new nurse advice. screwed up?

ii

After reading this post, I feel very scared. I am currently a nursing student. I have already read all the comments on this post and I got that she should have called the doctor or NP.

BUT, I just need to know what if a new nurse feel intimidated by a charged nurse or her preceptors. what if she already called the doctor before for other patients. what if she feels embarrassed for calling the doctor again and again. what if she does not want to be seen as an annoying nurse. I know everyone talking about how important to act as a patient's advocate and preserve nursing license. But, what if the situation was different and she called the doctor and got yelled because nothing happened to the patient;! is this the way always goes, that she has to bite the bullet of bossy doctors and bullied-workers ? !! what will be the solution in this situation? what if the patient was okay and she got yelled, could she defend it by saying that "I just did my job for client's safety or remind the doctor his/ her part in patient care !!?" Can We Defend our position at work or we get fired

This is where charting comes into play. Document your calls to the doctor, VS, patient symptoms, notifying charge nurse, etc. Also activate RRT or Code Team, hell any team that will come and assess this patient. Don't worry about what they think of you, always err on the side of caution. We save lives not impress coworkers.

ii

After reading this post, I feel very scared. I am currently a nursing student. I have already read all the comments on this post and I got that she should have called the doctor or NP.

BUT, I just need to know what if a new nurse feel intimidated by a charged nurse or her preceptors. what if she already called the doctor before for other patients. what if she feels embarrassed for calling the doctor again and again. what if she does not want to be seen as an annoying nurse. I know everyone talking about how important to act as a patient's advocate and preserve nursing license. But, what if the situation was different and she called the doctor and got yelled because nothing happened to the patient;! is this the way always goes, that she has to bite the bullet of bossy doctors and bullied-workers ? !! what will be the solution in this situation? what if the patient was okay and she got yelled, could she defend it by saying that "I just did my job for client's safety or remind the doctor his/ her part in patient care !!?" Can We Defend our position at work or we get fired

The thing is, if we don't alert the doctors, how would they know what our concerns are and how can it get fixed? Yes, sometimes doctors get pissy and annoyed, but ultimately you are protecting your patient and your license. I've lost track of the number of times I've called the doctor to give them the heads up that xyz has changed only to have them shrug and tell me just to keep watch. That's ok. They ball is in their court. And most of the time, the patient is ok. Sometimes we annoy the doctors; we try to keep it to a minimum, but patient safety always should come first. Unfortunately some times we get yelled at. We shouldn't be treated that way, but the fear of that also shouldn't prevent us from voicing concerns about a changing patient condition

As you practice more, you'll become more confident in your judgments and more confident what other pieces of data you need

ii

After reading this post, I feel very scared. I am currently a nursing student. I have already read all the comments on this post and I got that she should have called the doctor or NP.

BUT, I just need to know what if a new nurse feel intimidated by a charged nurse or her preceptors. what if she already called the doctor before for other patients. what if she feels embarrassed for calling the doctor again and again. what if she does not want to be seen as an annoying nurse. I know everyone talking about how important to act as a patient's advocate and preserve nursing license. But, what if the situation was different and she called the doctor and got yelled because nothing happened to the patient;! is this the way always goes, that she has to bite the bullet of bossy doctors and bullied-workers ? !! what will be the solution in this situation? what if the patient was okay and she got yelled, could she defend it by saying that "I just did my job for client's safety or remind the doctor his/ her part in patient care !!?" Can We Defend our position at work or we get fired

I work in the ICU and the majority of the time the provider is physically on my unit. Sometimes depending on the service they aren't on my unit, but that never stops me from paging or notifying them. I've had shifts where I'm like, "man, the resident must be sick and tired of me paging them" and I just laugh about it.

I've had it where a resident isn't concerned and has been ignoring what I was saying and what the previous nurse was saying (we had the same concerns) and I've been on the phone with the resident (who finally called me back) who was totally unaware that the attending was standing right next to me. The attending agreeded with my concerns and assessment and chewed that resident out big time. Document your concerns and who you notified, and keep trying when you have concerns over how a patient is doing. I will bug the crap out of a provider if I feel I have to- I'm doing my job and they are getting paid, so I'm darn well making sure they're doing their job.

