What would you do?

Specialties Emergency

Published

Ok, here's the story. I am a new grad who got hired for the ICU. However, I have to do a month in the ER as part of my new grad residency program. Last week, I was assigned to a triage nurse as an orientee. I was in triage with this nurse and a guy comes in with a C/O "swollen member with discharge".

The triage nurse made him a low acuity and he waited for about 2 1/2 hours in the waiting room before he was allowed to go to the back.

Well, when he gets to the back, he was assigned to a male nurse. The next thing I know, the nurse comes up to the triage raging about why didnt the triage nurse (that I was assigned to) look at this guy's member. Comes to find out, this guy was not circumsized, and the foreskin retracted, causing it to swell. The triage nurse I was assigned to assumed it was an STD issue and thus, making him a low acuity. The male nurse was highly upset, he came up to the front of triage, yelling that this guy could have lost his member and that we as triage nurses should "learn to do our job" as he storms to the back. This was in front of a packed waiting room full of patients.

The triage nurse was very upset behind this. As well as another nurse who had an orientee with her was upset as well. The patient ended up being ok.

Well, a couple of mornings later, the triage nurse got called into the director's office. He also requested I come along. I was very intimidated because I am a new grad, the ER is not my "home" and I didnt want to be dragged into unit drama. The director asked both of us what we witnessed and I told him what I saw. He asked me to put it in writing and I expressed my concern that I don't know the guy in question, I have seen him around the ER, and that I'm a new grad that had a difficult time landing a job and I don't want to do anything to cause my job to be in jeopardy. The director stated that it would be anonoymus, and the triage nurse said she will put something in writing. The director stated it's best that someone who's not part of the unit could give a subjective point of view, because apparently this nurse has had issues in the past.

I'm torn. I'm all one for minding my own business and I don't want to be involved in this incident regardless if what I state is anonoymus of not. I'm not going to be working in the ER, but I did consider taking a PRN position in the ER after my ICU orientation is over, and if this director is the one who decides who get hired, I could possibly screw up my chances of getting hired in the future if I don't provide a statement.

It seems to me they want to get rid of this nurse. I don't want to participate in this. I don't know this nurse nor his work ethics, and I do agree, what he did was not professional. What would you do in this situation?

Please help! I can't sleep because I'm worried about what I should do. :crying2:

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Specializes in Ortho, Neuro, Detox, Tele.

document the facts...make sure your name is not noted...and just go with it. Too many nurses are scared to document because they don't want to make trouble...but it's the only way to change some people.

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document the facts...make sure your name is not noted...and just go with it. Too many nurses are scared to document because they don't want to make trouble...but it's the only way to change some people.

Apparently, this has been an ongoing problem for this nurse according to the director and the triage nurse. Also, the other nurse and her orientee was asked to put something in writing as well. He wants me to send an email, which will have my name attached.

The director stated all this documentation will be taken to HR. Apparently, this guy has had major issues and the lastest blow up was the straw that broke the camel's back.

I just so happen had to be there to witness it.

*sigh*

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Specializes in Cardiac Telemetry, ED.

Okay, from what you have said and what I think of that, from where I sit, it seems you will not be singlehandedly responsible for this nurse losing his job unjustly. If he did behave that way in front of a full lobby, and this is a pattern of behavior for him, this is bigger than you, and your observations are not going to be the thing that did him in. There is a time and a place to take a stand and stick to your guns, but I don't see this as one of those. In this instance, I would go with the flow and let things flow as they will, because they will flow that way with or without you. No need to make an irritant of yourself over this by taking a stand that isn't really that important in the big picture, and end up shooting yourself in the foot in the process. Only shoot yourself in the foot when it is worth the price of admission; in this case, I don't see that it is.

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Okay, from what you have said and what I think of that, from where I sit, it seems you will not be singlehandedly responsible for this nurse losing his job unjustly. If he did behave that way in front of a full lobby, and this is a pattern of behavior for him, this is bigger than you, and your observations are not going to be the thing that did him in. There is a time and a place to take a stand and stick to your guns, but I don't see this as one of those. In this instance, I would go with the flow and let things flow as they will, because they will flow that way with or without you. No need to make an irritant of yourself over this by taking a stand that isn't really that important in the big picture, and end up shooting yourself in the foot in the process. Only shoot yourself in the foot when it is worth the price of admission; in this case, I don't see that it is.

This is along the lines of what the other nurses told me. He has a pattern of doing things like this. I guess they (ER staff) is getting fed up with him.

