What to do if you disagree with the care of another nurse's pt?

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I am a new nurse working on a medical floor. There was recently a situation at work where another nurse's patient had a sudden change in condition that seemed alarming enough to me to warrant calling a rapid response, but this was not done. I witnessed the pt's condition because I was at the pt's bedside assisting in his care while his RN paged/called the MD and did other things outside the room. I asked the pt's nurse more than once if we should just call a rapid response, but I was basically ignored.

After much delay, the pt was transferred to ICU, but I do not know the outcome after that. Had we called a rapid response, I do know the pt would have been assessed/treated by the MD and rapid response team immediately and the transfer would have occurred without delay.

I do not want to be a busybody who interferes with how other nurses care for their patients, I don't want to step on the toes of my coworkers, and I don't want to be a "know it all" that questions the actions of more experienced nurses. That said, I am very disturbed by the situation I witnessed because I honestly feel that the patient received poor care. I am also very confused about what my role is in such situations since I was not the patient's nurse.

Has anyone been in a situation like this, and if so, how do you handle it?

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That's a tough one. The pt's primary nurse was contacting the PCP instead of calling a rapid response so obviously she was aware/dealing with the situation. I assume she has more experience than you since you say you're a new nurse. She may have had this pt for days/know their hx more than you/know the PCP's parameters... It sounds like the primary nurse was handling the situation as she saw fit at the time. I'd need more info to give a more informed opinion.

How do you know for sure if a rapid response had been called the pt would have been transferred right away/treated by the MD? Not all rapid response calls get transferred.

It's hard to respond to this one without more info..... You're asking good questions, though, and it's obvious you care.

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That's a tough one. The pt's primary nurse was contacting the PCP instead of calling a rapid response so obviously she was aware/dealing with the situation. I assume she has more experience than you since you say you're a new nurse. She may have had this pt for days/know their hx more than you/know the PCP's parameters... It sounds like the primary nurse was handling the situation as she saw fit at the time. I'd need more info to give a more informed opinion.

How do you know for sure if a rapid response had been called the pt would have been transferred right away/treated by the MD? Not all rapid response calls get transferred.

It's hard to respond to this one without more info..... You're asking good questions, though, and it's obvious you care.

Thank you for the reply! I guess I assume the pt would have been transferred to ICU faster had a rapid response been called because the doctor did order the pt to be transferred to ICU after he assessed him.

To give more details... This particular pt was supposedly stabilized and awaiting discharge. No IV access, performing his own ADLs, q 8 hr V/S and all WNL, etc. Has history of cardiac problems including a cardiac arrest 2 months ago. This day, the pt suddenly c/o stabbing chest pain and tightness, stated he couldn't breathe, respiratory rate went to 45 breaths per minute and very shallow, O2 sat in high 80s on room air when normally in high 90s on room air, pulse was in 140s. BP and temp were okay. Once O2 was applied, his O2 sat went back up to about 95%, but he continued to have CP, tachycardia, and abnormal breathing.

To me, this situation warranted a much faster response and treatment than he received, hence I would have called a rapid response if I had been his nurse. It was obvious something "bad" was happening (PE, MI, who knows) with this patient which needed prompt diagnosis and treatment. I believe it took 30 minutes or so for the doctor to come assess him, 90 minutes or so to get him to the ICU and he didn't even have an EKG done or an IV placed by that time (stat labs had been drawn, no results posted, and that's it). It drove me crazy to watch the whole thing and not do anything. I know that if the rapid response team had come, all of this would have been done within a matter of minutes.

Again, this whole situation really bothered me to watch and I keep thinking about it. The guy was clearly in distress and it seemed nothing was being done fast enough. I don't have a lot of experience yet, so maybe I am overreacting a bit... Do you think that a rapid response was warranted in this situation?

Thank you so much for sharing your thoughts/opinions on this!

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Isn't there a protocol available that specifies in which circumstances a rapid response is required?

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If this had been your patient on your own, then you know in your practice that you would have called an RR. This did not happen, and if able, I would ask for clarification as to why. Just for your own future reference. Your practice may be different than another nurse's practice.

The only thing you could do (if allowed under your present role) is to attach patient to the monitor, get vitals, put on O2. You could further get IV access, get an EKG. WITH THAT BEING SAID--Don't go cowboy, but know your chest pain protocol, and start to institute. (Providing there are standing orders/protocol, and provided that it can be done under your preceptorship)

Any change in condition in most acute care units warrants a RR called. Again I would caution you to know the policy. The worst that can happen is a r/o of an MI. But don't do anything you are not allowed to do. That is why a review for future reference is so important.

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Specializes in Med-Surg, Emergency, CEN.
If this had been your patient on your own, then you know in your practice that you would have called an RR. This did not happen, and if able, I would ask for clarification as to why. Just for your own future reference. Your practice may be different than another nurse's practice.

The only thing you could do (if allowed under your present role) is to attach patient to the monitor, get vitals, put on O2. You could further get IV access, get an EKG. WITH THAT BEING SAID--Don't go cowboy, but know your chest pain protocol, and start to institute. (Providing there are standing orders/protocol, and provided that it can be done under your preceptorship)

Any change in condition in most acute care units warrants a RR called. Again I would caution you to know the policy. The worst that can happen is a r/o of an MI. But don't do anything you are not allowed to do. That is why a review for future reference is so important.

