I worked nights. A pt had mild chestpain a few days after surgery (sternal incision).They had d/c'd pain meds d/t AMS. Inthe a.m. (0600) he c/o of this pain,'soreness'. The brand new resident was there. She then ordered a stat portable CXR, stat trops, and stat EKG.
Guess who would have to do the labs and EKG? The normal staff for these things would arrive at 0700.
I tried to talk to her that he stated this was the same pain he has been having and that it was normal soreness. She stated that"I followed him yesterday and he didnt c/o this'. I stated maybe you were focused on his AMS yesterday. She insisted they be done. 0600 is a crunch time. I didnt feel these things were truly 'stat'.
I paged her and she didnt call back. I then paged her senior who modified her orders to 'routine', meaning they would be done this a.m. when regular staff were here (not STAT).
Then she called back, I told her I had talked to her denior, and he modofied them. She then said I should have talked to her first and "How would I like it if she went to MY supervisor?.....
I didnt go to the senior with a complaint but a legitimate patient care issue.
I would have carried out the orders STAT. However, seeing how the pt was post-op from chest surgery, I would have asked for pain meds. I realize you stated in the OP he had acute mental status changes previously, but they could have tried something non narcotic like Tylenol or Tordol.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
The patient was not in distress, and regular people would be coming at 0700. I have 6 patients. This was NOT stat.
Were you that sure that the patient that had some sort of cardiac procedure with a new onset of "some chest pain" was not having a cardiac event or pulmonary emboli from bedrest? That possibly had developed pericarditis? That maybe had an abcess or infection in the mediastinum? Possibly a development of a hematoma?Are you sure That you could explain to a court of law that this could wait an hour because you had 6 patients and you were at the end of your shift? Are you that sure you could defend yourself if something untoward happened? I don't think you'd have a leg to stand on. VERY SCARY...........It sounds like you had enough time to make a ton of phone calls. I wonder if that energy would be better spent caring for the patient and getting the orders over with to ensure the patients best outcome.........just a thought..
Specializes in Med Office, Home Health, School Nurse.
i completely agree with everyone else on this....
you were way out of line to even think of delaying the orders. it's not your job to question the resident's decisions, it's your job to do what's ordered. if something had happened to the patient, you would be out of a job and facing jail time before you could even say "but it was 6 am!".
things get busy and sometimes you have to stay past 7 am...it's called life. deal with it. this is one time where you could have gone a different direction and made the situation a whole lot better.
as many others have commented, the time you used to track down the senior doctor could have very well been spent actually carrying out the orders and avoiding the situation altogether.
i think you made a very bad decision that could have turned out really bad.
Specializes in Burn, CCU, CTICU, Trauma, SICU, MICU.
How would you feel if your dad's nurse put of orders for the next shift to do when he was experiencing what the nurse decided was just incisional pain? How would you like it, knowing that - RN got the orders at 6, wanted to go home so she spent the time it would take doing it, to complain at the docs so she wouldnt have to do it? Then count up to at least 730 until Day RN is out of report. Then another 30min at minimum before she is able to get to the bedside... 2 hours later, chest pain still occurring... how would you feel?
In the time it would take you to do it, you would have the labs back possibly before you even left and could have reviewed the 12 lead on the spot - and if everything was negative - you could have had the patient medicated close to change of shift, if not shortly there-after.
Delays only hurt people and intentional delays are just selfish. Unfortunately for you - nursing is one of the most selfless jobs you can choose. Deal with it.
(The resident) ordered a stat portable CXR, stat trops, and stat EKG.
Guess who would have to do the labs and EKG? The normal staff for these things would arrive at 0700.
...0600 is a crunch time. I didnt feel these things were truly 'stat'.
But that's not really your call... that's the MD's decision. And to be honest, it sounds like your decision was based more on it being "crunch time" than anything else.
I didnt go to the senior with a complaint but a legitimate patient care issue.
It doesn't sound to me like it was a patient-care issue but rather a nurse-convenience issue.
Personally, I think the doc had every right to be upset and that you owe her an apology.
