What is a new nurse to you?

[tokmom]

Is it a year? Two?

Yesterday, I had a nurse with 5 yrs experience miss a very high bp. The dr was not happy and neither was I. The CNA who took the bp didn't report it to the night shift RN, and the day shift nurse saw this number populate to the computer and she never questioned it. The number was dangerously high and should have been reported. This was no baseline for the patient.

Anyway, I told the assistant manager of the missed bp, stating lack of communication from the CNA, and the lack of critical thinking from the RN who never thought it was reportable. The A.M response back to me?

This nurse is new. She only has FIVE years experience under her belt.

Five years is NOT a new grad. Anyone should know that a bp that is 30+ pts higher both systolic and diastolic from baseline is NOT normal, especially someone with 5 yrs experience.

[Sugarcoma, RN]

I have 2 years experience and I consider myself a newer nurse, but I consider a new nurse to be 1 year or less. I would be upset that a pt. with that high of a BP went through 2 nurses before anything was done. It should have been rechecked immediately to confirm that number. Both nurses are equally responsible if the number was really that high.

How often are vitals taken in your facility? Did the a.m. nurse state why she thought it should not have been reported? What were following vitals like? Was the original number rechecked with a manual? Was the patient in pain? etc. etc. What is the patients trend? Is it possible the wrong sized cuff was used for that one reading? I have caught techs using regular size cuffs on bariactric patients. In one case we had a very large woman receiving multiple bp meds for her new onset htn post-op. The meds did not touch her BP. I finally figured out why when I went and saw the tech do her vitals, they were using the wrong sized cuff. We got the correct cuff and the pts. bp was actually on the low side, all bp meds were d/ced and the pts. new onset hypertension suddenly disappeared.

I would have definitely reported that the CNA did not notify the noc RN of that kind of number so that he/she could be re-educated. (If I knew that was in fact the case and not just second or third hand information.)

I am not sure I would have accused the other RN of a lack of critical thinking skills unless I had spoken with her directly and asked what further assessments she had made regarding that high bp reading.

I also agree bp med dosing should not be made on one reading 8 hours prior

[tokmom, BSN, RN]

"The CNA who took the bp didn't report it to the night shift RN"

How about the night shift RN, is she totally off the hook now?

No, the CNA didn't report it to the night shift RN. The bp was taken near the change of shift, so I'm thinking the night shift nurse never went back to check the bp in the computer. She never would have left it.

[tokmom, BSN, RN]

My question is this since it is unclear:

You spoke directly to this "new" RN with 5 years experience and she said she didn't think it was high or didn't see it?

She saw it, You have to enter it in a window that pops up and you can't scan the med unless you enter a number. This earlier number populated and she ok'd it.

The nurse didn't say much when I questioned her. She said she did see it, but had no answer on why she didn't do anything.

[tokmom, BSN, RN]

Were there any further BP's measured after that?

Was that number rechecked; perhaps the patients was temporarily agitated or in pain and the pressure decreased with pain meds?

Not for 8 hrs. He had been trending up, so his bp should have been checked more frequently. No, no pain or pain meds.

Even if the bp dropped in an hour or two, it still wasn't reported by the CNA and the RN didn't do squat about it, and three, the AM made excuses for the new nurse.

[tokmom, BSN, RN]

A doctor ordered meds on a b/p from 8 hrs prior????? No re-check??? How long was the b/p elevated..or was this just a one time event? Did this b/p come down on its own or were b/p meds given? This is just odd to me that any doctor would order anything and not have a new set of vitals, and I would not have given it without them either.

When the nurse went to give the pt his meds, she puts in the new bp. This time she populated the old bp in the screen instead of taking an new one. So when the md saw the bp, he assumed it was a new one, because it showed as such. So...why didn't t this nurse look back at old bp's and why did she accept an old bp to go by?

She had no answer.

The pt bp had been slowly trending up. Somewhere it had started to come down. Our day shift CNA would have said something, but he doesn't take bp's until 1400 because they are every 8 hr on stable pts.

[KalipsoRed]

Well if she saw it and did nothing she should be fired.

The CNA should be in some serious trouble for not reporting it to BOTH the day and nightshift RNs if it was change of shift. In fact she should have reported that kind of blood pressure as soon as she took it.

However, as a nurse with 3 years of experience, I can say that vitals taken by my CNA and not reported to me, just put in the computer, have been missed. I rely on my CNAs to tell me abnormal vitals and only look up blood pressures when administering meds. Is this what I should do? No. However, I find that this is what happens as I try to stay on top of things...it happens with lab work too. I only check K levels if I give lasix or potassium, I only check H&Hs if the patient recently had surgery or looks really pale. I'd like to check all my labs on all my patients....but there's that time issue and to many patients to get to...otherwise I'll be passing morning meds at noon.

P.S. It's not this way at the current hospital I work at they have a 5 to 1 patient ratio and every nurse gets their own aid! (Heaven! I know.) But the other 3 hospitals I've worked at, I've had the above issues.

[tokmom, BSN, RN]

Well if she saw it and did nothing she should be fired.

The CNA should be in some serious trouble for not reporting it to BOTH the day and nightshift RNs if it was change of shift. In fact she should have reported that kind of blood pressure as soon as she took it.

However, as a nurse with 3 years of experience, I can say that vitals taken by my CNA and not reported to me, just put in the computer, have been missed. I rely on my CNAs to tell me abnormal vitals and only look up blood pressures when administering meds. Is this what I should do? No. However, I find that this is what happens as I try to stay on top of things...it happens with lab work too. I only check K levels if I give lasix or potassium, I only check H&Hs if the patient recently had surgery or looks really pale. I'd like to check all my labs on all my patients....but there's that time issue and to many patients to get to...otherwise I'll be passing morning meds at noon.

P.S. It's not this way at the current hospital I work at they have a 5 to 1 patient ratio and every nurse gets their own aid! (Heaven! I know.) But the other 3 hospitals I've worked at, I've had the above issues.

It was a comedy of errors that thankfully didn't kill anybody. The entire thing will be investigated and the nurses educated.

[Thedreamer]

Wow that is very scary. Any nurse should have been able to catch that! I am curious about the "new nurse" thing. I was an LPN for 3.5 years in oncology/hospice and now am a "New Grad" RN. I just got hired into PCU and am very sharp. Then there are other people in my same boat who I graduated with whom have 10+ years LPN experience... in nursing homes. And now they are going into hospitals as new grads.

These "new" RNs have many years experience but arent the sharpest tools due to their backgrounds. Is the nurse who missed such a high BP in this pool of unseasoned seasoned nurses? On that same note, I would question her preceptor since obviously something wasnt done right along many check points in that nurses training.

P.s. That CNA definitely needs to either be retrained or reprimanded. I had a similar experience except the CNA charted NP as being 120/80.. I had just taken it at 180/100. Unethical/negligent charting is a very scary thing when you as the nurse are supposed to be putting trust in your team.

[linearthinker, DNP, RN]

I don't see what one thing has to do with the other. I would expect a CNA 2 days out of her program to know that that BP is unacceptable, ditto a nurse at any level.

In my mind, a nurse is a novice for the first 5 years or so. But see above. Novice means on a learning curve that gradually straightens out, but never "flat lines" until s/he does, lol. Novice does not mean dumb@ss.