What is a new nurse to you?

3 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.
What was the BP?

205/116.

Quote from tokmom205/116.

What!?!? And the NM excused her because she is "new"? Wow. The nurse is not providing what a reasonable, prudent nurse would do. IMHO. Nothing was done? Was clonidine ordered? Or did she not do anything at all?

Doc ordered meds, based on a bp that was taken 8 hr prior. The new bp was more reasonable 140/70's. The doc had to be notified of the new bp as the doses ordered might have been too high. Thank God the guy didn't stroke out. This nurse is new to the facility but not a new nurse.. Ai Yi Yi...No the AM didn't do anything. The dr and I did. (insert annoyed look)

As a new grad, I would have recognized that as a dangerous BP. There's no excuse for that at all. Even the CNA, without benefit of nursing school, would recognize that!

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?

"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?

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?

Quote from tokmomDoc ordered meds, based on a bp that was taken 8 hr prior. The new bp was more reasonable 140/70's. The doc had to be notified of the new bp as the doses ordered might have been too high. Thank God the guy didn't stroke out. This nurse is new to the facility but not a new nurse.. Ai Yi Yi...No the AM didn't do anything. The dr and I did. (insert annoyed look)

She should have known better. That is a dangerous BP. And if you have been steadily employed, I would think once you hit the 2nd year mark, that's not a new grad anymore. We're always learning, but after 2 years, a nurse should have enough insight to be effective on the job.

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