beeble

Hello: I am a relatively experienced nurse, and got a job at a new hospital in the new city I’m in. I had a patient on a heparin gtt, and per protocol, I stopped the gtt for one hour and restarted at a lower rate during the night. Just the usual. I was extremely busy with my two patients (ICU) who were more than anything for the busy- ness was that one needed a lot of attention, and the other had pretty constant coughing fits on the vent. I put a lot of time and attention into both, and also realized an overall picture for the center patient was that she was having cardiac issues (that had previously not been looked at) and I was trying to figure it out (big picture). Anyway, I gave report to a float nurse that had a float pool preceptee. I had thought I did a good job that night, and did a lot of “cleaning up” as I do, from the previous day (I work nights), and generally being thorough. I am not the type to sit and chat- I’m running between the two rooms, getting my baths done, labs, PRN’s, meds, tubing, etc. Then I got an email from the manager wanting to talk to me because someone had filled out a “psvr” (safety report). apparently I had not charted the stop time and start time for that hour of stop and start of the heparin. At my previous job- we didn’t specifically chart “stop”. We just charted the rage change when it was restarted and would write a note about stopping it per protocol for an hour. She also wrote that I didn’t chart the 50cc for a piggyback. I just remember being insanely busy with the two patients- the one that needed attention, the other with constant coughing fits— in addition to everything else, and that I had actually left that might thinking I’d done a really good job. I don’t usually ever go to management about someone else unless it’s pretty serious. If it’s something more minor, I usually would try to talk to them first before going to management. I did fill out a psvr recently for the entire ICU not having a syringe of d50, which is an emergency drug, and the pharmacy refusing to send one for an hour while they insisted one was on the unit (so I spent a whole hour searching the five fridges two- three times. Anyway that’s an example of where I’d complain. anyway now when I see this nurse (infrequent because she is float pool), I get very nervous because it’s like any tiny omission or mistake will be written up. This morning she came with another preceptee, and I was nervous and I guess I got snarky due to that and told her that I’d better be in my toes because I know she will write psvr’ s anything missed. She said “well heparin stopped should be charted the time it was stopped” and I said “if I complained about everything then I’d be writing things up constantly”. I asked her name because I wanted to be aware of who she is in the future (she usually has a preceptee chart everything so I didn’t know). I don’t know why that bothered me so much or why it feels so threatening. I probably shouldn’t have said anything, but I also wanted to express to her that wow - like I seriously would be writing everyone up all the time if people expect perfection. I did not not chart it due to laziness- she could have shot me an email? I want to stay away from toxicity… anyway- I’m asking for feedback about this? Thanks

Just wanted feedback regarding a situation that still hurts and confuses me. My nurse manager 'shared' with me one morning that the two clinical care specialists (RNs) on our floor were talking negative about me. She didn't explain exactly what they said. I don't really have any contact with them, save for my orientation on days, because I work nights. Nurse manager shrugged, and said 'I don't get it', and that was the end of that. Was I supposed to be glad she shared this with me? Now when I think of them, or see them in the morning (rare), I feel very uncomfortable. And it hurts, as they do not even know me.

Is it a boundary violation to buy something from a patient's family member, e.g. Mary Kay, Avon, etc?

What do you think of the need for sleep in a stable patient? Does your neuro surge team/resident on call come and fully awaken an A&O stable patient in the middle of the night to do a neuro check (i.e. lights fully on, fully awakening the patient and talking to him/her as though it were 2 pm, not 3 am, asking them how they are doing, ect). What is the norm at your facility?

surgeon mostly absent, otherwise covered by moonlighter who covers whole hospital at night.

PICC was pulled at 4 pm. Mom was upset no one was starting PIV. The one PIV started (@ ~11 pm) had pain/phlebitis right away. Mom was also upset at discovering tournequet accidentally left on for over an hour before discovered (hidden by gown). Patient's nurse told mom no one was avail to start PIV until a.m., so patient did not get abx from 12:00 noon until the next morning at ~09:00.

real life. Must add, pt is a hard stick.

specifically?

Pt lost PICC due to thrombosis at 4 pm. New PIV placed 11 pm, infiltrated right away. Pt has been on q 4 hour IV abx. So far missed 4, 8 and now midnight doses. Mom of this patient very angry no IV access established, and charge nurse decided mom is 'abusive' and that this could wait till morning. What is wrong with this scenario?

Thanks for the replies. Wondering why a coworker would ask me about this, especially 'not in private'....made for awkwardness.

