I have had several situations from work bother me for a day or two, but this one has stuck with me for weeks. I was working with a Dr. I have never worked with before, I am a fairly new nurse. I had a pt. who seemed to me to be circling the drain. I politely mentioned this fact to the Dr. and he ignored me. 30 min. later the pt. was getting worse--she seemed to be septic, BP going down, breathing faster, cool extremities, unable to obtain accurate spO2. I took the liberty of discussing with the pt. if they would want everything done if the pt. were to die and they said yes. I told the Dr. I was really worried about this pt., showed him vital sign trend--still nothing. I asked if I could start antibiotics and blood cultures, he agreed. BP still going down, this pt. looked like she should have been intubated 20 minutes ago, I got the Dr. to come look at pt., still nothing. I prepared the room for a code, got an order for dopamine after bothering the dr 6 or 7 more times. Well, to make a long story short the pt. died. I was pretty much standing there with BVM in hand waiting for it because I was positive she was about to die. I had already called respiratory as well. When she did die, I ran the code since no one else would take charge, I have only been in a few codes (and ACLS) so I can't say that things went textbook perfect.
I just keep going over every detail of this case in my head over and over and over again. I shoud have had someone defib her earlier since the Dr. wasn't having anyone do anything, I should have gone to my charge nurse to tell her that my pt was dying and no one is listening to me. I should have gone to talk with the family after the death but I chickened out. I know that I did the best I could possibly do with what knowledge and ability I have, but I can't help but think that we could have saved this lady if someone would have just listened to me. I should have screamed at the Dr. or something, but I guess being new I didn't want to be the boy who cried wolf. Maybe she would have died anyway, but the bottom line is, I don't think we did everything we could have done for her for an hour before she died.
that's a cheeky comment in light of what happened, but nothing i can say can change that and none of your second guessing can, either.
so the question becomes: what did you learn and how will you apply it in a similar, future situation?
my experience is that my intuition in such things are normally more right than not, and the quicker and more assertively i act on that intuition, the better off the chances for a better solution.
~faith,
timothy.
i completely agree.
you will become more comfortable in your assertiveness. as for saying you should have defibbed earlier, i don't really understand that comment. you can only defib when it's called for.
i'm sorry this happened. no sense in second guessing things now, just take this, tuck it away, and learn from it. next time i can guarantee you will be more aggressive in getting answers.
i hope you charted all your attempts with the doctor. that is what basically saves our butts.
You attempted to resolve this situation before it became life threatening and it sounds like you did very well in such a stressful situation. The outcome was not your fault.
I have noticed that some of our ER docs don't give as much credibility to the newer nurses; NO, of course its not right, but it happens.
The only thing different I would suggest is to involve your charge nurse, go up your chain of command when you don't get the needed response from the physician. Say you were called into court on a case like this, the first thing the attorney would grill you on is, "If you were not satisfied with the physician response/ if you felt the physician care was negligent, why didn't you go through your chain of command?" Because what you are saying is that you were uncomfortable with the physician's response, but still accepted it. This is what your charge nurse/supervisors/managers are there for; utilise them. This goes for any issue you have-if you are not getting the needed results, it is standard of care for you to go up the chain of command until the problem is resolved.
I empathize with you so very much. I have been a nurse for 20 years. 2 years ago I was involved in a sentinal event. I had floated out of my ICU where nurses have so much more autonomy. But also I was dealing with a doc I never had dealt with before. When I statrted having problems with my patient, I called right away but the problem was that the fluid bolus's I was giving kept transiently improving her bp, and the Doc just DID NOT CARE. I called the doc several times asking for tests I knew she needed and I was acutally screaming @ him on the phone. I finally transferred the patient to ICU on my own without an order, but the patient needed surgery and died anyway. This still haunts me 2 years later. I remember her name and everything about the case. Fortunatley I documented well. My hospital backed me 100% and the physician was brought up for review by his peers. I never heard of or saw him again & I don't know what happened at that review because it was confidential, but he is not at this hospital anymore. However, I am still tormented over this incident and I feel for you so much. Looking back, I would have called the House supervisor and had her go through the medical chief. But again she kept transiently improving and hind sight is 20/20. You can at least learn from this to trust your judgment.
I have always worked in facilities where if I had real concerns about how a MD was handling a patient's condition, there was always someone above me and above that MD that could be contacted to intervene. It was not always easy to do this, because some MD's took offense, and didn't like to be questioned. BUT, I was told if I ever just let the situation go, and it went to court, I would be just as guilty for allowing it to continue, and that could jeopardize my license. I guess I am lucky, as in all facilities I have worked in there was a chain of command for handling MD's who didn't seem to be taking care of the patient appropriately. I would definitely let the charge nurse know what is going on if that happens again, as they should know what is the appropriate action in that particular facility.
S#!T Happens and it always will. The thing that really matters is what you do with the S#!T. You can flush and learn nothing or fertilize your knowledge and grow.
These situations will just make you a better nurse.
You attempted to resolve this situation before it became life threatening and it sounds like you did very well in such a stressful situation. The outcome was not your fault.
I have noticed that some of our ER docs don't give as much credibility to the newer nurses; NO, of course its not right, but it happens.
The only thing different I would suggest is to involve your charge nurse, go up your chain of command when you don't get the needed response from the physician. Say you were called into court on a case like this, the first thing the attorney would grill you on is, "If you were not satisfied with the physician response/ if you felt the physician care was negligent, why didn't you go through your chain of command?" Because what you are saying is that you were uncomfortable with the physician's response, but still accepted it. This is what your charge nurse/supervisors/managers are there for; utilise them. This goes for any issue you have-if you are not getting the needed results, it is standard of care for you to go up the chain of command until the problem is resolved.
This is true. Being a new nurse sometimes I have a hard time getting docs to listen to me, so I bring out the big guns, I get our house supervisor (if I am charge) in on the situation and wake up some attendings! I work in a teaching hospital so I work with residents on-call at night, oh goodness...
Sounds like you are a very competent nurse, but a little unsure of yourself.
We new nurses just need to gain more confidence in our assessment and intuition. I know, I too am afraid of stepping on toes for "crying wolf" but when it's the real deal I am glad I did it.
I know it's totally different working in the ED, but you should really have way more support for situations like this or I would go elsewhere.
Sorry this happened to you. I would speak to your unit manager about this situation and why the doc was so unresponsive.
Having said that, there's always going to be days like this. You did a darned good job for your patient and you shouldn't be the one losing sleep over this.
I think the thing to be done in a situation like this is to follow the chain of command, which in your case would be the charge nurse, unit supervisor, etc. There is no point in second guessing yourself now. You have learned a valuable lesson.
It sounds like you did a wonderful job in caring for this patient. Persistence and being a patient advocate is very important. It sounds like you're very caring. Don't lose that in the years to come. That is such a wonderful trait, and the patients will see it in you no matter what the outcome of their condition.
Super_RN, BSN, RN
394 Posts
i completely agree.
you will become more comfortable in your assertiveness. as for saying you should have defibbed earlier, i don't really understand that comment. you can only defib when it's called for.
i'm sorry this happened. no sense in second guessing things now, just take this, tuck it away, and learn from it. next time i can guarantee you will be more aggressive in getting answers.
i hope you charted all your attempts with the doctor. that is what basically saves our butts.
:) super