Blow out at the desk, who was at fault? both share blame I think? - page 5

I was in charge yesterday and when I got there at 0700 I was told we would be getting a patient (a GI doc's receptionist) for 3 units of blood and go home. I assigned the patient and told the nurse... Read More

  1. by   wooh
    I've been a nurse for 30 years and clearly understand HIPAA and no I did not violate HIPAA. He is her doc, but thanks for your opinion anyway.
    Based on how politely you responded to my concerns regarding your OP, I'd be a little leary of asking you for help if I was a new grad. Perhaps the communication gap in this situation wasn't one-sided?
  2. by   KrysyRN
    [QUOTE=DutchgirlRN]I've been a nurse for 30 years and clearly understand HIPAA and no I did not violate HIPAA. He is her doc, but thanks for your opinion anyway.[QUOTE]

    Thanks for clearing this up. I, too, was disturbed at the thought that the patient's care might be discussed with another person not directly involved with the patient's care, doctor or not.

    I do disagree with assigning any type of blame or responsibility on the patient for not speaking up about getting blood sooner. The patient showed up at 7 a.m. for her blood. She did her part. To pass responsibility to the patient for not pushing a call bell, or notifying the staff that she was waiting, sounds so unethical to me. The patient should bare NO responsibility for that. Her nurse knew she was there. Her nurse chose to put the patient on the back burner. Her nurse chose not to ask for assistance. The patient did nothing wrong in my eyes. To tattle to the GI doc about the patient not pushing her call bell boggles my mind. And yes, to me, it sounds like tattling.

    Have any of you ever signed in at a doctor's office and waited 3 hours for your appointment? Have any of you ever signed in to an ER and waited 8 hours to be seen? Maybe this patient knew it would take time to get set up for the blood, but thought 4 hours was excessive, and that's when she decided to speak up. Or maybe she fell asleep, woke up 4 hours later, and realized no one had seen her yet. So many scenarios... but it still boils back to her nurse's failure to see that patient sooner.
  3. by   Tweety
    Quote from krysy
    I do disagree with assigning any type of blame or responsibility on the patient for not speaking up about getting blood sooner. The patient showed up at 7 a.m. for her blood. She did her part. To pass responsibility to the patient for not pushing a call bell, or notifying the staff that she was waiting, sounds so unethical to me. The patient should bare NO responsibility for that. Her nurse knew she was there. Her nurse chose to put the patient on the back burner. Her nurse chose not to ask for assistance. The patient did nothing wrong in my eyes. To tattle to the GI doc about the patient not pushing her call bell boggles my mind. And yes, to me, it sounds like tattling.

    Have any of you ever signed in at a doctor's office and waited 3 hours for your appointment? Have any of you ever signed in to an ER and waited 8 hours to be seen? Maybe this patient knew it would take time to get set up for the blood, but thought 4 hours was excessive, and that's when she decided to speak up. Or maybe she fell asleep, woke up 4 hours later, and realized no one had seen her yet. So many scenarios... but it still boils back to her nurse's failure to see that patient sooner.
    I agree 100% that when dealing with this situation, one should deal with the nurse, nurse's support staff and the charge nurse. The patient shouldn't even be brought up into this situation at all.

    Maybe this person was giving the staff the benefit of the doubt, and was an amazingly patient person. But the obvious anger at sitting there for four hours tells me that this might not be the case. A mature person might not have stewed for four hours and would have made some inquirers. But to hold her accountable for this situation is not the point at all. I was only wondering.

    If I have a doctors/dental appointment, I give them one hour before I get up and ask how long it will be. If I don't like the answer I leave. I've done that before. My doctor and dentist are both talkers and spend are chronically late, but they have an hour or I walk out, and yes I have walked out on my dentist before. I walked out on my haircutter when I used to use one by appointment. Nor would I sit in an ER and wait 8 hours without making frequent checks as to the status of my case if someone wasn't keeping me updated (which the one and only ER trip I ever made the staff did).

    That's just me. I can't judge someone who would sit quietly for hours on end, but I don't do it.
  4. by   DutchgirlRN
    Quote from mtnmom
    As a neutral observer, I cannot help but wonder if this nurse had asked for help in the past and gotten either no response or a negative response; that might have dissuaded her from asking again. In other words, had she been a victim of "nurses eating their young" by others on the unit previously? Also, what were her other 5 patients like that day? Does acuity factor into staffing in your unit? Was she truly overwhelmed and felt that she had nowhere to turn?
    Don't read too much into my post. No we do not eat our young on my floor and no she has not been turned down for help in the past. She was afraid that she would look like she couldn't handle her job if she had to ask for help. Simple as that. She understands now, it's ok to ask for help. I sure did yesterday when I was so overwhelmed.

    And does your unit have techs, NA's, etc....if so, why did one of them not go to greet the new admit?
    We have tech's and yesterday I spoke to the one on that hall. She had offered the lady a gown, she refused, she tried to get her v/s she refused.

