Jump to content

Talked down to by older nurse

Professionalism   (714 Views | 10 Replies)
by Teej0509 Teej0509 (New) New Nurse

63 Profile Views; 3 Posts

So a little background...I graduated in May and have recently been orienting on the postpartum floor I've been hired onto. The other day, right at shift change (of course), my preceptor and I got flagged into a room by our CNA who was taking vitals on a patient. She told us she was having chest pain and could barely talk to us or answer questions. Well, as we all know, you always assume it's cardiac until proven otherwise. My preceptor had me stay in the room so she could call our rapid response team and order a stat ECG, etc. So I stayed by the patient and calmly asked her questions such as the quality of her pain, if it radiated, etc. I also asked her if she ever had a ECG before and since she hadn't, I explained what it would entail and explained what our rapid response team was. When the rapid response team got there, we got her laid down and she was crying. I could tell she was scared and anxious. I stayed by her side and held her hand while the ECG happened and the rapid response team barely said anything directly to her. Even when the ECG was normal, they didn't even say it to her, just said "oh that's probably better than mine, just textbook NSR." So I told her "Your ECG looks normal, so your chest pain is probably not heart related. That's good news." Every time she opened her eyes, she looked at me.

I held her hand until the rapid response team called me by name to follow them out of the room. Then one of them proceeds to tell me I shouldn't "loom over a patient" when there's suspected cardiac event at play. I said "well, I could tell she was having anxiety so I was just trying to help." He then said "well you just make the family more anxious by doing that. I know you're new and new people want to be right up in it all but sometimes that's not right." And he went on about how there was like 6 nurses there (there were 3 of us, 1 was the incoming nurse and I was the only one who actually stayed in the room) like it was my fault when I didn't dictate anything that happened in the room.

 

I'm just kinda flabbergasted because I feel like I shouldn't just leave the patient and also that I wasn't in the way, just keeping the patient calm and informed. Please tell me if you think that I was doing something wrong because I know I am new, but I really felt like I was doing the right thing. 

Share this post


Link to post
Share on other sites

laflaca has 5 years experience as a BSN, RN.

366 Posts; 8,653 Profile Views

So, a few things occur to me in reading this:

One thing to consider, when you think about how you want to come across at work - why do you specify that it was an "older" nurse?  I'm wondering what the person's age had to do with this.....in the same way it would be a little weird to say it was "an immigrant nurse," or  "a male nurse" or "an Orthodox Jewish nurse" who said something that hit you the wrong way....how are the nurse's personal characteristics relevant here?  Be careful about that stuff, so you're not misunderstood.

Apart from that - you did a nice thing, reassuring the patient.  That's good.  If you ever work as an ER nurse or on a rapid response team, you will also understand that sometimes the best way to help a patient is to quickly perform an action with only a very brief explanation, and that could seem brusque at times.  But if it's really an MI then more talking=more time to the cath lab=more damage.  If it were me in the bed, I would forego the extra reassurance if it meant a better chance at living. 

One good thing about leaving the room with the team - even though your heart might be with the patient still - is that you'd get to hear them review the case.  You'll learn something. 

Something that's sad about nursing, but also real, is that we don't always get to do the stuff you did in this case.  You obviously are comfortable in the role of giving emotional support, but next time it's going to be you who needs to call the RRT, find the ekg machine, and update the doc and the arriving team.  I would suggest taking your preceptor's advice right now, even if it kinda goes against the grain. 

When you've got the skills to entirely handle these situations independently, you can be the person who's really good at 1) handling emergencies AND 2) communicating kindly with anxious patients.  But #1 takes precedence, because it keeps people alive. 

 

Share this post


Link to post
Share on other sites

3 Posts; 63 Profile Views

Honestly he's probably about the same age as me, just been doing this longer. I guess older is a bad choice of words. I was fine being pulled out of the room because it was all kind of said and done at that point. I just thought some of what he said was a little surprising. He was not my preceptor, not sure if that got lost in my story. My preceptor was on the phone for most of it communicating with the doctor about what was going on. She told me from the start that the doctor was pretty sure it was musculoskeletal or anxiety but of course always best to play things safe. I really just took on the role I did because I was new and let the more experienced nurses do the calling, analyzing ECG, etc. Our RRT protocols are kind of strange in that we as floor nurses don't have a lot of authority to do the things they do. When my preceptor got the order for the ECG, I asked if she was going to get the machine and she told me we aren't even supposed to hook it up and to let RRT handle it. Just a lot of learning I suppose. Also, when he did call me out, I didn't argue with him. If there weren't as many of us as there were, which he kept pointing out like I had something to do with that, I probably wouldn't have had the ability to emotionally take care of her like I did. Like I said, I saw myself as kind of stepping back and letting them handle it and still felt scolded so I don't know. He scolded my preceptor too which was strange to me. I at the very least learned some protocols 

Share this post


Link to post
Share on other sites

3 Posts; 63 Profile Views

I appreciate your advice though. I know I have a lot to learn! 

Share this post


Link to post
Share on other sites

laflaca has 5 years experience as a BSN, RN.

366 Posts; 8,653 Profile Views

It's impossible to totally understand what was going on there....could be some kind of politics/history between your unit and the RRT, could be something about that guy personally, could be something about that day.  Sometimes people speak sharply in rapid responses or codes.  The best code/RRT leaders are both effective and positive, but no one pulls that off 100% of the time. 

