Standing up to my charge nurse prevented a mistake

[002rn05]

so, my pt suddenly developed chest pain, SOB, and extreme dizziness right at the start of shift and I immediately went to my charge to notify her that I'd be calling the MD. I received orders for a stat EKG and troponin level. Unfortunately this pt only had access through a Midline in the subclavian, and due to the patients stage V renal failure, was pitting 4 edema without a vein in site. Per policy we are not allowed to draw blood from midlines. I requested an order for a foot draw, but the draw was unsuccessful.

My charge, in front of everyone at the nurses station, grabbed my patients chart and started to demand that I draw from the midline because according to her it was intact a PICC. I knew that I should not draw from the line as I had been reported by the previous shift NOT to, and I also knew that the line was in fact a midline... But she continued. She raised her voice for all to hear demanding to know why I wouldn't draw and stating over and over that I have an ORDER to draw (which was really the radiologist sign off saying I could "use" the line but never stated I could draw from it.)

I politely told her I was not comfortable with drawing from the line since I had been told not to and that I would need confirmation to draw. She was infuriated. I knew somewhere there had to be more clarification documented so I searched through his/her chart and found the MDs order NOT to draw. I was so proud of myself for doing what I knew was right, but now I fear my charge is reckless and as a new nurse feel out of sorts with everything that happened.

Has anyone else experienced this type of hierarchal bullying? What did you do? Especially as a new nurse I feel like I've lost my leader.

[Catzilla]

Then you say "I'm sorry, but I can't. I'm calling the doc right now to see where he wants to go from here"

your charge shouldn't yell- it sounds like neither of your were really communicating effectively. I find the plaintiff 49% at fault ?

going forward, work on your approach - see if that changes things around

[IrishIzCPNP, MSN, RN, APRN, NP]

You did the right thing. Had you done the drawn the labs something went wrong you would have been in huge trouble. You wouldn't have a policy or an MD order to back up what you did. In fact you would have gone against policy and an MD order.

You were correct in not accessing the line in your actions. Period.

You just need to contact MD for new orders.

[dansamy]

Then you say "I'm sorry, but I can't. I'm calling the doc right now to see where he wants to go from here"

your charge shouldn't yell- it sounds like neither of your were really communicating effectively. I find the plaintiff 49% at fault ?de0a

going forward, work on your approach - see if that changes things around

This. Once labs were unable to be obtained, you were obligated to notify the MD & get other orders. You can't just skip the labs. THIS patient turned out fine. The NEXT one might not. And that might include an order to obtain labs from a less than ideal access.

[002rn05]

Exactly on both comments above. My concern moving forward is this apparent communication issue and the fact that she was very unwilling to at least hear me out and I was trying (not as effectively as I thought!) to communicate with her to explain both why the doctor had told me, what I had received in report, and why I knew I couldn't draw from the line. I understand her sense of urgency- I was panicked too of course- but in this situation, communication went out the door and a power struggle of sorts that I was not prepared for prevailed. I just never want this to happen again and am trying to think back to how this could be prevented.

[002rn05]

Dansamy- I did. We had a foot draw order. I had notified the MD. And again to let him know we could not get the draw. Doc had no other suggestions and the trops went out the door when the EKG came back unchanged.

[dansamy]

Dansamy- I did. We had a foot draw order. I had notified the MD. And again to let him know we could not get the draw. Doc had no other suggestions and the trops went out the door when the EKG came back unchanged.

You needed either an order to cancel the labs OR another order to address obtaining them. The labs don't just go out the door because the EKG was unchanged. You needed to address it.

[002rn05]

Again to be clear, my language was not clinical but what I was saying was the labs were cancelled by the MD when I notified him of the unsuccessful foot draws.

[dansamy]

Again to be clear my language was not clinical but what I was saying was the labs were cancelled by the MD when I notified him of the unsuccessful foot draws.[/quote']

Then you were covered.

[KelRN215, BSN, RN]

I think your missing the point. You can not draw from a midline. The French is to small and drawing from it causes hemolysis of the sample and makes it useless. Not only that but drawing from too small of a French increases the risk of clot. This patient already had a DVT in the other arm. How is putting the pt at an unnecessary risk beneficial just for the sake of drawing a sample that will be useless?

This isn't really true. Midlines are not recommended to be used for routine labs but you CAN in fact draw from a midline and in an emergency it might be your only option. I've drawn blood from midlines plenty of times. Midlines can be the exact same product as a PICC, but for some reason or another the line can't be advanced to the SVC. That's the only reason I've ever had a patient with a midline... or the line was once central and the kid pulled it out partway. In peds we draw off of whatever we have and, if the kid has a line, that's where their labs come from.

[ORNursetobe33]

OP don't listen to most of the nurses on this thread. I will be nice and call them naysayers. You did the right thing and I am sure the doc agreed. Had you just done the draw your charge would not even do and the patient had some negative outcome they would have been telling you you should not have done it and you would have been thrown under the bus. You Can't win, so don't try. You were able to sleep after the shift, conscience clear and THAT you should be proud of.

[Altra, BSN, RN]

So you feel like vindicated that a "mistake" was averted because you refused to draw blood from a dizzy, dyspneic patient having chest pain. Hmm.

OP, if I am ever your patient and I suddenly develop CP, SOB and dizziness ... draw my blood from whatever access you can get. Please and thank you. And if my doc says, "oh, no EKG changes ... cancel the labs" ... or writes an idiotic order like "no blood draws from midline" ... please assist me to sign myself out AMA so that I can get a doc who has his/her stuff together.

[MunkiRN, BSN, RN]

When I read this I see a young nurse who doesn't know how to handle a situation asking an older nurse with more experience what they would do. To be honest, I would have drawn from the midline if I couldn't get any other access, especially if the pt continued to get worse. Worrying about a power struggle between you and your charge is almost pointless. There really is no power struggle, the charge nurse is the charge nurse and therefore they have the power. Its fine to get into arguments and make your position clear, and its fine to be right and they are wrong. But in nursing you need some tough skin, if you want to get along then you have to have to be willing to let things go after the fact. Seriously, its not worth worrying about, and I know your charge nurse has moved on. That's my recommendation to you. Please don't worry about power struggles, you won't last long if thats what your focusing on.