I go in tonight, and I'm gonna go ahead and write up what I witnessed and leave it at that. Whatever happens after that point, happens.

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Did this guy yell in front of everyone in the loby specific information about the patient? It seems like he was violating HIPAA in addition to lacking professionalism. I think if you send this email account of events in an objective manner with just the facts that you are doing what you are supposed to do. Good Luck!

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Did this guy yell in front of everyone in the loby specific information about the patient? It seems like he was violating HIPAA in addition to lacking professionalism. I think if you send this email account of events in an objective manner with just the facts that you are doing what you are supposed to do. Good Luck!

He asked in a confrontational way, "why didnt you check out that guy's member? He could have lost it!" Then he yelled, "you guys need to learn how to do your job!" and then stormed off. This was in the desk area, right before you get to triage, and where other patients in the waiting area could hear.

Some said he pointed his finger when he said it, I didnt see that part. I only heard what he said.

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Specializes in Emergency Medicine.

I'm torn. I'm all one for minding my own business and I don't want to be involved in this incident regardless if what I state is anonymous of not. I'm not going to be working in the ER, but I did consider taking a PRN position in the ER after my ICU orientation is over, and if this director is the one who decides who get hired, I could possibly screw up my chances of getting hired in the future if I don't provide a statement.

Make a statement. Keep it objective. Refrain from opinion. Be honest...oh, and grow a pair.

You have been placed in a bad spot because you don't work in that environment and don't know the whole story.

Maybe the male nurse is burnt out, maybe they're trying to get rid of him anyway. Your "statement" should not make much of a difference so stand up and show them you're not wishy-washy. Not a good ER trait.

This scenario is pretty innocent enough. According to the ENA you shouldn't second guess the triage nurse. There should be a system of peer review to help place appropriate acuity during triage that is constructive not hurtful.

They will make corrective action and the world will move on.

About "minding your own business"-

There will be a time when you might observe something completely inappropriate. You might see something that might threaten the health and well-being of a patient or threaten the safety of a coworker. What then?

You are an RN now and licensed to practice what, ignorance...? I know you're not in your comfort zone as of yet but understand that as an RN you are a licensed professional. Mediocrity is unacceptable in critical care. Whether in the ER or the Unit you must advocate for the patient ALWAYS! Think about that as you evolve and mature.

Best of luck to you. Critical Care is where it's at! Welcome to the madness.:twocents:

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While he should have expressed his frustration and concerns to the triage nurse in private, I am trying to see his side as well. Had the triage nurse properly assessed this patient, instead of assuming he had an STD, would she have made him wait over two hours to be seen?

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Specializes in ICU, IMCU.

I agree with gninab. The patient was NOT fully assessed. We all know what assuming things will get you in nursing.....either a dead patient or a lawsuit. So, my personal view is that this guy's unprofessionalism probably shouldn't be viewed more seriously as this nurse not properly evaluating a patient. "A,B,C,D" airway, breathing, circulation, disability....seriously...he could have lost a limb. :) They should both be in the directors office being disciplined.

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Welcome to Nursing and Being Accountable. As a Nurse you aren't only Professionally Accountable for your Practice, but also accountable to the Conditions of your Workplace, the Behavior of your Coworkers, Safety and Ethical Issues. If you're not Management or Supervisory, your scope of Accountability in a case like this is to get in writing as requested, what you witnessed in the behavior of this person. Just be sure you tell the truth, are objective and are free of preconceived perceptions and influences by others in your write up. Write only what you saw, and this will ensure you're being fair and you can have a clear conscious knowing you were unbiased and truthful. Good luck!

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I would like to thank everyone for their responses. I have already sent an email to the director about what I've witnessed.

Please bear with me, as this is a second career for me, and I'm still learning the culture of nursing.

I do feel it's my duty to advocate for my patients, but I'm also the type of person who pick and choose my battles. Since the ER wasnt my home persay, I just didnt want to be involved in unit issues.

The night this incident happened, the triage nurse was spoken to by the charge nurse regarding the whole "assessment" issue. I think from there it escalated to the director.

It's just that I'm a new grad, I try to keep my head to the grind, and it's hard enough trying to learn a new job without all this other mess going on. And on top of it, it was very hard for me to land this position and I didnt want to do anything to jeopardize my job. I got a son to take care of and bills to pay. All I wanted to do was learn what I needed to know in the ER and move on to my home unit.

Anyway, what's done is done. Like I said, what happens from here, happens.

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