"And it's all going to be your fault"

[AngelfireRN]

You know, I've been thinking....

Dangerous pastime, apparently, because the more I think about this, the madder I get. I am not doing my blood pressure any favors here.

I have been a member for a while now, read these threads even before I became a member, and I have noticed a disturbing trend. I am wondering if anyone else has as well.

It all our fault.

I don't care what happens, who does it, who causes it, the nurse gets blamed. Management backs up the customer-cum-patient, admin backs up the managers, HR backs up the admin.

So, I dreamed this little warning label of sorts up for all those wide-eyed, fresh-faced nurses-to-be out there. I wish someone had told me what I was getting myself into.

Dear Soon-to-Be Nurse:

A Friendly Warning. It's all going to be your fault.

After school, you'll get a job. You'll be ready to take on the world. Get ready. It's coming.

You'll get asked for medical advice by every family member, friend, relation, acqaintance, and person you don't even know that gets wind that you are a nurse. One of 4 things will happen:

1) You will advise them, they will not follow the advice. They will not get well. And it's all going to be your fault.

2)You will tell them that you would rather not advise them, that they need to consult their regular doc. They won't do it amd that won't get well. And it's all going to be your fault.

3) You will advise them and the advice will not help and the y will not get well. And it's all going to be your fault.

4) You will advise them, they will get well, pass along the advice to a friend, who had a DIFFERENT problem, and he will not get well. And it's all going to be your fault.

You will go to work. You'll go in to meet your patients for the day (or night). You'll smile and be perky. They will complain because they just found out that they have a dreaded disease and they don't want to be smiled at. And it's all going to be your fault.

You'll go in to see your next patient, still upset by the reaction of your first, and are a little less upbeat. They will complain because they have had a bad day and they think that their nurse should be happy just to serve them. And it's all going to be your fault.

The doctor did not order the pain medicine that Patient Number 3 ordered because the patient is a known drug abuser who is only in for his fix. The doctor explicitly states in his orders that he is not to be called for orders for pain. That patient refuses to accept this. And it's all going to be your fault.

Patient Number 4 is NPO, and Aunt Katie can not understand why he can not have something to eat. After all, he's hungry, and you are starving him to death. All the other nurses fed him. You're just mean. And it's all going to be your fault.

The doctor comes in to see Patient 4 and finds him wolfing down pizza that Aunt Katie brought him because she knows what he needs better that you do. They snuck the pizza in as you were coding Patient 5. Patient 4 now has to reschedule his surgery since he ate. And it's all going to be your fault.

The doctor will call the supervisor to tell her how incompetently run this floor is and how no one ever does what they are supposed to do. The supervisor will pacify the doctor and the patients and family. She will tell you to be more careful in how you present yourself, because the patients perception of you, while not measurable, is important. Never mind that you have done everything by the book, to the letter, and that, Oh yes, nuber 5 is alive, thank you. No, no, we have to work on our image and smile, smile, smile, (except around patient 1) even though you may have just herniated your umbilicus doing compressions, because our patients have a perception. And if it goes to heck, it's all going to be YOUR fault.

No, the above did not happen. Maybe I am just jaded. That's why I got away from the bedside, and why I am getting my NP. I want to be a manager that has my nurse's back. That will say, "No, Mr. Loudmouth, you may NOT have 4 cheeseburgers. You may NOT call my nurses foul names. You may NOT help yourself to any and everything on this floor like it was your own personal mini-mart." If I ever acted the way I have seen some sups act, "Well just watch how you present yourself.", I would hope someone smacked me!

Flame me if you want to. I really do think newbies should be warned about things. I think they should be trained how to handle it, not sold up the river. Maybe this would also help with the shortage. Just maybe. Thanks.

[oramar]

I think the OP is right on the money and I'm a newish nurse(just under 2 years). I would also like to add that certain personality types get blamed more than others. Meaning, management doesn't like to confront the bullies, the lazy, or the loud. If they can try to pin something on Nurse Nice, they figure they're covered. And God help you if you sprout a backbone and attempt to defend yourself. You'll incur more of their wrath because Nurse Nice is supposed to back down immediately, according to their warped little rulebook.

Yep, I'm jaded already but at least I am in a better position to fight this kind of nonsense!

