Primary Dressing

[Sleepingless]

I understand the concept of reinforcing and not changing a primary dressing and hip surgeries are generally oooz ooooz oooooz but... 0900 fresh from pacu, 2.5cm circle ooz, 1000 5cm, 1100 12cm with strikethrough reinforced, 1130 strikethrough reinforced, 1200 strikethough reinforced requested RN assessment, " still looks fine tell me if gets worse come get me", 1230 strikethrough removed three layers of reinforcement 6x6 full cant see ink lines, requested RN assessment, "the surgeon does not want us to remove dressing and look, I will call him" (Pulled off floor for mid conference and lunch) returned at 1440 linens are soiled 7x10 spot reinforcement removed (not by me) reapplied, changed sheets, 1500 strikethrough still no surgeon, continued same pattern until 1930 (Shift change) night shift nurse made call gave report and hospitialists was visiting as my time finished at 1945 not happy with the day, preceptor was no help said RN needs orders to assess primary dressing. This rule did not apply to the night shift nurse she removed the dressing to find tissue evisorating from closure and skin damage from being saturated in blood for 10hrs. PISSED is putting it lightly RN told Dr to get off ass now and meet her in pt room. Sry for the long post but I do have two questions.

She made her needs known by getting hostile and seriously blunt, Not sure I could do it like that, so how can I express a need to get something done without resorting to hostility?

Is there an actual rule (I have looked and have found no such thing at least for Kentucky data, can not get at hospital policy) that a Dr must order a dressing change?

[Rose_Queen, BSN, MSN, RN]

A lot of surgical dressing changes for the first time may involve the surgeon doing it him/herself to assess the incision as their preference. As far as the surgeon not coming in, hostility is not necessary, sometimes bluntness is a good thing, and there is always backup- going up the chain of command for assistance. Related to orders for dressing changes, it may be part of standing orders or part of policy and procedures for that particular unit.

[Sleepingless]

I really liked the purpose statement at the end, fits nicely to my dilemma. As A student chain of command is really, umm not available, but in practice that would be what house or ???? but should I really just pass the buck even then? Waiting for a frail 86yo f to trend downward seems well (not proactive nursing) sry just dont like the middle man syndrome here, is there no proactive direction? The night shift took control did she step outside practice? bluntness (assertive communications) ya I got that never really works but ok (always seems passive aggressive when using) called snipeing here, i have tried the approach is always less than expected outcome much lower than what is needed.

[RN403, BSN, RN]

As a student your next chain in command could be your clinical instructor or the nurse manager of the floor. You don't have to be aggressive about it you could simply state that you are concerned about the pt's safety/well-being and allow them to take it from there.

In practice I would go to my nurse manager/nursing supervisor if I felt that there was an issue being ignored by MD or felt that the MD's response did not help the situation.