In a spur of the moment thing, I applied for an open position on another unit online, then decided not to take it. A week or so later, a co-worker asked me about it, at the desk in front of multiple staff. I had told no one about this. She said she heard about it from someone on the other unit "I forgot who", she said. I didn't want anyone to know, especially since I decided not to pursue it. I was put on the spot, and told her no, I am not sure what you are talking about--- I didn't feel it was hers or anyone elses business, unless I decided to share this. I did tell another trusted co-worker about this incident, and he said I should have been truthful, and I agree, I felt funny about that, but really did not want to get into it, or explain anything. The only people that would have known about my application would have been HR, and the new unit's management. What went on here?

actually, the complainer was another new staff, who had previously been an na on a different unit, she is a relatively new grad. my orientee looked at the md like he was from the mon, not me, and commented to me that she didnt see what his problem was. i made her shift as comfortable as it possibly could have been for her.

Thanks for the replies. I never thought about hearsay, but you are right, it is...She was not privy to the phone call, nor the 2nd, more sincere, apology, which she wasnt around for. And she didnt bother to ask me about it, like 'what happened?'...Yes the reaction from the supervisor makes me wonder what little esteem she has for me, and should I bother working for a unit that holds me so low.... And you are right, I dont actually know what the report to her was from this coworker, but she did say that it was this coworker who made the complai t, couched under 'concern'. I do know I dont want to precept again, so as to avoid any further 'indiscretions'. Thanks for the compliment on my assertiveness. I am a pretty sincere person, and really do try to be kind to people(which may be why this rude md needed to think about it and call me back, lol). I really do give my heart and soul while at work, and after that, i feel i dont deserve to be treated poorly. i dont gossip, and i try to focus on doing the best job i can while i am there, and being supportive of coworkers, a team player....and no, i am far from perfect , i try my best at work, and i know others arent perfect, and try their best, and i try to be tolerant, and hope others are tolerant of me...ect Also, at this stage in my life, i donthave time for anything else.

Are you sure the nurses were glaring at you? Make time whe you know that particular nurse is on, and go and talk with her about it. It will help you process this situation, which sounds like its upsetting for you. I am sure you will feel better once you can talk to her.

sometimes you need to go through steps to get an accurate picture of a situation. For some reason, the thermometer you had wasnt reading accurately, perhaps. you took the temps, and did what they requested. i know parents can be very high stress if their child is sick. Eventually they got their answer. To be honest, the only thing I can see is what you did, retaking the temp, and because the parents were visibly upset at the warmth of the baby, perhaps getting the nurse...but other than that, you did nothing wrong. I am a nurse, and my son has had surgery, and believe me, i was a nervous wreck, i would have rather it be me than my child...so sometimes you have to look at the stress family members have and learn not to take it personally, but to empathize.

still trying to process this, can anyone offer additional insight/opinions? thanks

well, i am just that upset. i work hard enough. i also know that i just dont want to engage in this type of thing, at all. life is too short.

normally i would approach the person like you said. in this case, i am so repulsed, and view this person as really immature, that i dont think it would go well. i am concerned about how mgt dealt with it. also, i would not like to precept anymore at all. all in all, after working so hard, it just makes me question whether this unit, with its coworkers and mgt, are worth any more effort, and maybe i should seek a diff unit....

thanks for the replies. i send text messages for non urgent needs so the md can think about before calling me with an answer. i dont want to argue with him/her about anything....or defend any position, i am merely putting it out there.... wondering about this supervisor, and how she took it and ran. she later in the talk apologized for her 'accusatory tone, but i am now disgusted, will have bad feelings about this co worker, and be reluctant in my dislike to ever help her again, unless its an emergency, ect....it just sets up such a bad tone, how to handle it?

sorry for typos, writing this on a phone...

i work 12 hour shifts in an acut care setting. At 11 pm, i was told i would be precepting, and got a new pt load. the preceptee is an experienced nurse. one of the patients had been admitted for bleeding, and had gotten 6 units prbc, 2 units ffp, and platelets during the day. last labs were at 4 pm, and none ordered until 6 am. i text paged the treatment team on call resident to ask if he wanted midnight rechecks. he immed called back, and started yelling into the phone, what do you want hgb for, tell me, and on and on. i told him last checks were at 4....he con't to yell ,and what do you want them for', i said, why dont you think about it, and call me back...he hung up on me. he shortly afterwards came to the unit, and half apologized, i said why do you hang up on me, he said, you were asking why i am asking you about why i needed a hgb, and to think about it and call you back. he said it was 'half my fault' but he apologized, and said he had previously just been yelled at. later he came back to the u it again, and sincerely apologized. i worked cooperatively with my preceptee, working together, explaining as we went along, letting her do what she could, ect, trying to make her feel comfortable and supported. in the later morning, i helped a relatively new coworker get some drips hung and deal with her pt desatting. as i was leaving in the morning, the clinical specialist 'asst nurse mgr', pulled me aside and said in a very challenging tone, like talking to a child, a coworker had expressed 'concerns' about a md interaction at the desk in front of a preceptee that was awkward. did i not have a scuffle with an md, ect, and that that lacked professionalis in front of the preceptee. ***. i was like 'i treated the preceptee as nice as i possibly could. i called the md for a hgb on a bleeding pt, and he yeled at me, and hung up on me. he came to the unit 2x to apologize. you dont need tohave an accusatory tone when talking to me. i am the last person you need to speak to about conflict, i am nicer to people here than 95% of your staff, and that means everyone fro the janitor to the attending. if this person were uncomfortable, she could have come to me, or not let me help her for the last hour of work. i resent the tattletailing as unproductive ans malicious, but thank you forsharing this with me. i will let you know that at this stage in my life, i will not work with this pettiness, and request a meeting btwn you and the staf person and i, as now this makes me feel awkward....ect, i was very upset... what do you think of the staff person 'sharing her concer', she is a relatively new grad....

