Sucide lies: is it CYA or blaming? - pg.3 | allnurses

Sucide lies: is it CYA or blaming? - page 4

So I had a pt this evening who was suicidal. Blatantly suicidal. He was found in his home with a gun drinking and saying he wants to end it. So he went to the Psych lock down part of the ED and when... Read More

  1. Visit  anotherone profile page
    0
    Charge nurse aware? That won't go too far. i would call the nursing supervisor.You don't have to be in charge to do that. Most would pull a tech from another floor if it came down to that. I have seen this done where I work many times. This is one of the times were pt to staff ratios are actually followed.
  2. Visit  anotherone profile page
    1
    Quote from BostonTerrierLoverRN
    . I have seen them put MD residents on 1:1's in low staffing situations.
    And I thought our staffing was bad!!!!!! Do they take call from the pt's room? I am being serious. I don't know how this would work in my hospital on night shift.
    BostonTerrierLoverRN likes this.
  3. Visit  BostonTerrierLoverRN profile page
    2
    Quote from anotherone
    And I thought our staffing was bad!!!!!! Do they take call from the pt's room? I am being serious. I don't know how this would work in my hospital on night shift.
    No, it's an emergency department I failed to say, so they are pulled off from taking cases, and placed on the 1:1. It's rare, but with the holidays coming, it will happen. There are always plenty of interns and residents in this Med Ctr's ED, they get great educations, but they also get to do full care, lol.

    But, in my opinion, they come out much better rounded physicians who can start IVs, foleys, stoma care, and so on. I have rarely done their dressings, they do "full care" on their cases. So, if your the resident MD or Intern who unfortunately picked up the case, 1:1, while the others make fun and head for their sleep room.
    GradyGramNot and anotherone like this.
  4. Visit  Anna Flaxis profile page
    2
    This might seem like splitting hairs, but I never chart that someone else is "aware". You can't really say for certainty what anyone is aware of. I chart "Charge Nurse notified" or "MD informed" or something to that nature, which describes an *action*, not an assumption about someone else's state of mind.

    It's similar with patient teaching. I never chart "Patient understands". Instead, I always chart something like "Patient verbalizes understanding and gives appropriate return demonstration".
    Sugarcoma and GradyGramNot like this.
  5. Visit  hiddencatRN profile page
    0
    I agree that "charge RN made aware" doesn't cya, but it does mean that if something happens, they will have to answer in addition to the primary RN. It's not throwing them under the bus; it's pulling them under with you. If the charge RN doesn't like that, the charge RN should have prioritized that 1:1.
  6. Visit  ~Mi Vida Loca~RN profile page
    0
    We have security watch our Suicidal Patients, not our techs or Nurses.
  7. Visit  Tiffanybaybay profile page
    0
    OK, I'm actually glad I posted this for future reference. It was a slow night and I was able to watch him all night. I didn't get any other patients. But I did sit at the nurses station and I didn't sit within arms length like the policy stated. I didn't think of sitting in the room to maintain the 1:1 myself because another patient could have arrived. Now that you guys have made it clear it seems like the most appropriate thing would be to be the 1:1 myself and become unavailable if another patient would arrive.

    I think that would put the burden on the other nurses you know? Sitting in a room while another patient arrives. Nothing happened and he was fine but I needed to know how to handle this situation because it has happened, and things went wrong. I've seen nurses step away from a patient only to return and find the patient hanging by his belt from the ceiling. I don't want that to be me.

    Also it is interesting to note that charting that the charge is aware wouldn't CYA. I guess I've always felt that if they were my superior they are responsible for the decisions they make, since they have the ability to make them and I don't. But I guess that if I know better then I need to stick up for myself. I always second guess myself, so I guess that's where the passive aggressiveness comes in. There's a voice in the back of my head saying, no you're wrong, they know something more than you. I guess I have to learn to become more confident. THANKS!
  8. Visit  CountyRat profile page
    2
    Quote from hiddencatRN
    I agree that "charge RN made aware" doesn't cya, but it does mean that if something happens, they will have to answer in addition to the primary RN. It's not throwing them under the bus; it's pulling them under with you.
    Another way for describing this is, "getting into the same lifeboat as the boss." I hope the ship does not sink, but if it does, I want to be in the boat with someone with more to loose, and more power to survive, the consequences.
    morte and hiddencatRN like this.
  9. Visit  Esme12 profile page
    2
    Quote from Tiffanybaybay
    OK, I'm actually glad I posted this for future reference. It was a slow night and I was able to watch him all night. I didn't get any other patients. But I did sit at the nurses station and I didn't sit within arms length like the policy stated. I didn't think of sitting in the room to maintain the 1:1 myself because another patient could have arrived. Now that you guys have made it clear it seems like the most appropriate thing would be to be the 1:1 myself and become unavailable if another patient would arrive.

