What to do in critical patient situations?

HouTx, BSN, MSN, EdD · Nov 13, 2015

Check your organizational policies. I'm sure that there is a process for those 'after hour' situations. Don't ignore your own gut feelings. When there's something happening with one of your patients that is outside your scope of practice or expertise.... don't let it go. If your supervisor will not respond by at least assessing the patient her/himself, you need to escalate. Go up the chain of command until you get a response. I don't know of any instance in which a nurse's license was imperiled by paying too much attention to a patient's changing condition. On the other hand, failure to recognize/react appropriately is an all too common reason for loss of a nursing license.

bbyRN, BSN, RN · Apr 8, 2016

I work on a TCU - that might be the same or similar to a post-acute job like yours.

First, you posted months ago. I expect you are fairly seasoned now, though still have many questions. Maybe you have a decent working relationship with your on-calls now. I hope so. Maybe your supervisor is being more helpful. I hope so.

My two cents:

Call another nurse who has experience at your facility with your question if it is late at night, or even if you have started working AMs. I have learned a lot from my fellow nurses.

Pay attention to your ABCs (and D and E for that matter - environment? Sometimes the O2 has run out; sometimes an O2 line is not hooked up to the O2 even if it is hooked up to the Pt. Etc.) Take care of your ABCs quickly and then ask your questions. Get vital signs and have the chart open before you before calling the on-call.

We have nurse triage lines for some docs - so you get to talk to a more experienced nurse first - late at night. You can learn a lot that way.

Ask questions early in your shift. Look up stuff on line in reputable web sources to keep learning - plus this will keep you fresh and interested. Look up stuff here on allnurses.

Cover your a$$ with documentation or without documentation.

Keep learning what is an emergency and what is not. What is urgent and what is not. And, you have to do this after your shift because we are too busy on the shift.

I hope that you are still questioning everything - that is asking questions and learning, as well as questioning.

Good luck.

SleeepyRN · May 3, 2016

I am a new grad nurse working at a post-hospital rehab facility. I'm still in orientation with 4 more days (only 10 days of orientation x) ), but I worked one day by myself with 10 patients. It went well, but something popped up in my shift with one of my patients and I asked the Nursing Supervisor about it...
It wasn't something critical, but I thought it was strange. When I asked the Supervisor about it, she kind of disregarded it immediately like it was silly.
It just concerns me in the future though because what if it is a critical situation (not emergency) and the Supervisor disregards it again? I work the 3-11 shift and I'm concerned if I call their doctor for orders they won't pick up and will be sleeping and I noticed the on-call NP has hours until 9 pm. If something happens past 9 pm without anyone to call, do I just call 911 and explain to them the situation and whether or not to send them to the hospital?

There is NO MD, NP, PA on call after 9? Forget that. I wouldn't work there.

littlespitfire · May 17, 2016

Old post but maybe someone will read this and get some reassurance. I'm a midnight nurse, on rehab and we take very acute people. We are no strangers to codes, complications, and crashing. Wd work with dozens of doctors and people come from out of state to be with us. After dealing with that many doctors, I can safely say every physicians group has someone on call every night. They have answering services that page out for us (tablet style, not pager. So they know what's up when they call back.) I also have a few private cell numbers for docs who know I don't page unless something is seriously wrong. They hand it out to certain nurses. During the day we have the in house np and PT doc to help when issues arise. Nights, not so much. So 1, assess. Is it something that can be fixed by giving that hydralazine a little early? Is the patient experiencing something we aren't expecting? Do we have the means and time in house to fix it, without doing something illegal or paging the on call? If we can fix it, or try to, we do. There are many interventions we can initiate that we don't need to call doc for. Always let shift mates know what's up and call super and say heads up, patient x has this going on. If patient is declining rapidly, or we can't fix it, 2, we page out. I will not page more than twice. Doc doesn't page back after the second time, 15 mins apart, you probably won't. Only wait if condition allows it. If we are paging out, there's no doubt this patient is going to the hospital. It's bad if we page at 0330. Our policy also states we can page the medical director or assistant med director if necessary. While we are waiting for return page, we team up- one monitors the patient, usually with a CNA. The others start printing mars and copying transfer packet stuff. At this point we are waiting for that verbal order to ship. If it's obvious we can't wait, we call EMS and building super writes the standing order to ship. EMS will have a number straight to dispatch. If there's a code, that is the ONLY time 911 gets called. We run it and work until EMS gets there. Doc gets pages after for an update.

Things like critical labs, drastic lab changes in certain values, x Ray or ekg results that are severe get paged. Asymptomatic patients our docs prefer we wait until the am to call, symptomatic is immediate, or if they say "call me when this comes in" then obviously we call. I do like to clarify that one though, because they forget our lab and x Ray is 24 hr and we do get results in the middle of the night.

the longer you work, the more honed your skill and gut will become. Confer with co workers. We talk and bounce ideas and ask "what do you think?" All the time. If your nurse sense is tingling, there's something going on.