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.
It almost gives me hope that nurse are really seen as professionals in their own right!
Here is where Nursing goes terribly wrong,... love yourself first.
I have said it before many times, professionalism is a "state of mind", not a title or a mass perception.
You know the professional when you see him/her, it's anyone (in any line of work) who is the best at what they do, knows it, and it's obvious for all to see.
Here is where Nursing goes terribly wrong,... love yourself first.
I have said it before many times, professionalism is a "state of mind", not a title or a mass perception.
You know the professional when you see him/her, it's anyone (in any line of work) who is the best at what they do, knows it, and it's obvious for all to see.
the original poster dissapeared faster than george bush when obama took office after all the responses. But in all seriousness, never downplay chest pain. You might disagree with the orders but for the safety of the patient go ahead and do them and THEN talk to the intern and tell them why you disagree.
Specializes in Management, Emergency, Psych, Med Surg.
I don't want to second guess anyone here and I would want to see the patient for myself before I could render a definite opinion but my first instinct is to go ahead and do the tests then as ordered. Perhaps this resident has less experience than others and the pain may be nothing.... but it may be something. I have worked in a very large CV ICU where we did 30 heart cases a day and I have seen more than one patient drop dead from a post op MI. In the time it takes to call people to over ride her orders, these tests could have been done. I always error on the side of patient safety.
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. [/q
I think your time, energy, and your pt.s survival rates would have been better served by getting them moved to a higher level of care than by arguing about "what you are too busy to do". I just have to shake my head sometimes when I see posts like this!
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,
No need to argue, simply do not implement as you describe. Troponins and EKGs however, tell a different acute R/O story.
I probably would of had the ECG done by the time the Dr had called me back or arrived to review the pt. And if I was feeling energetic at 6am bloods already drawn and a path slip sitting waiting to be signed with CK, Trops & FBE in the bag. You don't fool around with CP!
On a related comment CAROLMACCA66 mentioned about staying over. Happens all the time on the 13-21.30 shift. But nurses here work a rotating roster so the next time you are on a 07-15.30 you speak up and get away early! No clocking in and out, so you will get paid for it and be away by 14/14.30
I think your time, energy, and your pt.s survival rates would have been better served by getting them moved to a higher level of care than by arguing about "what you are too busy to do". I just have to shake my head sometimes when I see posts like this!
So you have limitless time and energy? I just shake my head sometimes when I see posts like this.
My argument would be something along the lines of, "If you want this, then you need to tell me what care to cut on my 4,5,8,9 other patients. OR you can transfer them to ICU. But you cannot get THAT on this floor right now without compromising the care of all the other patients. Because unlike steelydanfan, I only have two hands, two legs and 1 brain.
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Flying ICU RN
460 Posts
Here is where Nursing goes terribly wrong,... love yourself first.
I have said it before many times, professionalism is a "state of mind", not a title or a mass perception.
You know the professional when you see him/her, it's anyone (in any line of work) who is the best at what they do, knows it, and it's obvious for all to see.