Is the other nurse new? Even if she wasn't, did she feel freaked out and sort of freeze up and hope it would get better on its own? Where I work, people jump in to help each other out. If someone needs an IV, and it's not my pt, I either place one or call IV team for them. If they need an EKG, I grab it. Then if they ask (which they don't cuz we're used to it), I say "Because we are a team and there's so much to get done and you were juggling this and other pts."

If you decide to ask, I'd do it very carefully. The other nurse will already feel defensive since the pt ended up in ICU, showing that he/she should have acted but didn't. Personally, I would leave that part of it alone.

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I need to find out how, or if, I can delete accidental posts! To KISS......what I was saying was to Keep It Simple Stupid.....I know it might be awkward but the way you describe your situation, it sure sounds like an emergency.

I would calmly tell the nurse what I was going to do, (although inside I would probably feel panicky).....put in an IV, call cardio for an EKG. If she said "no" without a good reason I would let the charge nurse or supervisor know that patient so and so was in distress and his nurse needed some help.

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Specializes in Acute Care Cardiac, Education, Prof Practice.

How do you know for sure if a rapid response had been called the pt would have been transferred right away/treated by the MD? Not all rapid response calls get transferred.

I agree. I have had RR in a the room, an MD order on the chart, and was waiting 30 minutes for a bed when the family came in and told us the patient was supposed to be a DNR, but it hadn't been communicated from the ER. After the MD and Chaplain talked to the family to double check this decision I called placement was told "ah I am glad I was dragging my feet on that one" because they didn't want to take her in ICU. There is a lot more to getting a bed and transfer than simply an MD order.

Isn't there a protocol available that specifies in which circumstances a rapid response is required?

Not necessarily, or if there is it is based on nursing judgement of need. At the hospital I worked at for most of my career the floor actually frowned upon calling RR right away because the team was so tight and could often manage situations on their own. It was encouraged to grab your team before you made that call. However we were also cardiac and knew to get an stat EKG and everyone had an IV by protocol on the floor.

If you decide to ask, I'd do it very carefully. The other nurse will already feel defensive since the pt ended up in ICU, showing that he/she should have acted but didn't.

While I agree that approaching with respect is important here, I do not agree that a patient winding up in ICU is a failure on the nurses part in general. ICU happens.

To the OP: It appears you understand the severity of the situation, knew what YOU would have done, and can stand to be a valuable asset in the future to your team. I would perhaps leave this situation alone, rather than potentially alienate a co-worker. You may find, in the future, that this nurse had an off day, or really does need help, in which it is more than likely known by other staff/managers.

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Specializes in Nursing Professional Development.

Some of the key elements of being a successful nurse are teamwork, communication, and the establishment of positive relationships with your colleagues. We won't always agree with the decisions made by everyone we work with all the time. The important thing is that we have established the positive professional relationships necessary to engage in conversations about such issues.

Have you established such a positive relationship with anyone on your unit (e.g. preceptor, educator, experienced nurse, etc.) that you could review this case with? Or discuss your interpersonal dynamics with this other nurse? Is there someone who could help you analyze whether or not the care provided was appropriate and how both you and this other nurse handled things?

That's why it's important to work on your relationships from the "get-go." Establish those relationships up front and they can serve as a foundation to discuss and resolve these issues as they happen. If you had a good relationship with that other nurse, you could have said, "Hey, Betty. I have a question. Why are you waiting for the attending physician to respond and not calling for the rapid response team? I think this guy might need the quicker response." -- and it would not be a big deal, it would just be two colleagues discussing a case. If you were not satisfied with the result of that conversation, you might be able to discuss it with the Charge Nurse or some other person with the authority to check on the patient and influence the care as needed.

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Based on the CP, HR, and RR, I believe a Rapid Response should have been called.

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Specializes in ICU.

Calling a "rapid response" wouldn't have ensured the patient got "better treatment." Remember, the ICU has to be prepared to accept the patient~ they have to have an available bed and nurse. We rarely call RR at my facility, and when we do, only experienced RN's respond (a doctor does not come to our RR's.) You said you are a "new nurse." Do you know for a fact what all was done for the patient, while waiting for ICU, and what the doctor specifically ordered? Also, did the ICU have to move a patient out, in order to accept this one? At my facility, we would not have moved this patient to ICU until we had labs and xrays back anyway, if then.

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Specializes in Pain, critical care, administration, med.

I was a team leader for the rapid response team. My role was to assist the staff and order appropriate testing, assessment and implement interventions to increase the patients outcome.

So this nurse was right in asking the question. The idea of RRT is to decrease mortality and morbidity in patients. The literature for the past 20yrs shows that patients often have subtle signs and symptoms if decline at least 6-8 hours prior to the actual event. So what is the answer... Call early. Hospitals develop their own criteria but the bottom line is if you are uncomfortable with it call it. It doesn't have to be your patient any healthcare worker can call it. Don't worry if the doctor doesn't like it you are the advocate for the patient. The doctors often try to lighten the potential severity of a situation.

A recent situation on my unit was a 26 to women with a extensive history including sickle cell. She is brought to the ED with what was thought to be a UTI. Labs... WBC 48, bands 27, lactate 10. So she was admitted to a medical surgical unit. The patient looks poor and real sick. The nurse over the 8 hours she had her was on top of the patients condition. She called and followed up with everything. So at the end of the nurses 8 hour shift the patient coded and died. Was the nurse wrong ...no....did she do everything possible? I would have to say no. Calling a ERT would have brought fresh eyes to the situation and perhaps this patient might still be alive. As an aside her blood cultures after her death showed gram negative.

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