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Discussion

Undermining Authority

I floated to another unit last week, one that has a very bad reputation throughout the hospital for nurses who don't have good thinking skills. Even the physicians don't leave orders with staff nurses, they ask for a management person.

Anyway, I had a 30-ish patient acting out...crying, screaming all of a sudden (her husband had left for a few hours, she was in with pneumonia and a bad cold)...she wanted sugar because she KNEW her blood sugar was going to plummet after it was checked and was 68. Mind you, that's right where her dr wanted it to be, but I gave her a carton of milk per protocol and called her doc because she was acting out so much, to see if he wanted to change her usual Novolog dose she was supposed to get. He was angry I gave the milk (hey, they lady was FREAKING OUT) but then said it was OK after I told him about her mental state. He said he wanted her blood sugar right where it was. The patient wanted it higher. Patient trumps Dr. in these circumstances....but wait, it gets better...

I told the charge nurse about the patient's screaming out into the hall and frightening the other patients; she goes to talk to the patient. I can hear her from outside the room, she is telling the patinet that the hospital protocol is wrong, we should NEVER LET a patient's blood sugar go under 80 under any circumstances, she read about this recently, and the policy should be changed. Oh, thanks. Now I have 7 more hours to deal with this patient whom I have just calmed down and here you go stirring the pot. The charge nurse moved the patient to a private room (she was in a semi with an unoccupied second bed) and gave her a "care bear" they give for patient satisfaction. Talk about #1 rewarding bad behavior and #2 undermining my authority to follow proper protocol/ Dr's orders.

Then the next day the charge nurse had taken this patinet as a one-on-one. (This was over a weekend). I wonder what happened the following day when the usual routine ensued.

This is exactly why this floor has such a bad reputation. I thought about confronting the charge nurse and tell her how her actions are detrimental to unit cohesiveness, but hey, it's not my floor and it was just for one shift....anyway, I get the feeling that they LIKE the pot stirred over there, like they wallow in it and like it that way.

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some units are just toxic. hope you don't have to float there often.

Hmmmmm could this be another example of "Keeping the patient happy-even if its not in their best interest" just to ENSURE good patient satisfaction scores?:eek:

Is the physician aware that the charge nurse was playing doctor?

I think you are correct. Last week we had a code in the ICU and a patient's family member was trying to come into the ICU. I told her she couldnt come in at the moment.

She told my Manager I 'put' her out of the unit. My manager told me I had to apologize to her.

Hmmmmm could this be another example of "Keeping the patient happy-even if its not in their best interest" just to ENSURE good patient satisfaction scores?:eek:

omg...

68 is pretty low. Maybe it accounts for her mental status. People know their own bodies. I think the doc is a little extreme.

As for the rest, I don't quite know what to say. I'm not sure your "authority" is the issue. But I think you should speak frankly, respectfully, openly, and directly with your boss so you will know where she is coming from.

reminds me of a few nights ago, I was to administer soap suds enema till clear to a pt. The first one did not produce anything but brown liquid return, I was giving the second and and the charge nurse for some unknown reason came into the room, looked at me and said in front of the pt and wife, " you are not inserting it far enough in", I was in awe that she would do this in front of the pt. I was inserting it at least six inches which is protocal, she proceeded to go out and complain of my technique to the other nurses in which they responded to her, " what do you want him to do, rupture the bowel?" I finished the procedure my way, which produced a massive explosion which I was glad to help clean up because the pt stated "wow that feels so much better....."

Our hospital protocol and indeed some of the MD protocols call for OJ for between 60 and 80. I have never heard of anyone letting a blood glucose go that low. Is that something NEW?

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Our usual SSI starts at 100; that is, blood sugar minus 100 divided by 10 or 20. Our endocrinologists like LOW sugars, and actually that is current evidence to support the lower the sugar, the better the outcome for hte patient. Trouble is, the patients are accostomed to high sugars and some freak out at the prospect of having a blood sugar under 100.

The physician in this case said "she is high strung, she has an anxiety problem ever since I've known her". As in, "yeah, she's a drama queen, that doesn't make me change my orders".

i have rarely seen orders for glucose support (juice or other food, instagel, etc) for blood sugars higher than 60...saw a SS start at 98 once....usually at 150...down from 200 a few years ago....

A little off topic, sort of...

I've noticed that our SSI start at a much lower blood sugar level than even two years ago. Most used to not start until 200 or 250; now many start at 100. Obviously with patients who are brittle, ill, and prone to bottom out they don't often start that low; but for patients who are chronically hyperglycemic, the SSI starts pretty low. It took me a while to get comfortable with it, I must admit.

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