Please let me VENT!!

[Alibaba]

Ok..I am a new nurse with less than 4 months total in the field and currently in LTC.

A couple of weeks ago, I get a call from dialysis letting me know that my pt hct is steadily dropping 26.4,24.7,22. (they draw labs every 2 days and these were one week's results) I do a guaic and its +ve for occult blood. they suspect GI bleed and want an appt with a GI doc. so I call the NP and he recommends an MD the only prob is when I call for the appt, the earliest I can get is Jan 2nd I call the NP back and ask would he recommend another doc and she says no that date is fine. So now my poor lady is probably bleeding inside, and she's having to get blood like once a week to keep going to dialysis and we won't find out what's wrong till next year!!!

Last week, one of my AAOx3 pt goes completely disoriented, her speech is completely incoherent, can't provide an answer to 'what's your name?' type of question...when she tries to talk, she can not complete a thought. skin cool and clamy (not diabetic, blood sugar 122) rolling eyes to back, going in and out of alertness, c/o n/v, having twitches all over body. I mean completely uncharactestic of this pt. vitals completely unstable. I call NP and what does she say? do a CBC in the morning??

I don't know what, but I feel like something is missing. maybe there's breakdown of communication, maybe I am reading too much into symptoms, maybe I expect too darn much, but I am feeling completely frustrated. My supervisor just says 'do what the NP said'. As you can see, this is just a vent and I don't really have a question, but these are just two occurences out of many that make me question both my sanity, and my career choice.

Thanks for letting me vent.

[1Tulip]

I've never had my job seriously threatened because I was vocal about worrisome patient symptoms. Which is saying a lot after 35 years of being "uppity".

[canoehead, BSN, RN]

Definitely reassess and recall, minute by minute if need be. I've had patients transferred to the ICU to "shut the nurses up" and low and behold, they arrest WITH NO WARNING!!! Amazing how that happens.

[ZASHAGALKA, RN]

You'd be surprise how much this works - in a calm voice, state:

"I disagree with you. If YOU disagree with me, then you need to immediately come in and assess this patient. Oh, and bring your doc along with you, because otherwise, I'm just gonna call him in, anyway."

Whenever I have said this to an intern/resident, the answer is always a resigned: "What exactly do you want?"

In your case, you want an order to transfer these pts to an ED for a thorough, immediate evaluation. (and I can't imagine a guiac positive pt w/ dropping HH wouldn't be admitted for observation and probable EGD/colonoscopy.)

And the previous poster is correct - it isn't a matter of document to cya. The standard of care is what would a prudent nurse do? You already know that just documenting isn't enough. A prudent nurse would do more. You are a prudent nurse, and that is exactly what you want to do - more. Now advocate for that. Passing meds isn't your primary job - advocacy is.

~faith,

Timothy.