You have obviously caught on to the realities of nursing quick considering you only have two years experience. I have watched the bad nurses hang around for years because they are so nasty that managment is afraid to take them to task about their behaviors. Meanwhile, I watched the nurses who are decent human being be driven out by managers that abuse them because they know they can get away with it.(and of course the nasty nurses had a lot to do with them leaving)

[facetiousgoddess]

a couple of years ago i got chewed royally out by a gi doc because my patient had only taken a few sips of her golytle.

when he had finished reading me the riot act, we went in together to look at the patient.

she projectile vomited right at his shoes.

that was not my fault!

true that was not your fault!!!! but don't you sometimes, kinda wish, we could will things like that to happen? so we could honestly say :igtsyt: "that is my fault!!!!!!!!":smokin:

tres

still sick n twisted

[aKyRN81]

.

I have also found that I get lots of patients and family who see that I will be their nurse, and when I go to do report, say things like "thank God you're here!" or "I'm so glad you are my nurse tonight." It really makes all the bad stuff go away.

Enjoy that, but....and here comes old killjoy now.......be aware that this can also be a form of manipulation. In your newfound position of " their best and favorite" nurse, you will certainly want to keep them happy, and may find yourself devoting more and more time to that patient and family in an attempt to keep your place!

"I'm so glad you are my nurse tonight" is sometimes followed by 'That nurse last shift or last night....or whenever....was really mean ...or incompetent....or whatever'. This is meant to create a desire in you to either show how much better a nurse YOU are or set up a conflict with the previous nurse.

Sorry if I sound jaded, but I've seen an awful lot of this kind of thing. Once I changed an IV because of date, and as I got it in, the patient said "Oh, you're good, I'll ask for you everytime. The nurse who put the first one in really hurt me and it took forever to get in. She didn't know how to do them" Guess who did the first one also!!!!!

So enjoy the happy comments but be aware!

[Rabid Response]

Ha. Oh don't I know it! I had a patient who was NPO except for ice chips. D/t AMS and a recent extubation, the written orders were that he was under strict aspiration precautions. Of course the patient was not happy with this at all, bellowing for something to eat and drink. The resident was in the room with us while I fed the patient ice chips for five minutes--all the while I was explaining (while having abuse heaped on me) why he couldn't have a cup of water to drink. Finally, I had to go take care of another patient. When I left the room the resident was still in there. I put the cup of ice on a counter top far from the bed (patient was bedbound). A few minutes later I was passing the room and heard the patient coughing and sputtering. He was holding the cup of ice and melting water in his hand, and half of it was down the front of his gown. He yelled at me when I took it away from him--"The DOCTOR gave it to me!!!' Not only did I get to be the bad guy, but I am 100% sure if that patient had aspirated (and been intubated for the third time!) it would have been my head on a platter. I then asked the resident to write new orders pertaining to the patient's NPO status and aspiration precautions if he felt that it was safe for the patient to drink water alone, and he seemed to think it was really unnecessary and amusing. Ugh. The worst thing about this job is all the ass-covering I need to do to feel even a little bit safe.

[AngelfireRN, MSN, RN, APRN]

How about:

Patient insists on going to smoke, but is unable to take himself. He signs out AMA, has his family take him out, they LEAVE HIM, security brings him back, but he is no longer admitted. He wants his pain meds, but he is discharged. No IV, No orders, of course, he's discharged. Family refuses to come for him, because you should have just taken him out and said to heck with your other six sick patients. Patient refuses to leave the floor, NM come to see what the rumpus is, house sup gets called, etc.

And it's all your fault.

[MedicalLPN, LPN]

Yeah if you're going into nursing you better have a big buttocks because everyone's gonna take a chunk out of it.

As for the doc that got thrown up on by a pt, that's awesome, I know a couple docs who could stand to be vomited on lol

[tencat]

Love the story about the patient yakking on the doctor. Such poetic justice:yeah:

How about the diabetic who has an A1C of 9, has already lost a leg, has an ulcer on the other foot that has dry necrosis and nurse treats with debriding gel per standard practice guidelines, ulcer gets infected and it's the nurse's fault. Oh, and did I mention that family members have taken it upon themselves to debride the wound with a razor blade on a regular basis despite being counselled on how NOT beneficial that is? But that's not the cause of the infection. It's the nurse's fault.

[santhony44, MSN, RN, NP]

Angelfire: I really hate to be the one to break it to you, but you won't stop hearing that phrase when you become a NP.

