Hi, i am a fairly new nurse. ive been working on a rehab floor in a ltc facility. yesterday, while i was passing meds, the aide called me to check on a resident because he was not responding. I went inside the resident's room, called him by his name several times but didnt respond at all, his eyes were just open, he was breathing, he was perspiring and he was a little cold when i touched him. Cant obtain BP. Oxygen sat was at 87%. I put him on oxygen. Called my supervisor for help. I asked her right away if i should call 911 since this might be going on for more than 5 minutes and she said yes. So i called 911. Went back to pt room and tried to get his BP and it was 80/60. When EMT arrived, after 2 mins, the resident started to talk. Eventhough he started responding, we still sent him to er for evaluation.
now, the unit manager and the other staff nurses are questioning me why i sent the man out. I told them the whole story but they keep on talking behind my back and saying that i was wrong. btw, the resident was admitted to the hospital.
if you encountered a pt that was obviously in need of emergent med'l care, would you really waste precious time by awaiting a dr's order?
even if an order is needed, i can promise you, they would eat you up and spit you out, if/when it went to court.
a "prudent" nurse would recognize and act upon a pt in emergent, medical need.
i can't even imagine a nurse answering question, "why wasn't pt sent out?".
nurse: "because dr said no."
seriously, we truly need to think of consequences to our passive/non-existent actions.
leslie
This is very surprising to me. We would not be able, under any circumstances, to transfer any patient out of our facility w/o a MD order to transfer, a MD to accept and MD to MD hand-off. That said, our IM guys transfer anyone with anything more serious than crabs, so it wouldn't be hard.
you absolutely did the right thing. i work in an LTC, too, and when i first started, i wasn't very comfortable sending someone out to emerg...but the very first person i sent out turned out to be with sepsis and would have died if he wasn't treated ASAP... it has taught me to trust my instincts. Don't mind your co-workers...you won't be answering to them if something bad happened to your resident...and they won't be answering to the family as well! It's better to be safe than sorry. =)
This is very surprising to me. We would not be able, under any circumstances, to transfer any patient out of our facility w/o a MD order to transfer, a MD to accept and MD to MD hand-off. That said, our IM guys transfer anyone with anything more serious than crabs, so it wouldn't be hard.
?? So if someone was coding you'd wait until the doc calls back (even in the middle of the night), to give your oders to send before calling 911?? Remind me to never send my family member to your facility.
It's been HOURS before when I've waited for a call back. Patients would be dead if I sat there and waited for his 'ok' to send..
yes everything i wrote here, i also documented on my notes. I dont know why theyre mad that i sent the man out. just this morning this coworker of mine questioned me. i told her the whole story and asked her "what do u want me to do then?" and she kept quiet. its so hard being new at work coz it seems that they dont trust you with your judgement that much.
That sums it up pretty much. Hold your own- stick with your judgement.Ask questions when you should, but follow your instincts too.
The patient got admitted- what else is there to this story?Kudos on a job well done.
Specializes in Emergency Department, House Supervisor.
You did the right thing. The only thing to think about when someone is diaphoretic and non-responsive is their blood sugar. However, it sounds like that wasn't the issue. If you have altered loc, no bp, diaphorsesis...it's a CODE.
I worked a lot of places and I have NEVER seen a nurse given the benifit of the doubt when it comes to making a complex clinical decision.
That is so sad. It makes me appreciate where I work. We are expected to be able to make those kind of decisions, and you will have every single nurse on the floor in your patient's room helping you. The next day the practitioner will ask you about it and compliment you for a job well done. I think it's also why we have a minimal amount of actual codes.
Arm chair quarterbacking is a favorite passtime in nursing. I worked a lot of places and I have NEVER seen a nurse given the benifit of the doubt when it comes to making a complex clinical decision. You could raise the dead and other staff would still question whether you should have raised them sooner, or higher, or at all. I wish I could tell you it will get better- it woun't. Get comfortable with your own decisions and it makes no difference what the arm chair quarterbaks have to say. By the way: this arm chair quarterback thinks you did a fine job and made all the right decisions (but what do I know).
linearthinker, DNP, RN
1,688 Posts
This is very surprising to me. We would not be able, under any circumstances, to transfer any patient out of our facility w/o a MD order to transfer, a MD to accept and MD to MD hand-off. That said, our IM guys transfer anyone with anything more serious than crabs, so it wouldn't be hard.