GilligansPlace
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I’m in the category of ‘who cares what sex they are?’ Seriously, do you think twice about taking care of male patients when you have to see them in more vulnerable positions? Probably not because hopefully, you’re a professional just there to do your job. Your business is of no more interest to a male circulator than a female circulator.
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I don’t think I’d waste my time on a doctorate then. You can totally use your master’s in a hands off role and still be in nursing though. No one should be ‘forced’ to put anything in their body they are not comfortable with.
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I should add the only reason I took vitals is because I was calling the doctor. I did not expect her pressure to be low; I just never call a physician without current VS and the ones taken by the tech that morning were going on 4 hours old. Her HR was in the 60s, and I thought her writhing in the bed was throwing the dynamap off. If I had gotten a low pressure with the dynamap, I would have called the RR immediately. It just so happened I paged him on the way back to the nurses station to get my manual cuff out of my bag, anticipating a return phone call to take longer. I was actually worried he would hang up because he called while I was taking her pressure manually and so it rang like 6 times before I finished and could answer.
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I definitely saw her point of view, but I don’t think she had all the information. I actually paged the physician before I had a BP (again anticipating asking for a urinary catheter order in a patient complaining of not being able to use the bathroom). He called back actually WHILE I was taking the manual pressure and then gave orders and said he’d come see her. Obviously once I had a blood pressure, her being able to void was not my priority anymore. While starting the bolus she had a BM. I then realized her complaint earlier had nothing to do with urinary retention, it was bowel related. At that point I realized her straining to have a BM probably caused the low BP and ended up calling the RR because the physician still hadn’t made it up to see her yet. I definitely think calling the RR was appropriate as a first line, but in my misunderstanding of her discomfort, I had already called the physician. I’m not sure if that’s easy to follow. The patients daughter was on the phone by this point and wanted me to call the RR, but again the physician gave orders, they were being implemented and he was en route. The manager of the floor (I’m in the float pool) texted me today to ask me about availability for some of her short days so I’m guessing she wasn’t too upset by it at least.
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Her daughter was not present until afterward. She was on the phone with her father and when I left to get the fluids to start the bolus he handed the phone to my tech who was still at the bedside said the daughter was yelling at her to ‘call a ****** rapid response right now’. Once she got there, one of her accusations was that I ignored her direct request. I had to explain to her that she hadn’t spoken to me on the phone at all. She was then upset I left the bedside to first, get my manual BP cuff and then to get fluids out of the Pyxis. The tech was at the bedside and I can’t summon things with my mind so I’m not sure what else I could have done? Calling another nurse would have delayed it longer.
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Yes! Thank you. I definitely wish I had handled the verbal exchange with the daughter better. I should have kept quiet and not tried to defend myself against the allegations. I was trying to explain to her my thought process (she showed up after the incident was over) but she was not in a position to hear it. I will definitely take that lesson forward.
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Well, initially it started with the patient complaining “she couldn’t go to the bathroom”. I had personally walked her to the bathroom about two hours earlier and knew that she had voided without difficulty so my concern at the time was actually that she was having urinary retention. I grabbed the dynamap out of the hall to get a set of vitals. She looked super uncomfortable was complaining about that, so I wasn’t too surprised when I couldn’t get the dynamap to pick up a pressure because I thought it was because she was moving around with discomfort. I went back to the nurses station to get my manual blood pressure cuff and page the doctor in the meantime, anticipating getting an order to cath her if I bladder scanned her and got a high volume back. It just so happened that the physician called back while I was getting the manual pressure which was 60s over 40s at that point. She was in with CHF exacerbation so he immediately told me we had probably over diuresed her and start a fluid bolus. After I came back with the supplies to start the bolus I realized she was actually trying to have a bowel movement. She did pass a large piece of hard stool followed by diarrhea And then I realized she had probably vageled down trying to move that stool out. I paged the doctor again to ask him if he wanted me to continue the bolus because her ejection fraction is like 15% and I thought the culprit was probably the bowel movement and I didn’t want to get her in volume overload if that was the problem. I ended up calling the rapid response because he did not return my page and had not made it to the bedside. I actually called the rapid response because I wanted an opinion on whether or not I should have continued the bolus, I was so afraid I was going to put her into flash pulmonary edema for an episode of a vagal response that would resolve itself. Her pressures were up to 80s/50s by the time the rapid response team and the physician showed up. He instructed me to continue the bolus and dictated which labs he wanted drawn. The physician and the rapid response team left once her pressures were in the 90s and the only changes to her orders were to DC the diuretics. He initially instructed me to keep her on our floor and then ended up transferring her to IMC because the daughter showed up at that point and threw a fit in the hall about it.
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So, long story short, my patient’s daughter (also a nurse) threatened me and informed me She was reporting me to the BNE. The patient had a hypotensive episode and she was upset I called the physician (who then said he would come see her right away) versus calling a Rapid Response. I implemented the physicians orders and then I did actually end up calling a RR because he did not arrive as quickly as I expected. The whole incident from onset to RR was 27 minutes. The physician’s progress note states (in his own words) that the daughter was upset but he informed her that the nurse had called him and he was en route to see her when I called the RR. Nothing was done in the RR except labs being drawn because I had already started a fluid bolus prior to calling it per the orders received from calling the physician. The physician was actually going to leave the patient on the OBS floor, but ended up transferring her to IMC to appease the family essentially. Myself, the charge RN and the physician all documented the aggression of the patients daughter, but I’ve never been threatened before and I’m honestly more upset of being accused of being a bad nurse than anything else. I did tell the daughter that I would not stand backed into a corner while she yelled at me (my tech actually came in from three doors down to see if she needed to call security because she was yelling so loud) and I think that really set her off. The family ‘fired’ me and I left the room (patients pressures were 90s/60s at this point and literally everyone else had left the unit from the RR, including the doctor). I charted her threats, quoted some of her comments and noted that she was extremely aggressive and displaying threatening body language (leaning toward me, waving her hands and pointing at my face). I guess I’m just wondering if anyone else has been threatened with report to the BNE and what happened? The physician said he thought I acted appropriately, the charge nurse said she could see the daughter’s point (and honestly I do too, I’m more upset about the confrontational aspect of it than the actual criticism I think). Thoughts or advice?