assist. I would agree that his statement of you being "passive-aggressive" had to do with you going out of your way to ask him knowing its not his "patient/area" for a forehead probe and then coming in to see you had one that you were using. I do not consider the term passive aggressive abusive. If you look at the definition of passive-aggressive it sounds like it could have been perceived by him.
As a nurse, you should be able to tell if you patient is in respiratory distress without a number. You should also have policies in place to obtain assistance if that was the case without waiting for your designated RT to call back. I perceive that the situation had you stressed and you felt like the RT was attacking you but TBH I don't know what you expected him to do. You asked for a forehead pulse ox, he said he didn't have one, and obviously came to assess the situation. You stated there were reasons for not using a finger pulse ox initially, did you try placing the finger pulse ox on the toes, ear, nose to try for a more accurate reading while attempting to locate a forehead pulse ox. Was your charge nurse helping you? Could you have called a rapid response to have more resources at your disposal?
While I agree that the RT does not sound like a model employee or epitome of being a helpful interdisciplinary team member I think you are trying to divert too much onto him and his inactions.
Well, grey gull, its interesting that you joined today-- to comment on my post?
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In any event, it is not the RTs job to psychologically analyze statements made by an RN, and to diagnose, particularily when a patient is in distress, and in a patient room. The focus is on the patient. And when the intent is to 'hurt', then I call thaat abuse, especially since I was doing everything in my power to help the patient in a systematic way.
I'm just getting started and your post just happened to be on the first page near the top.
Do you think you could have handled the situation differently?
Can you find out how to get pulse ox probes for the next time? Since they are very chargeable, very few RT departments are allowed to stock them and they must be in some charging system.
Can you show proof that the RT intended to hurt the patient or you? If the patient was harmed, the house supervisor should have been notified immediately and the RT should have been questioned if it was truly his intent to "hurt" the patient or you.
If this patient was in distress, do you not have the option to call a Rapid Response team or a more experienced RN? There will be times when RTs are busy and can not always come running. There are also times when they get 10 - 20 calls just to "check a sat" when the RNs have their own pulse ox just a couple feet away. Sometimes our own co-workers get a little lazy also.
Your post sounds like this is more of a personal issue or personality conflict than just patient care because you threw in many other little tidbits to give the impression this RT is a lazy bum. Or, you are taking this at a very personal level. Take a breather. If something like this upsets you, it is going to be a long road for you in nursing.
Grey Gull, I am sorry, I dont think you are getting it. I am doing very well in nursing BTW. I am not sure why you are harping on me or trying to turn this around...
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I broke down your post so you might be able to see where the passive/aggressive statement is coming from.
You have stated that the patient is "desatting" but you admit to not having a good reading or probe. Your whole post focused on "the probe". When calling a Respiratory Therapist, Rapid Response team or another member of the nursing staff, it might also be a good idea to give a brief clinical picture rather than "I can't get a sat". Sometimes we get hung up on numbers and from your post we don't even know what the numbers were that you consider to be bad. Some may be running per protocol to allow SpO2 to drift to 86% if they have a baseline Hb and ABG. This RT may have been expecting you to rely on more than just numbers from a bad probe. Next time you could say "patient looks/sounds like crap and I can't get a sat" but of course only if the patient looks like crap.
At what stage of the hypoxia issue was this patient?
What protocol were you using and at what stage to where the RT had to initiate weaning?
You are a team member and a peer. If someone says a patient looks like crap, I don't care what the Sat is........If you are the senior staff member present it is your responsibility to act like it and guide the less experienced to greater learning............not antagonize them or bully them into submission. I have met many "professionals" like this in my career. I have always found if someone is unwilling to teach and hoard their knowledge........they really have no knowledge to begin with to share. Personally I choose to use such opportunities like this to teach a professional how to trouble shoot and respond to better the patient outcome and care:twocents:
At the risk of being bashed, I'll put in my two cents.
While I don't agree at all with how the RT handled things (the passive-aggressive comment was unnecessary, yes), I don't consider it "very mean," "abusive," or something worth a write up. I think you're putting yourself more in to the victim role than you need to. Further evidence of that is accusing GreyGull of joining this site just to comment on your thread. This site has a TON of members, and people joining all the time, and everyone has to have a first post. GG's happened to be on this thread. Yet, you automatically assumed it was to target you? IMO that reflects on how deeply you took the RT's comment. He shouldn't have said it, but I don't think it's worthy of such a strong reaction. Move on.
I'm just getting started and your post just happened to be on the first page near the top.
Do you think you could have handled the situation differently?
Can you find out how to get pulse ox probes for the next time? Since they are very chargeable, very few RT departments are allowed to stock them and they must be in some charging system.
Can you show proof that the RT intended to hurt the patient or you? If the patient was harmed, the house supervisor should have been notified immediately and the RT should have been questioned if it was truly his intent to "hurt" the patient or you.
If this patient was in distress, do you not have the option to call a Rapid Response team or a more experienced RN? There will be times when RTs are busy and can not always come running. There are also times when they get 10 - 20 calls just to "check a sat" when the RNs have their own pulse ox just a couple feet away. Sometimes our own co-workers get a little lazy also.
Your post sounds like this is more of a personal issue or personality conflict than just patient care because you threw in many other little tidbits to give the impression this RT is a lazy bum. Or, you are taking this at a very personal level. Take a breather. If something like this upsets you, it is going to be a long road for you in nursing.
You seem to have overlooked the possibility that the OP just fabricated this whole situation just to have something to post. However, it's pretty hard to have much of a discussion on that basis. It seems more useful, to me, to take the poster's report at face value, in which case I believe that the RT's behavior was passive/aggressive. And he need not have intended to harm the patient to be derelict in his duties.