I recently had a patient come to me from the OR. They were sinus rhythm when they arrived, but then dropped to the 50's (and even started dropping to the mid-40's at times). They were asymptomatic, but I still let the provider know and got an EKG right away. It was sinus brady- no type of heart block or anything so the provider wasn't concerned. It resolved without any intervention after about 24 hours. The key with this patient was that they were asymptomatic, but even so I still got an EKG and told the provider.

ii

After reading this post, I feel very scared. I am currently a nursing student. I have already read all the comments on this post and I got that she should have called the doctor or NP.

BUT, I just need to know what if a new nurse feel intimidated by a charged nurse or her preceptors. what if she already called the doctor before for other patients. what if she feels embarrassed for calling the doctor again and again. what if she does not want to be seen as an annoying nurse. I know everyone talking about how important to act as a patient's advocate and preserve nursing license. But, what if the situation was different and she called the doctor and got yelled because nothing happened to the patient;! is this the way always goes, that she has to bite the bullet of bossy doctors and bullied-workers ? !! what will be the solution in this situation? what if the patient was okay and she got yelled, could she defend it by saying that "I just did my job for client's safety or remind the doctor his/ her part in patient care !!?" Can We Defend our position at work or we get fired

Somewhere along the line in nursing school we get taught that MDs are Gods that are constantly in a bad mood and don't want to hear about their patient status. This is not true. Stop believing this.

I've been working in a hospital for 3 years. The only time I had a doctor raise his voice at me over the phone, I held firm and told him he was wrong (he was), and he backed down. I've had doctors that sound annoyed on the phone but are just sweet as pie in person. The most common theme is that they just want the required info and no fluff -- patient name, what you are requesting and why. Don't go through the full SBAR, especially in a hospital where the doctors are acutely aware of these people. If you need to give some history to back up your request, that's fine, but don't give a full history up front. Do an appropriate assessment before you call and have your information available to you when you call. Eventually the doctors get to know you and you them, so you can learn their preferred communication methods (i.e. we have one doctor that prefers to be emailed sent to him rather than a phone call if the concern isn't urgent).

But never forget that MDs are human. They have good days and they have days where they can let stress get the worst of them. They are not infallible. You are not less worthy of respect simply for not having those letters behind your name. Stop looking at them as gods and think of calling the MDs are a short conversation with another human that just needs to know the facts. They have many more patients than nurses do, so they need us to be their eyes and ears. Neither of us can do our job without the other.

Patient: 40 something year old Jane-Doe. No medical history.

Is post operative. Underwent general anesthesia. Had a ureter stent placement and stone removal.

BP 80/50 HR 41 100% on 2L cannula.

subjective: Looks pale. She said she looks pale, also. Feels groggy. A bit swollen/edematous in the arms.

States "was an athlete BACK IN THE DAYS. My blood pressure runs low, but not that low. I never had my heart rate measured." In the ER, base line was 100s/60s and her HR was 70s. Maybe because of pain?

Should this warrant a "Hello Doctor! Explain above. That's it." Or should I have left it alone? I ask because the patient was OK when I left a couple days ago. My Charge Nurse said she'll be OK. Don't need the MD. But my director wants to talk to me about this. So I think something happened to the patient. I go back in tomorrow.

Thanks. Should I have made the call?

You said your charge nurse said she'd be OK, so I assume you spoke to the charge about the patient's condition. Either way, I would have made the call. I definitely would have documented any time I spoke to someone about the patient's condition. However, any time the patient's post-op condition is like this, err on the side of caution and make the call.

Don't be scared. Yes, you can say "I did my job, I was concerned for the patient." Management should be pleased that you're concerned over your patient's condition. After all, you're saving them the expensive costs of the legal department defending litigation brought on by negligence.

Now, at some point, you will learn what these doctors expect. You will learn what is more emergent or urgent and what can wait until morning. For instance, an order for colace because a patient is constipated can wait until morning. That's an easy example. A drastic or uncharacteristic change in heart rate with subjective symptoms is a change that needs to be addressed.

Please don't be afraid. Hopefully, you'll have mentors or preceptors available when you get that first job and they'll be able to help guide you.