Try this one:

It's Friday, 15 minutes till closing time. It's probably a Friday when you're on your way out of town, or to your kid's sporting event, or to a romantic rendezvous with your SO; in other words, you want out of there on time in the worst way, and were hoping to tiptoe out about five minutes early.

A loud, obnoxious patient appears at your front desk. The patient has a diagnosis of hypertension, diabetes, or both, with perhaps some other goodies thrown in. The patient more than likely reeks of cigarette smoke. The patient looks like a poster child for a MI. The patient is there because "I am out of my meds."

You look on the patient's chart. One month ( or 5 or 6 weeks ago) the patient was given a one-month prescription for these meds: one month only because the patient had missed three appointments in a row and has not had appropriate lab work done in a year and a half. The last time the patient was seen, his (or her) blood pressure and/or blood sugar was not where it needed to be and the patient was told to return to the clinic in two weeks. That was, oh, six months or so ago. When the patient was given the last one-month prescription, the patient was told he/she absolutely, positively would not be given another script without being seen and having labs done.

The clinic is a sliding-scale clinic and the patient has access to free transportation. A couple of the patient's meds cost $5 a prescription. The others are provided, free, by the companies; you have a person in the clinic who does all the paperwork for the patient.

The patient is standing at the front desk yelling "If I don't get my prescription and something happens to me it's all going to be your fault."

[AngelfireRN, MSN, RN, APRN]

santhony, I have no illusion about it getting better when I am an NP. In fact, it'll probably only get worse. Oh, well.

[aeauooo]

Patient insists on going to smoke, but is unable to take himself. He signs out AMA, has his family take him out, they LEAVE HIM, security brings him back, but he is no longer admitted.

When I was working at Harborview in Seattle I got report on a patient who I was told no longer required restraints.

Somehow, I knew what to expect when I went to that room.

I called security to ask if they could locate my errant patient. One of the guys said he had seen the soon-to-be-former-patient while he was coming in to work - heading down Yessler (a.k.a. "skid road").

I checked with the powers that be, and discharged him AMA.

Don't you know that at the end of my shift, he was back in the room he had previously occupied expecting to be treated. The guy had gone down to Pioneer Square and done what people do in Pioneer Square.

"Sorry, you're not a patient here any more."

[Altra, BSN, RN]

As a nursing instructor, I always told my students about this and then showed them how good documentation and assertive behavior can often stop the nonsense.

Amen.

I recognize this thread for what it is -- healthy venting. But it's a necessary psychological survival skill to learn to own what is truly your responsibility, and to not own what is not. This is a life skill, not unique to nursing.

I could say that it was "my fault" as the triage nurse that the young adult runny nose sat in the ER waiting room last night for 3 hours while all forms of hell broke loose in the back. He certainly did his best to make it appear to be my fault, putting on quite a show of verbal and emotional manipulation for the entire waiting room of 25+ people. I was never rude. I never raised my voice. I was not accusatory. I just never changed my stance that no, you will not be rushed back to a treatment room right now. I apologized the first time - that reflexive kind of, "thanks for waiting, I appreciate your patience" thing. But I did not apologize again after that. What would I be apologizing for -- medically appropriate decision-making? Isn't that what it is that we do in health care? :wink2:

I rechecked his VS (they remained not just normal, but excellent), and documented the recheck along with a narrative note on each & every one of the 8 times he came back into the triage area, and a narrative note on the episode in which he barged in as I was triaging another patient, and I called security.

Another episode from last night ... harried, frustrated MD came out to triage to find out why med list on sick patient that I took back a little while ago is not completed. I flipped to the sheet in the chart where I had written, "family states forgot to bring meds." I understand his frustration as he was trying to write admission orders for a very sick patient, but in no way, shape or form is it my fault that I don't know the 37 meds/dosages that the patient takes at home. I do not feel yelled at, nor feel badly that the sheet was not completed as I am, as yet, not yet able to teleport myself to the patient's house to retrieve her meds and re-teleport myself back to triage in time for the next arrival.

Hang in there guys. Own what is yours. Deflect the rest. Nurses are my heroes.

[suzy253, RN]

A couple of nights ago, pt was scheduled for an ECHO; transport came to get him and he refused to go. CNA came to get me (I was on dinner break if you believe that!) and I went back to talk to him about it. He was irate, absolutely refusing the test. Notified charge and charted it. Now the patient is saying that he never refused it. Must be my fault! :stone