    All that being said, her reaction is troubling...not to mention that she left ANY pt unseen for several hours. She was extremely lucky in this case to have chosen to leave someone alone who had a good outcome....miraculous for anyone needing 3 units of blood, I think.
    Maybe the orientation process needs to be looked at more carefully. Maybe new nurses need longer orientation on the floor, or this type of thing (not looking at a patient at all, asking for help, etc.) needs to be covered in the general new hire orientation. just curious...do you have a lot of new grads and do most of them do well?
    I'd say 95% of our new grads do fine. She one has been doing fine also. She had a bad day, got overwhelmed and didn't want to ask for help. I feel sure she now understands how important it is to lay your eyes on each patient early. Her preceptor is wonderful and doesn't understand this either.

    From what I can tell you handled it well....just trying to brainstorm and analyze for possible "root causes". If everyone learns from this experience (most especially the new nurse) then all is not lost.[/quote]
  5. by   DutchgirlRN
    Quote from wooh
    Based on how politely you responded to my concerns regarding your OP, I'd be a little leary of asking you for help if I was a new grad. Perhaps the communication gap in this situation wasn't one-sided?
    The gap was one-sided as she was blowing up at me, at the desk, not visa-versa. I am "always" available to help. I have been a student myself and understand how it feels. I love to precept and have been requested to be the preceptor to many of our techs who graduate as nurses.
  6. by   DutchgirlRN
    I do disagree with assigning any type of blame or responsibility on the patient for not speaking up about getting blood sooner. The patient showed up at 7 a.m. for her blood. She did her part. To pass responsibility to the patient for not pushing a call bell, or notifying the staff that she was waiting, sounds so unethical to me. The patient should bare NO responsibility for that. Her nurse knew she was there. Her nurse chose to put the patient on the back burner. Her nurse chose not to ask for assistance. The patient did nothing wrong in my eyes. To tattle to the GI doc about the patient not pushing her call bell boggles my mind. And yes, to me, it sounds like tattling. So many scenarios... but it still boils back to her nurse's failure to see that patient sooner.
    I do see your point and and I'm with you. It definately does boil back to the nurse's failure but as a patient, I guarantee you I would have been up at the desk alot sooner asking "am I getting my blood or what?"
  7. by   sjrn85
    Wow...this sure is one "interesting" unit! From a new grad who faked a British accent, talked to computers and televisions, and got her job b/c of her influential parents, to this new situation.

    One thing's for sure...no shortage of drama there! :chuckle
  8. by   Marie_LPN, RN
    Sounds awful. I like a drama-free place of employment.
  9. by   SarasotaRN2b
    Quote from DutchgirlRN
    #3 the patient herself bears some responsibility for not using her call light. I wouldn't sit in a room for 4 hours waiting for something to happen, she may be somewhat of a marter.
    As much as we would like for patients to take responsibility for themselves, that is not something we should count on. The nurse should have stuck her head in there.

    I think that what you've done is what a good charge would do. Don't beat yourself up about it.
  10. by   penguin2
    Quote from DutchgirlRN
    You obviously did not read the posts carefully.

    A little confused here-- tell me if I'm missing something here-- but I think spidermonkey meant the PATIENT should have been checked on by you as the charge person that night- earlier- like when the blood bank kept calling, rather than after she'd had a chance to become upset about this.
  11. by   penguin2
    Quote from wooh
    Based on how politely you responded to my concerns regarding your OP, I'd be a little leary of asking you for help if I was a new grad. Perhaps the communication gap in this situation wasn't one-sided?
    Funny, I am sensing some hostility from the OP too, after reading all the posts here & her replies. It's becoming clear as to what the underlying problems on this unit may be...it's hard to ask for help when there is a general feeling of no teamwork and the charge person isn't approachable & becomes defensive to those she's asked for advice. Also, confronting someone at the desk is inappropriate & unacceptable. I would not be so quick to blame a new nurse & call the patient a "martyr" either.
  12. by   LoriAlabamaRN
    I also pick up some serious attitude from the poster... I hate to say that but it really seems as if she wants us to tell her she was 100% right and any other responses will not be tolerated... I know that as a supervisor, if I had had the same situation I would have checked on the patient myself. Especially if the nurse was rather new and the issue was hanging blood. I don't think the new nurse was right by waiting so long, not by any means. However, I would have followed up on it myself as well. I certainly wouldn't have decided the patient was just a "martyr" who wanted to be neglected. I would have offered to help that nurse instead of assuming she will be comfortable coming to me and asking my help- especially when the blood didn't get picked up. There are ways to assist without making the new nurse feel incompetent. Maybe you should look into those.

    Lori
  13. by   ceecel.dee
    7am is a terrible time for an admit!
    sorry, but i'm feeling a bit sympathetic towards this new grad! yes, she should have made a bee-line for this (or any gi bleed) patient's room to initiate the transfusion and get baseline assessment. but...charge nurses are also responsible for the patients, and make rounds on all the patients...don't they?
    i do think that the discussion that was had with the new nurse was very appropriate, but there is blame to go around in this potentially dangerous situation.

    never trust a gi bleed

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