Perhaps the resident over-reacted somewhat. Sometimes residents overassess and may overtreat. It's part of their learning process (and may unfortunately be expensive, but that's an entirely different issue). HOWEVER, IMO, there is NO reason to question physician orders when the MD came to see the patient, made an assessment and a treatment plan, and gave you the orders to implement, UNLESS it was unsafe (which is was not.) Not your role. Don't like "STAT"? Too bad. I bet your day shift nurse would have liked it a whole lot less if you had dumped all that work on the beginning of her busy shift, which if I am understanding correctly, you did.
If you want to override a doctor's assessment and go over his/her head if you think it's wrong, or something got missed, or there was a mistake made, or something else needs to be done, I feel that is appropriate. In this situation, what happened was not appropriate.
A side note -- if too many tests are being ordered inappropriately, sometimes management can work with the docs to help cut that stuff down. We relatively recently stopped doing CKMBs/troponins on post-CABG patients because they were always elevated following cardiac surgery and the results didn't change the treatment plan.
I'm kind of blown away by this. The resident ordered stat labs on a post-surgical patient with chest pain and you got them changed because.......they were inconvenient? And then you dumped the orders on the incoming nurse?
If I were that nurse I would have reported you.
And on top of that, you're ticked off because the resident got mad at you?
I have to disagree with "it's not our job to question, we're just supposed to do." If that were the case, why bother with nursing school?
We have every right to question a resident's orders if we feel they're inappropriate.
We have every right to go over a resident's head if we feel the orders are inappropriate.
And 6am is a crappy time to get hit with some new orders. (As is 6pm.)
But while I think the orders were probably an overreaction on the resident's part, it wouldn't have been worth the fight for me. Weighing the "just do it" versus the trouble of paging someone, waiting for the call back, perhaps not having gotten what I wanted and still having to do it all after the phone calls...
I'd have done it, whined to my coworkers about the stupid resident, eventually gotten the results back and driven home smugly satisified that I was right.
That said, I've argued orders not for inappropriateness but because of increased workload. When something gets ordered q 30 minutes or q hour on a med-surg floor, I have gone to the doctor and said, "For me to have time to actually do that, which of these other 5/7/8/etc. other patients would you like me to ignore?" Sometimes you have to point out that a particular patient is NOT your only patient, even to the doctors that should know better.
I think it comes down to pick your battles. Sometimes even if you win, the battle isn't worth the cost.
Again, sorry you had a crappy morning. It always seems to be the days you HAVE to leave on time that stuff like this happens too.
How would you feel if you had chest pain or (soreness in the chest) and this was done to you? Pain is what the patient says it is. With what you posted, it appears that you didn’t want to do it just because it was inconvenient. If I were the resident, I would have had reported you to your NM and would have had written you up.
I cannot believe that you call the senior resident to change the orders just because you felt they were not 'stat" worthy and also because it was close to your shift change. Imagine if those troponins would have come positive with EKG changes? I can agree with you that sometimes nurses disagree with our plan but to change it just because of shift change? are you kidding me. If a physician saw this patient personally and examine her and decided she/he wanted stat labwork ESPECIALLY ON A CHEST PAIN PATIENT then it has to be done because as a lot of people said already these test were not harmful to the patient, a possible AMI could have been.
I those test would have come back + you would have been looking for a new job.
you dont BS with chest pain, no matter the scenario (s/p chest surgery).
it's not your job to question the resident's decisions, it's your job to do what's ordered.
i agree with most of your post, but it is my job to question orders. any trained monkey could do the skills i do day in and out, but the thinking is what makes my training and skills unique to a nurse. i routinely question orders, and "just doing what's ordered" could end a nurse in jail. however, i do not feel that this was a situation that called for the orders to be questioned, and certainly not for the reason of convenience.
That possibly had developed pericarditis? That maybe had an abcess or infection in the mediastinum? Possibly a development of a hematoma?Are you sure That you could explain to a court of law that this could wait an hour because you had 6 patients and you were at the end of your shift?
Are you that sure you could defend yourself if something untoward happened? I don't think you'd have a leg to stand on. VERY SCARY...........It sounds like you had enough time to make a ton of phone calls. I wonder if that energy would be better spent caring for the patient and getting the orders over with to ensure the patients best outcome.........just a thought..
ChristineN, BSN, RN
3,465 Posts
I would have carried out the orders STAT. However, seeing how the pt was post-op from chest surgery, I would have asked for pain meds. I realize you stated in the OP he had acute mental status changes previously, but they could have tried something non narcotic like Tylenol or Tordol.