Hello everyone, I am a new RN (Jan 2021) and went from my nursing job at a long term care facility to a Post Surgical (with medical overflow) back in the beginning of April. I have been out of orientation for maybe a week total and at first I didn’t have patients that were declining enough to page doctors but last night was probably the worst night I’ve had since I have started. I am not struggling with knowing when to call a doctor or considering what could be wrong with my patient but I am struggling with communicating effectively when talking to a physician. My pt last night was technically post op day 1 into day 2 bc I work night shift. Basically overnight there were some changes in vitals (the biggest being that I had to put them on 5L of O2 after being stable on 3L) that were leaning towards the pt progressing into shock and when I paged the doctor I was told to decrease IV fluids and give IV lasix which was crazy to me bc the pt had a decently low BP that was clearly trending down. To be fair it was an on call doctor so they never really know the entire story no matter how much you tell them, but I thought I painted a good picture of the pt and they chalked it up to a possible PE and sedation from their PCA pump which yes that could also be possible (spoiler: CT was negative for PE). After all this the midnight labs come back and WBCs are increased, critical CO2 of 14, increase in creatinine and no change in pt after the orders. What are you supposed to do when a physician is on a completely different page than you are? How do you suggest more things to try? I felt so bad all night for the pt and there was nothing I could do. I didn’t feel like it was wrong to assess for a PE but I feel like we could’ve covered more bases and being a new nurse I haven’t gotten comfortable suggesting things yet. Any help is appreciated 🙂.
