I am a new RN with limited experience. Out of desperation in this job market, I had to take a job in a LTC facility / rehab where I am all alone at night with 30 residents to care for, 3/4 of these are skilled! I am having so much trouble deciding when to call the on-call doctor at night when the situation is questionable, not an emergency situation. I will give an example...
PT is a few days to a week post-op. She has returned to the facility s/p open cholecystectomy. Her current problems include widespread edema (she has history of +1 edema to lower extremities, now she has +2 edema to BLLEs, +1 to arms, hands, and face.) VS are all stable except her O2 sats, which have been 88% RA, 92% 2L NC throughout the evening shift. Lungs are CTA, resident alert and oriented, little fatigued. C/O slight SOB when on RA. Resident states she really does not want to return to the hospital.
On my shift, while resident is asleep, her O2 sats are 84% on RA, 88-91% 2L O2. No other abnormals except for the edema and some slight upper respiratory congestion, presents with weak, moist, occasionally productive cough. Lungs remain CTA. Resident is not taking any additional pain medication.
Evening shift was unconcerned about her present condition, I was unsure if there was any correspondence with the MD, except that the records from the hospital were faxed over upon her readmit.
On-call doctor has history of not ordering anything at night, unless there is an emergency he will give order to send resident out to hospital.
What I did: Monitored the resident frequently throughout the night, assessing her orientation status and lungs several times, turned O2 up to 4L to keep her sats at 90-91%.
This is one of the many questionable situations that I face working NOC shift. I hate this because during the day you can contact the doctor for this and that, and you can get a hold of the doctor that is familiar with the resident.
What else could I have done? I didn't want to send the resident out to the hospital, and she kept reassuring me that she was fine and didn't see why I would consider sending her out. I guess I could have gotten an order for a nebulizer treatment or something?
Just want to know what any experienced nurses would typically do in this situation///:nurse:
BTW, the day shift nurse stated that there was no reason to wake the doctor for this situation, that the PCP had followed the client at the hospital and was aware of her current status, but how was I to know that?