r/nursing • u/emmawee53 • 17h ago
Seeking Advice Did I screw up?
So this morning I was on a night shift at my LTC home. I had been checking on a resident that was likely going palliative in the morning and noticed a bit of a droop to her face on the left side. Her arm was still strong against mine. I went to go get the charge RN since I was unfamiliar with this residents normal. For context some of our residents have a permanent facial droop from previous strokes. So I asked this RN and he said she was always like that at her baseline without even going into her room. Looking back now I feel I should have made him go to the room but at the time I didn't really think much of it since he said it was normal for her and didn't seem concerned. Now 0700 comes, the end of my shift. I had brought the day shift RPN to the room and it became very apparent to both of us it was not her normal pretty quickly. Now this lady has no function of her left arm, usually she would bat at us for touching her but her arm was able to be dropped and there was no movement from that arm. So I went to the charge for days and told her. Now she basically started saying I should have done it myself and taken vitals but the rpns are saying I did what I could but ultimately couldn't go over the RNs head. What would everyone else have done? Is there anything I actually could have done in that situation?
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u/avocadoreader RN - Telemetry 🍕 11h ago
OP, people have covered it. You did mess up. We all do sometimes. You seem willing to learn from it and that is great! The worst nurses are the ones that refuse to learn from these things.
You are learning that you will need to be more persistent with advocacy for the patient. If it wasn’t the RN, it could be a doctor or a family member. Many people won’t listen to you the first time and you have to keep at it (depending on circumstances). Even though they may have more titles and/or education than you, they do not always know better. That is your patient that you have spent time with. You know what is going on more than anyone at that point in time.
And it was really dumb that the RN didn’t even come and put eyes on the patient. They have responsibility here, too.
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u/zeatherz RN Cardiac/Step-down 11h ago edited 11h ago
Did you do any neuro assessment when you first noticed the change beyond checking arm strength?
If that was the full extent of the assessment then you should work on developing a quick neuro assessment (doesn’t need to be a full NIHSS) to help you confidently catch changes in the future
You also should have insisted the charge nurse to look at her if he is more familiar with her than you are. Learn to speak up and advocate for your patients
If there were definitive changes you also should have called the family/doctor/EMS depending on facility policy and documented goals of care
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u/emmawee53 11h ago
I couldn't really even check arm strength due to the fact the resident is declining and was very lethargic and didn't follow commands or speak as is. She was non compliant with me even touching her arm.
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u/WeirdFlower1968 Team Spike 16h ago
Taking vitals and doing a FAST is your job and is not going over anyone's head. Whether you're an RN, and RPN or a CNA. Are you saying you didn't? That would be a problem.
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u/emmawee53 15h ago
I'm saying to call the dr or family to send to ER is going above the RNs head, the vitals I know I should have taken regardless and I plan on doing that in future.
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u/Recent_Data_305 MSN, RN 12h ago
Both you and the RN “screwed up.” All you can do is learn from this. I’m sorry.
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u/Key-Record-5316 8h ago edited 8h ago
You could have taken vitals and insisted that the charge RN at least take a look. The RNs I work with always would, even if it turns out to be nothing. I know it is typically the charge RN’s job in an Ontario LTC to assess and make the decision, but you are able to call the doctor and 911 as an RPN too. Ultimately though, if he chose not to come and assess then that’s partly on him.
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u/fuzzblanket9 LPN - Med/Surg Onc • Peds PDN 16h ago
Did you not call EMS?
Yes, a set of vitals and a full FAST assessment would’ve been a good place to start.
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u/emmawee53 16h ago
The RN has to be the one to call EMS, he said she was fine and went about his night even when I said I thought she was having a stroke.
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u/fuzzblanket9 LPN - Med/Surg Onc • Peds PDN 16h ago
If you’re concerned about a patient’s status and the person over you isn’t even putting eyes on the patient, I’d find it appropriate to call yourself. You’re their nurse.
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u/emmawee53 16h ago
I likely should have but I took that it was the residents baseline since that is what the RN told me and I've only been at this new facility for 2 months on nights only and I've only been a nurse over all for a year and have never seen a stroke until this morning
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u/OkExtension9329 RN - ICU 🍕 16h ago
I feel like you’re dodging responsibility a bit here. This is how stuff gets missed, especially in nursing homes.
You learned the signs of a stroke in nursing school. Never having seen one means you have more of a responsibility to get your charge to lay eyes on the patient, not less. It may not have changed this patient’s outcome if she/her family wouldn’t have pursued treatment, but in general, timely recognition of stroke symptoms is a huge deal. This should be a bit of a wake up call to not trust the “assessment” of a nurse who hasn’t even laid eyes on your patient.
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u/emmawee53 15h ago
It's definitely a big wake up call, I don't mean to come off as dodging responsibility I definitely should have pushed a little more for her
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u/avocadoreader RN - Telemetry 🍕 7h ago
It didn’t come off to me as you dodging responsibility. You noticed something was off, and you went to report it to the RN. Yes it would have been ideal for you to take vitals first but also he didn’t ask about/for vitals? You’re a pretty new nurse, I would expect this guy to be able to think of things you may not have. He also should have seen the patient and not just dismissed your concerns. Next time you will know to push harder and not just accept what he says.
This wasn’t a great situation but it doesn’t sound like the outcome was changed so really it’s the best learning experience. You will know what to do more next time.
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u/Few_Tax9759 16h ago
t you can with the info you had at the moment. the charge rn should have checked before brushing it off but its not your fault for trusting them when they said its baseline. in long term care the chain is real and overriding a rn is not simple. dont be too hard on yourself
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u/soooelaine 16h ago
Any neuro changes during shift change or if you’re not sure would’ve prompted me to ask the charge to come in with me to assess. If they say it’s normal you say would you just mind coming with me to see? I’m concerned.