    I think that would put the burden on the other nurses you know? Sitting in a room while another patient arrives. Nothing happened and he was fine but I needed to know how to handle this situation because it has happened, and things went wrong. I've seen nurses step away from a patient only to return and find the patient hanging by his belt from the ceiling. I don't want that to be me.

    Also it is interesting to note that charting that the charge is aware wouldn't CYA. I guess I've always felt that if they were my superior they are responsible for the decisions they make, since they have the ability to make them and I don't. But I guess that if I know better then I need to stick up for myself. I always second guess myself, so I guess that's where the passive aggressiveness comes in. There's a voice in the back of my head saying, no you're wrong, they know something more than you. I guess I have to learn to become more confident. THANKS!
    We live in a litigious society. Saying the charge nurse aware....doesn't say they were notified. If the charge nurse wants you to help the other nurses they would use the resources more appropriately. I would encourage you to notify the supervisor as she sent the help for a specific reason and not for the charge nurse to "pull them" as soon as they arrive......and use them as they saw fit. The supervisor was pulling them for liability to provide them with 1:1 "arms length" observation. I would take the charge nurse aside and remind them what the tech was sent for and if they could not utilize them as untended I would return them to the floor the I pulled from.

    If another patient arrived....then the charge nurse has one of two options. Re-direct staff to best utilize the staff available....OR.....take the patient that arrived. Their choice. You need to care for you.. Politely.......but care for you none the less. Always post this stuff....get the public opinion. In a court of law the "reasonable and prudent" thing to do and nurse is the "standard" of care. Inform yourself......education/knowledge is power. I've seen patient remove needles and heroin form some very unusual places and shoot up and over dose. A SI patient with a plan....will carry out that plan and the next opportunity. Some patients are well versed in the system....contract for safety and I had one one that psych discharged (against all protest by me) and hung himself in the parking garage. Trust me that didn't get on the news.

    While we are on the subject....get malpractice insurance.....“Praemonitus praemunitus” translates to “forewarned is forearmed,”

    I wish you the best!
    GradyGramNot and hiddencatRN like this.
  10. Visit  Metody profile page
    3
    Just because a patient is calm doesn't mean they've stopped being suicidal. Sometimes it means they've finally figured out how to do it, and all their worries are going to be lifted. It's very soothing to think that soon, you won't be in any more pain. And just because they appear to be still, that doesn't mean they're safe, either; in nursing school, when we did our rotation in the psych ward, one of the patients had massive scarring on his forearm from when he'd found a paperclip and carved at himself. He'd been in bed with his back to the door and was quiet and discrete enough that no one found him until he'd nearly hit bone.

    Your charge nurse is dangerous. She knew she was doing the wrong thing, and she was ****** because now there's a record of it.

    And to address the issue of throwing burden on other nurses: that wouldn't be your fault. It'd be the fault of whoever decided it was more important to have an aide on the floor instead of another nurse.
    chevyv, Sugarcoma, and GradyGramNot like this.
  11. Visit  muffylpn profile page
    0
    First I did not read thru the comments. I have worked psych. in a hospital setting for 23 yrs. 1) If it was a Dr.'s order you are in the wrong-and you and the charge nurse could both be screwed if something happened. 2) You asked the charge to pull the CNA and the charge nurse agreed-that person can now be blamed ( there is a charge nurse for a reason-this is one of them).3) If you have a hospital policy about 1:1 and constant obs. that is what needs to be followed-if it is not, the hospital will NEVER support you should something happen. 4) Lots of Pts contract for safety and LIE. Lastly in my state a 1:1 is done with a person being in arms length of the Pt. Constant obs. is Pt must be be in view of the person watching them but a written hospital policy will overide what is considered the norm. Lastly with this person's labs being all messed up was there a potential fall risk cause people say all sorts of stuff after a fall as to why it happened-biazzar lawsuits happen and people who lie win them-just saying
  12. Visit  chevyv profile page
    1
    I guess the first thing is the 1:1. A 1:1 at my facility is within 3-5 ft at all times. Who's head would roll if the pt did do something and you were within eye sight but too far away to prevent injury? Pts who want to harm themselves are very fast! Not sure what the policy is at your facility. The second thing is charting that the charge nurse was aware. Even if they were aware, they could easily deny that. I took a course about charting to keep you out of the courtroom and it was drilled into my head not to do this. Charting that you consulted with so and so via telephone at such and such time and if orders were initiated or no new orders would be okay, but stating your charge nurse was aware of your decision to pull the 1:1 would be not good.
    Anna Flaxis likes this.
  13. Visit  DC Collins profile page
    0
    If the order says 1:1 and you didn't enforce the 1:1 (advocating for your patient) and something went wrong you would be up **** creek without a boat, much less a paddle. If you want to change the circumstances you get the order changed.

    In our ED, our policy is 1:1 once suicide is mentioned even if the pt takes it back. Only our social worker or doctor (who will usually defer to our social worker) can take them off 1:1.

    CYA!

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