I have, on other threads, defended the statement, "That's not my patient," and I still do. If I'm getting pain meds for my patient and your patient needs his pillow fluffed, your patient needs to call you. I'll pass along the message as soon as I can, or even fluff it when I get time, but I can't neglect my patients to spare someone else the inconvenience of using the call button. Or, if your patient is asking for meds, I'll let you know, because I don't know what they've had, what's ordered, etc.
On the other hand, if I'm walking past a room and hear stridor, I'm gonna stop. I'll call the assigned nurse and probably defer to her judgement unless I see she needs mine, but the time to argue about turf is when everyone is stable.
It's possible, of course, that the RT "sitting on the computer," was doing some legitimate duty of his role. I don't think that matters. You hear of a patient in distress, you respond. Promptly. The only exception is when doing so puts another patient at risk. And it doesn't matter in the least if some nurses "cry wolf," or even that this particular nurse has a reputation for doing so.
There almost certainly things the OP could have done differently. Maybe she needed to be more assertive in conveying that the situation was urgent. Paging the MD and the CN certainly sound appropriate. If I were in charge, I'd want to be there. But there are people in every discipline who mosey to emergencies, and it sure sounds like the RT described could be one of them.
You are a team member and a peer. If someone says a patient looks like crap, I don't care what the Sat is........If you are the senior staff member present it is your responsibility to act like it and guide the less experienced to greater learning............not antagonize them or bully them into submission. I have met many "professionals" like this in my career. I have always found if someone is unwilling to teach and hoard their knowledge........they really have no knowledge to begin with to share. Personally I choose to use such opportunities like this to teach a professional how to trouble shoot and respond to better the patient outcome and care:twocents:
The OP did not state the patient looked "like crap". Those were my words. A clinical assessment of the patient will get someone's attention faster than "pulse ox not picking up, need a new one". Just from "need a new pulse ox" does not constitute an emergency and sometimes one must prioritize their responses. If I was working in the unit with someone who asked me to get them a new pulse ox, I probably would not immediately drop what I was doing either. If the patient was in distress I would hope the appropriate actions would be taken before going off to find another pulse ox. If the patient is in distress and you need RT, convey that instead of making the pulse ox the priority in your page.
The point I am attempting to convey is that you should give a clear message of what you want or the patient condition to other health care professionals who have more than just the ICU to cover. This includes Lab, Radiology, Lift Team, Respiratory and Pharmacy. Quite often doctors and RNs will call them and make it sound like their situation is more STAT than someone else's. The other professionals may believe you and leave a patient or put off another order on a patient who is actually more critical only to find you wanted to get the lab results or patient moved that you forgot to order earlier. It may be more your emergency than it is the patient's.
We are also only reading one side of the story. With the strong description of the RT and the extra info not pertaining to this incident, it is probably useless to offer another view of the situation. Beeble is making it clear that we should side against the RT. The personal attack on me also makes that more evident. I did not come here to single out anyone.
I apologize to beeble if you are offended by my first posts but I will not side with you just because this is your thread on this forum. I do know there are many different sides to the same story. I also do not know you or what your reputation might be amongst your co-workers and other professionals. My post was neither to stick up for you or the RT but rather point out some communication issues and present a different point of view since a few of the others posting here had bashing the RT covered.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
The OP did not state the patient looked "like crap". Those were my words. A clinical assessment of the patient will get someone's attention faster than "pulse ox not picking up, need a new one". Just from "need a new pulse ox" does not constitute an emergency and sometimes one must prioritize their responses. If I was working in the unit with someone who asked me to get them a new pulse ox, I probably would not immediately drop what I was doing either. If the patient was in distress I would hope the appropriate actions would be taken before going off to find another pulse ox. If the patient is in distress and you need RT, convey that instead of making the pulse ox the priority in your page.
The point I am attempting to convey is that you should give a clear message of what you want or the patient condition to other health care professionals who have more than just the ICU to cover. This includes Lab, Radiology, Lift Team, Respiratory and Pharmacy. Quite often doctors and RNs will call them and make it sound like their situation is more STAT than someone else's. The other professionals may believe you and leave a patient or put off another order on a patient who is actually more critical only to find you wanted to get the lab results or patient moved that you forgot to order earlier. It may be more your emergency than it is the patient's.
We are also only reading one side of the story. With the strong description of the RT and the extra info not pertaining to this incident, it is probably useless to offer another view of the situation. Beeble is making it clear that we should side against the RT. The personal attack on me also makes that more evident. I did not come here to single out anyone.
I apologize to beeble if you are offended by my first posts but I will not side with you just because this is your thread on this forum. I do know there are many different sides to the same story. I also do not know you or what your reputation might be amongst your co-workers and other professionals. My post was neither to stick up for you or the RT but rather point out some communication issues and present a different point of view since a few of the others posting here had bashing the RT covered.
True.....well said......I was just responding to her side I agree!
GreyGull
517 Posts
I broke down your post so you might be able to see where the passive/aggressive statement is coming from.
You have stated that the patient is "desatting" but you admit to not having a good reading or probe. Your whole post focused on "the probe". When calling a Respiratory Therapist, Rapid Response team or another member of the nursing staff, it might also be a good idea to give a brief clinical picture rather than "I can't get a sat". Sometimes we get hung up on numbers and from your post we don't even know what the numbers were that you consider to be bad. Some may be running per protocol to allow SpO2 to drift to 86% if they have a baseline Hb and ABG. This RT may have been expecting you to rely on more than just numbers from a bad probe. Next time you could say "patient looks/sounds like crap and I can't get a sat" but of course only if the patient looks like crap.
At what stage of the hypoxia issue was this patient?
What protocol were you using and at what stage to where the RT had to initiate weaning?