As you noted, you're not calling the shots - it's your time to observe, learn, and think about how you'd handle situations in the future.  You can file this experience away, go over what you learned, and see how it fits in the bigger picture as you develop your practice.  Glad your patient was OK.
 

Share this post


Link to post
Share on other sites

kaylee. has 7 years experience and specializes in Stepdown . Telemetry.

282 Posts; 3,358 Profile Views

I don’t think there is anything inherently “wrong” with what you did. Alot was going on and you picked up on the fact that no one was paying her much attention and THIS was probably making her more scared. Since there was little you could contribute to the clinical situation, you saw this was something you COULD do. And it was important.  It was not YOUR actions making her or the family more scared. 

It seems like the RRT nurse is the type that feels superior and must point this out. Also since he criticized the preceptor as well. 

One thing I will point out is to be cautious with what you say to reassure. A normal EKG doesnt rule out cardiac issues. Just be careful to recognize when you should say things like that. 
 

All in all I think you had good instincts in this situation and that RRT was belittling you. 

Edited by kaylee.

Share this post


Link to post
Share on other sites

12 Followers; 3,832 Posts; 28,928 Profile Views

I'm pretty sure I know what this was about:

(And yes, this is my experienced opinion)...😬

I would guess roughly 95-99% of the time....a more laid-back support/reassurance is the sort of thing that is most appropriate. If the person who counseled you did use the words "loom over" then I'm quite certain the concern was that your patient interaction was not necessarily therapeutic. Hear me out....this is a mistake many people make! Patients need actual reassurance, generally speaking--not someone to grasp their hand and appear to hang on with almost as much fear as the patient has.

Any measure of patient anxiety requires an overtly calm demeanor; a professional calm, which, at this point in your career might seem as if it is a little detached.

**There is a happy medium--and it falls right between what you did, which could be said to be sort of coddling in nature, and what they did--which was too detached so appeared uncaring.

It isn't that no one else "cared" about this patient; it's that the way they cared was to do the things necessary to make sure she wasn't having a medical emergency. They should have addressed her properly and professionally instead of talking "about" her situation in her presence. But physical touch, close spacing and the like are not necessary and it isn't infrequent that such interactions can actually complicate the situation.

Does this make sense?

 

Share this post


Link to post
Share on other sites

7 Followers; 3,345 Posts; 23,346 Profile Views

7 minutes ago, JKL33 said:

It isn't that no one else "cared" about this patient; it's that the way they cared was to do the things necessary to make sure she wasn't having a medical emergency.

Another thing to add is that extraneous chatter during an emergency, real or otherwise" just adds to the chaos. During RRT's and Codes "sterile communication" leads to fewer missed steps and a much calmer environment. Unfortunately it can also lead to hurt feelings in staff who do not work in the type of environment where they are accustomed to that form of interaction.

Share this post


Link to post
Share on other sites

12 Followers; 3,832 Posts; 28,928 Profile Views

When things are bad, we must never forget the patient. In those times, we come near, maybe use physical touch, give words of information/encouragement/reassurance, help them hang in there, let them know what's going on, etc.

But there is a huuuuuge difference between "actual bad" and "temporarily/mildly concerning." And that is the difference in the scenario described in the OP.

When things are "temporarily concerning" and we respond with an emotional crisis-type response, it really is inappropriate (and I mean that in a kind way, not as a chastisement).

OP, don't feel bad about this interaction with the RRT member. There is something to be learned here. His non-verbals may have been off a little, but I think overall he gave you excellent information.

 

 

Share this post


Link to post
Share on other sites

RNNPICU has 13 years experience as a BSN, RN and specializes in PICU.

1,059 Posts; 12,346 Profile Views

OP:

Just out of curiousity, why did you not go with your preceptor to see how he/she called the rapid, spoke with the physician.  It was nice that you stayed with the patient, but when you are the nurse, you aren't going to be with the patient, you are going to be the one calling, etc. It could have been a beneficial learning experience seeing how the physician responded t questions by your preceptor and how that goes. And yes, it is true, it is imperative that non-essential talking does not occur during a rapid response or a code. The people involved need to hear orders, action plans, and be able to repeat back and respond.  There is a closed loop communication.  If you are to the patient, some of that communication could be interrupted or even misconstrued. 

You can still be therapeutic with your patient even if you are not holding their hand. This will come with time.  Keep on learning and each day is a new learning experience. You will get there. 

Share this post


Link to post
Share on other sites

caffeinatednurse has 4 years experience as a BSN, RN and specializes in Med-surg, telemetry, oncology, rehab, LTC, ALF.

273 Posts; 3,892 Profile Views

Since I wasn't there, I can't tell you whether what you did was appropriate or not. If another nurse says that you "loomed over the pt" then maybe that's worth considering.

I will tell you that during rapid responses at my hospital, everybody should be out of the room unless they're the responding team, the primary nurse, or the charge nurse. I'm sorry to say there's little room (if any) for orientees or students. If I felt that you were in the way during a rapid response, I would tell you to move out of the room. I have done so many times, and so have our doctors. Often, our providers do an excellent job of telling the pt what's happening and why we're doing it in a quick, efficient way. 

Share this post


Link to post
Share on other sites
×

This site uses cookies. By using this site, you consent to the placement of these cookies. Read our Privacy, Cookies, and Terms of Service Policies to learn more.