State your concerns and ask primary MD to call/consult with cardiologist.

Appreciate your response. Cant deal with exchange like that when patient is actively crumping. I was the only one there for my patient and had to figure out what I should do and do it, not deal with this aide, seconds count. Exchange was for me to get him out of my focus so I could stay focused on pt., which didnt work, obviously. Slamming things is NEVER acceptable. I did say to him I would address this later, which he did not accept. I was concerned about my patient at that time, not his idiosynchasies.

Hi! I currently work in critical care, on this unit since last fall. There is a lot to learn. I worked last night. There is an aide who has worked there for 30 or so years. He is very set in his ways, and for example, starts his day at 0630 (no one does that anymore) and punches out at 1500. Takes his lunch at 1100, NO MATTER WHAT. Will get frustrated if you bring fresh towels in the room for a clean up "Why are you doing that, there are towels in the drawer" (in the room)). I know several of the longer term staff roll their eyes when speaking of him. They say he used to really be crabby until an accident about a year ago. But I always respected his longevity, and got along, and was always really nice to him. I worked overnight last night. I had tried raising the head of a patients bed and noticed a crunching sound, it was an O2 tank wedged in the foot pillows of a Kinair bed. I took it out and propped by the wall. I was changing lines. My patient decided very suddenly at 0630 to drop his sats, while on a vent, to 73, and raise his BP to 200. My charge RN was notifying RT/MDs while I was giving O2, suctioning, ect. and wondering if he was having a PE. Just then, the aide was in the room stocking washcloths, and saw the O2 tank and said to me, "This is very dangerous, this shouldnt be like this, ect" I said "I can't talk to you right now I am dealing with this situation" "This is equally as dangerous, AND YOU WILL TALK TO ME" "I WILL NOT TALK TO YOU NOW" ""YOU WILL TALK TOME NOW" "No, I WILL TALK TO LATER" "YOU WILL TALK TO ME NOW" this excange went back and forth while I am trying to get the pt's sats up and see if RT was called. The MDs were in the room at this point. He SLAMMED the washcloth drawer, and STOMPED out of the room, waving his arms in disgust at me. I was so shaken I could hardly focus on pt and MDs and their questions. The sats slowly came back up after several long minutes, and BP down, still dont know what happened, but was still shaken a little while later when MDs rounded and were asking me questions. I went to asst nurse mgr, and told her the above, and she said that O2 tanks were this guys "pet peeve". She said she would talk to him, and it was right my focus should be on pt. I did see him and her casually and calmly chatting a few mintutes later (as I was charting). I am worried this guy will go off on me in the future, or get 'mad' at something, like a request for a turn, and really honestly would prefer never to see him ever again, but since I know that won't happen, what should I do? How should I handle this, and what do you think of this situation? Very upsetting for me!! Thanks

Hi, I am starting n a new unit after working 3 years on a different unit at the same hospital. This new unit has more critical patients. I generally am doing ok, it's a lot f new learning. I had a preceptor the other night who seems very knowlegable, but sometimes intense. I like all the new learning, and want to learn as much as possible while still in orientation, however, this preceptor will 'quiz' you...Like do you know the s/sx of this, why we do that' ect. I don't know all this off the bat, I am new! Anyway, we had a critical patient the ther day, and while I was assessing, charting, ect, she is simulatneaously asking questions and interjecting. I was giving meds and hanging blood products, and she said to me "Speed it up!" I then said, "I can't speed it up!!! I am going as fast as I can! I don't want to make mistakes" and then proceeded to say that while I am grateful for the knowledge she has, I have been a nurse for 5 years, but this area is new to me, I know speeding it up leads to errors, and I am going as fast as I can, and her quizzing and interjecting while I am trying to get things done is stressing me, and if she has a criticism on my speed, we can talk abut that later". She was aplolgetic, and then so was I and I felt like an a-s-s the entire shift and tw days later. Hope I don't get a reputation. Did I sound like an a-s-s?