Other nurses taking over your patients without asking?

[txRN07]

Has anyone experienced this? I am a newly licensed RN since June, and I have been off orientation for many months now, I have not gotten into any trouble, I am assigned to 6-7 patients per day, and things have been going great. There is this LVN who has only been there a few more months than me, and every time one of my patients starts de-sat'ing or codes, she leaves her patients and goes flying into my patient's room and just takes over, and tells me what to do as if I don't already know, this has happened 4 times so far. I am very soft spoken and am trying to subtly tell her to back off. It is starting to really upset me, she asks me "are your charts opened? have you done this, that? etc." Tired of being treated like I don't know what I'm doing. My boss has been happy with my work so far, no problems.:angryfire

[txRN07]

Well let's see, we'll have a patient that has been on a nasal cannula all the way up to 6 liters, and have been keeping sats over 95%, and so many times the sats go down out of nowhere, and they need to be upgraded to a face mask.

[DutchgirlRN, ASN, RN]

Honey, if any of my patients start de-satting or coding, I want that nurse and every single one of my coworkers to get in there and help me!

This is not about personalities; this is about patient survival. If she's faster than you are with this stuff, then you need to learn to get faster and do this stuff before she does. She's trying to help you.

Please take it in the spirit in which it's intended. One day, you'll have a Code when she's not there, and no one will come to help you when you need that extra pair of hands, and you'll see what I mean.

:yeahthat::yeahthat::yeahthat::yeahthat::yeahthat::yeahthat::yeahthat:

Being a new nurse, since June, does not mean you've been off of orientation for months. IMHO 6-7 patients for a new nurse is dangerous. I would personally be glad for this LPN looking out for me. I'd be thanking her. I've been a nurse for 32 years and in a code type situation...the more the merrier!

[TazziRN, RN]

having been the victim of nurses like that, i can totally understand your frustrations. when it happens, as soon as the pt is stable enough for me to leave, i leave nurse beentheredonethat alone with the pt. without fail, every nurse i've done this to except one has eventually found me and asked why i left. my answer: "you took over the situation on my pt so i assumed you wanted to keep the pt."

i know you can't do that in a floor unit but you can take control back when she does that. as another poster suggested, ask her to get things for you or to call lab, rt, etc.

some have said that in a crunch they want all available staff to help. they're right, but helping does not include taking over and making the primary nurse look/feel like an idiot.

is she approachable? would she listen if you sat down to talk to her alone? it may indeed be that she doesn't realize how she's coming across and is just trying to guide you. she may be only a few months newer than you but that early in the career a few months can make a big difference. a good way to start the conversation would be "i notice that you keep reminding me about my charts, etc., and that you seem to think i don't know what i'm doing with my pts. is there something in my work that you see that i may not know about?"

[UM Review RN, ASN, RN]

I hope I'm not assuming too much here, but when a patient is de-satting on 6 L NC, a list of things to get/ask the doc for (and this is only a partial list, depending on what's going on with the patient) goes way beyond a simple mask.

I'd be getting vitals, repositioning the patient, calling Respiratory, calling the doc, and thinking in terms of asking for:

ABGs stat, a CXR, Nebulizer treatment, Lasix (and Foley), cardiac enzymes, transfer to ICU, labs (cardiac enzymes, BMP, Mag, Phos, CBC, BNP).

Getting all of these things done as fast as possible is critical and you can't do them all by yourself. (Actually, you could, but the patient might not survive the wait.)

[DutchgirlRN, ASN, RN]

A little off subject here...I admitted a new patient in HH last weekend. I read in the intake paperwork that he was on 02 @ 5L BNC and his sats remain in the mid 70's regardless. Now that I'm PRN I don't have an 02 sat monitor anymore. So, I didn't get his 02 sat. He was SOB with minimal activity, naturally, but he was dyspnic and his color was good.

The next day he was seen by one of the regulars. She got his 02 sat and it was 76%, she freaked out...called the office, called the doctor, was ready to call 911. All the while the patient was calm, cool, collected...talking, good color. Well the doctor called back and his order was "no sats ever on this patient".

You would think the nurse would read up on a patient she had never seen before prior to the visit.

[DutchgirlRN, ASN, RN]

I've been trying to edit my last post to "he wasn't dyspnic" but it just won't work. Trying to clear that up before I get flamed.

[TazziRN, RN]

Angie, when you go into a pt's room to help during a crisis, do you take over? I don't think so. That's the issue here, not that people are trying to help. TX feels like she's being shoved out of the way of her own pts, and for a new nurse that is not a good feeling.

[RNperdiem, RN]

In nursing, I have not had much trouble with nurses trying to take care of my patients in addition to their own.

In ICU, it is common to check up on a patient that is not yours if they are desaturating, if their IV pumps are beeping, or their pressures are low. We wouldn't make any major changes without consulting the primary nurses, but here it is considered teamwork, not a criticism of your nursing skills.

[deeDawntee, RN]

You need to tell that LVN that you have things under control and that if you want her help, you will ask for it. She is WAY over-stepping her boundaries. It sounds as if you are doing a good job and know how to assess and how to intervene with your patients' problems. You also have your charge nurse as a back-up. The LVN needs to keep her nose on her own patients. The appropriate thing to do would be just to inform you "do you know your pt's sat is 88" or whatever. That is what we do in the ICU, because more often than not, the other nurse is already intervening, has called RT or the Doc, and if we come barging into the room to "save the day" it is sooooo uncalled for.... there is a BIG difference in being part of the team to help a patient and coming in and taking over someone else's patient. I would NEVER allow it. She needs to be put in her place. "I appreciate your help, I have it under control, you can leave now." Or ask her do to something specific, like can you page RT. Stand up for yourself AND your patient. You are the expert on your own patient. Don't let ANYONE do that to you!!!!

[Hellllllo Nurse, BSN, RN]

I hope I'm not assuming too much here, but when a patient is de-satting on 6 L NC, a list of things to get/ask the doc for (and this is only a partial list, depending on what's going on with the patient) goes way beyond a simple mask.

I'd be getting vitals, repositioning the patient, calling Respiratory, calling the doc, and thinking in terms of asking for:

ABGs stat, a CXR, Nebulizer treatment, Lasix (and Foley), cardiac enzymes, transfer to ICU, labs (cardiac enzymes, BMP, Mag, Phos, CBC, BNP).

Getting all of these things done as fast as possible is critical and you can't do them all by yourself. (Actually, you could, but the patient might not survive the wait.)

I was thinking along these lines, as well.

[Hellllllo Nurse, BSN, RN]

Angie, when you go into a pt's room to help during a crisis, do you take over? I don't think so. That's the issue here, not that people are trying to help. TX feels like she's being shoved out of the way of her own pts, and for a new nurse that is not a good feeling.

I agree with the above- I think I just got distracted by the number of codes mentioned in the first post.

[FireStarterRN, BSN, RN]

There are some nurses who tend to take over another's patients without consulting the primary nurse, not just in emegencies but for other things, such as giving pain meds or other interventions. It can be an irritating trait, and borders on being disrespectful.

I worked nights once with a very anal, rather OCD nurse who was obsessed with charting and would check on my charts. Plus, she had a tendency to wake up patients a lot in the night, and when I was on my break she would wake up my patients and p1$$ them off. She obviously didn't trust other nurses to do their job, she did this to others as well. That woman really irritated me!!!