on overstepping.

nurses are just people like everybody else.  so i guess it makes sense that not everyone is going to react to a situation the same way.

the patient was a man stabbed in the neck by his wife.  he was immediately post op.  he found out that his underaged child couldn't stay overnight, so he decided to leave AMA.

time to worry?  for me, definitely.  the guy just got out of surgery.  the anesthesia is still hanging around, and lord knows it makes some people crazy.  he shouldn't leave, or at least he shouldn't leave until the doctor could try to talk him out of it.

but his nurse saw it differently.  she tried to talk him into staying and he wouldn't.  she paged the doctor and he didn't call back.  the patient was stable, he signed the AMA papers, she did all she could.

except call the chief resident.  if one doctor isn't paying attention to you, you go above him.  but when i suggested that she try that, she told me that she "wasn't really concerned about it".

well that made my blood boil.  how could you not be concerned about a person who literally just got out of surgery with a stab wound to the neck up and leaving?  she was WRONG.

so i paged the chief resident.

and the other nurse found out, and she was mad.

maybe it's because management is trying to push this idea of "all of our patients are all of our patients". they take that to mean that people can't walk past beeping IV pumps or bathroom call lights because "it's not my patient".  but i take it a little differently.  to me, it means that as a nurse on the floor, i have the responsibility to intervene in situations where i feel that a patient is not being provided with the care that they need.  for example, if a patient looks sick and the primary nurse isn't doing anything about it, you jump in and start doing stuff, basically whether she likes it or not.

but it's a fine line to walk.  and it's gone my way more than once.  this lady was not my patient, but i pushed for her to be in the ICU because she was way too sick for the floor and her nurse was too new to realize it.  this little old man wasn't my patient either, but he went to the ICU after i stumbled upon his nurse telling him to take deep breaths with sats in the 70s.  and i've "helped" my coworkers this way more than even that.

because it's all about the patients, right?

or is it all about me?  me being right, me liking to save the day, me wanting to be in charge?

things have gone the other way too.  once i paged a bunch of doctors about a patient that wasn't mine who looked HORRIBLE, like he was about to code.  turns out he looks like that quite regularly and they weren't impressed.  and then there was tonight.  i paged the chief resident, they were in a trauma, and he couldn't come up.

the patient took his papers and left AMA.

i overstepped my boundaries, made my coworker mad, and the whole thing came back to bite me.

and i'm thinking about it, and i really don't like myself for being this way.  and just because people don't always do things the way that i would doesn't mean that their way is wrong.  and it doesn't give me the right to take over every time i feel the urge to be in charge.

maybe i was right, and maybe i wasn't.  i hold myself to a high standard, but maybe it's time to take some of my own advice and just focus on myself.  would i let a brand-new post-op leave AMA without a fight?  no.  but he wasn't mine, and the responsibility for him does not fall on me.

when everyone on the floor was brand new, all the patients were essentially mine.  but around here, in the land of turnover, "veterans" are two years out of school.  so now that these girls have been here over a year, i guess it's time to let go.

and i guess that instead of overstepping, i need to just step away.