So far in my OB clinical I have spent time in nursery, NICU, and post partum. Nursery and NICU were right up my alley since I want to do pediatrics. Post partum was a bust--like I was going to have an awesome experience checking fundi, and teaching the multiple underage new moms how to breastfeed.
I was truly bored...until they admitted a 2 week status post hysterectomy patient who was in SVT. Considering the post partum floor isn't a monitored floor, that little gem of an admit by the house supervisor left us all scratching our heads. The patient had already failed adenosine in the ED, but IV push metoprolol brought her down from the 210s to the 160s by the second dose. Clearly stable (WTF!?) they shipped her up to post partum(???) before giving the 3rd dose. The nurses I was working with were clearly excellent OB nurses, with years of experience between them. But when faced with a CV patient, it was clear I knew about as much about OB as they did about abnormal heart rhythms.
The nurse was about to just push the metoprolol (without knowing what it was!?!) when I said, "Umm...I don't know if it's a real world practice or not, but our books say the patient has to be on a monitor to give this drug IV." So she got the pulse-ox and clipped on the patient's finger. "Ummm...I think we need an ECG monitor to watch for dysrhythmias, not just monitor the heart rate." At this point the nurse gave me her best Vulcan Mind-Crush Death Stare, so I politely excused myself from the room and made my way out to a quiet corner of the nurses station.
Now I've been known to come off more than a little "know-it-all"-ish, mostly because I do know a lot of stuff--I can't help it, I just remember stuff. I don't mean to come across in an arrogant manner--in fact I hate being around people like that. I really, really have been working hard to just keep my mouth shut, but sometimes I pop off before I have the chance to reign myself in. I'm sure my preceptors each week just shudder when they meet me. I am so, so aware that I have sooo much to learn yet, and I try so hard to exude this, rather than the other.
Anyway, it wasn't 2 minutes later that I overheard the nurse around the corner talking to the house supervisor on the phone, telling her she wasn't comfortable giving the medication without having the patient on a monitor, etc. I was glad she didn't just push the medication, and I actually felt pretty bad for her. She was having a rough day. It wasn't 5 minutes later she got her head bitten off by the admitting physician for paging him about the patient while he was in the middle of a C-section. I would have liked to apologize, but I doubted it would have been well-received. I just let things lie.
So you experienced nurses out there, any advice on how a newbie can "know stuff" without coming off like a know-it-all smart ass?
Because I'm not sure I'm going to be a popular guy come internship time.
You did the right thing, because you kept patient safety in mind. The ANA Code of Ethics (I think... we have it posted on our unit in a place where I don't spend too much time) says above all else we are here for the patient; the quality of professional relationships are secondary. As someone who has had to grow a lot in those kinds of interactions, my suggestion is practice better delivery for the next situation. Maybe just say, "Where can I get a cardiac monitor?," to show that you want to contribute, rather than just pointing out the nurse's discrepancies, as she might have perceived.
ReplyDeletePS. I know from experience that nurses HATE students saying anything "corrective" in front of the patient. Even if you're just trying to incorporate the patient in the plan of care. :P
Otherwise bravo on your nursing excellence in competent care!
You can know stuff.....but it's all in the delivery. I often ask things in the form of a question. That way they have to give rationale and dialogue is opened up. "Nurses eat their young" is truly directed at smartass newbies. They won't eat you if you come at it in a different manner.....a sweeter way.
ReplyDelete"know-it-all ish"...my brother from another mother...I feel your pain...
ReplyDeleteLOL, I would probably slap you... JUST KIDDING, but I agree with the having the proper delivery advice.. You know how someone can be so sweet but are also telling you off, and you are so confused, you say did she just insult me with a smile.. Yeah like that, be like that.. lol
ReplyDeleteYou know, speaking as an old crusty thing, if the nurse is defensive or insecure there is no good way of saying it...nevertheless, you must say it. Bit of a conundrum, that.
ReplyDeletePersonally, I would welcome any sort of directive from ANYONE in any situation if it saved my butt. However, point is, no one should give ANY medication if unfamiliar with it BEFORE looking up the policy for administration.
ReplyDeleteProblem with the OB unit, there are many nurses that have worked only OB. (notice I didn't say ALL) I think I had mentioned this elsewhere, when preferred areas of choice for new grads was discussed, that a good solid 2 yrs on a general Med/Surg unit would benefit any new nurse prior to specializing. :) XY, you sound like a student I would like to have preceptored.