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

  1. 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 that the patient had arrived. At 0815 the BB called to say that the blood was ready and I told the nurse. At 0845 BB called back to say the blood hadn't been picked up yet. (they never do this but figured hey she works for the GI doc) I told them the nurse was almost through making her morning med pass and would be there shortly. Now fast forward to 1100.

    The tech comes to me and tells me that the lady in room #_____is really pissed and wants to see the charge nurse. I go down there and she is sitting on the bed in her street clothes, madder than h*** because her blood hasn't been started yet, no IV, no breakfast, no lunch, no nothing. I asked her why she hadn't used her call light, she said "why should I you all have known that I was here." I apoligized to her, assured her I would find out what the problem was and that I would get her food, her IV and blood started. Which I did.

    Then I called the nurse to the desk. I said what is the problem? She said well I've been so over whelmed with my other 5 patients I haven't had time for her and I figured she'd be here all day anyway so no big deal, also I blame the night shift for not settling her in.
    I said

    # 1 whenever a patient is assigned to you for any reason you "always" go in the room within the first 30 mins, even if just to stick your head in, and introduce yourself and see if they need anything. If you don't you may someday find that a patient has been dead for hours.

    # 2 If you're ever overwhelmed you come to the charge nurse and ask for help. If I can't help I'll find someone who can even if we have to call the supervisor. In this case I would have been able to help you out, no problem. She said she didn't want to ask for help because it would appear she couldn't handle her job. I said no we all need help sometimes (She been an RN about 6-9 months)

    #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.

    #4 it is not the fault of the night shift. She arrived at 0700 and assigned at that time and the night shift nurses didn't even know she was there. She got really mad "well my preceptor never told me I had to check on patients at the beginning of my shift", well I'm telling you now you need to, no matter what, at least stick your head in the door.

    She raised a fuss, called the supervisor, who backed me up, but then the nurse also talked to the other nurses about me making a big deal out of her not seeing a patient for 4 hours. I'm not letting it bother me because I'm right and I think I handled it right, I'm just needing to vent a little.

    P.S. I know this GI doc pretty well. Do you think I should mention to him that she had not used her call light in 4 hours and may have acted like a marter or just apoligize for what happened? Thanks!
    Last edit by DutchgirlRN on Oct 30, '05
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  2. 140 Comments

  3. by   Katnip
    Yes, you handled it correctly.

    There have been multiple stories posted here about patients who had been dead for hours because nobody checked up on them.

    I'm surprised that this nurse doesn't look in at all her patients at the beginning of each shift. That's always been a priority when I worked on the floor. At the very least, the nurse should have given the call bell to the patient and told her to call for what she needs.

    I'm surprised at your supervisors attitude also. Maybe you should look up some of those articles.
  4. by   DutchgirlRN
    Thanks for the opinion cyberkat and the encouragement. I just fixed my post because the supervisor wasn't the one going around talking about me to the other nurses it was the nurse who had neglected the patient. I guess my fingers were so busy typing I didn't make that clear so I have fixed my post. Oh horrors, if my supervisor had actually done that I'd have been on the line to the CNO first thing Monday morning. My supervisor is really great!
  5. by   Katnip
    Ahh. Ok. That part about the supervisor is clear now.

    I'm sure the experienced nurses are going to help set her straight. I mean 4 hours???

    Yes, med passes are important, but you need to make sure you've got living patients, too. Somebody who is in to receive 3 units of blood isn't in the best of shape no matter what.
  6. by   jnette
    Wow.

    I agree you handled it well... very well IMO. And I, too, am shocked that this patient was never checked on in all this time. Very troubling.

    I hear so many stories from our patients who are sent to the hospital for various reasons... awful tales of having been left in their rooms for up to eight hours ... no meals ever offered, nothing. This is simply unacceptable.

    It would be plain ol' common sense (not to mention COURTESY) to check in with your patient... she could have explained to her about needing to pass her meds first, and that she would be with her as soon as she was able. In the meantime to make herself comfortable and be sure to ring her callbell if she needed anything.

    And as you stated, if she felt overwhelmed, it was her responsibility to let someone else know and ask for assistance.

    Had I been this patient, I would have been angry as well. Can hardly blame her. :stone
  7. by   Audreyfay
    Perfect job Dutch! You did the right thing. The others will set her straight. So she talks about you a little. You did the right thing.:kiss
  8. by   SKM-NURSIEPOOH
    first of all...this nurse in question has some priority & critical thinking issues that must be addressed by your nm! preceptor or not...it's definitely their responsibility to *know* how to organize one's shift by *this* point of their nursing career albeit six to nine months. this person needs to stop making excuses & take a good look at themself. perhaps a self evaluation is needed?

    i'm absolutely am floored that this person felt or thought they were some how wronged in this. they need to take responsibility in this period...displacing blame onto others isn't the key. you were certainly correct in telling them that the night shift had nothing to do with this as well as telling them they should've popped in to assess the patient....which they didn't do & wasn't about to by four hours into the shift. that right there are grounds for neglect imo. how on this earth can this person expect to *know* when their patients' are deviating from their baseline if they don't do an initial assessment! how long would it have taken for them to do so before going to do meds....& how or why would they attempt doing meds if initial assessments haven't been done?

    this person is walking on a slippery slope of sloppy & piss poor not to mention...dangerous nursing...imo. they definitely need re-evaluating. i also feel that she needs counseling as well as disciplinary actions. their whole attitude needs adjusting.

    the only thing i differ in what you've said was placing some onuses onto the patient. what if this patient had of had a changed in mental status whereby they couldn't ring the call bell? what if the call bell wasn't in their reach? what if this person *did* expire? no....placing blame on the patient is a out for this nurse in question. i do understand your thought process here in that this person probably just sat there deliberately waiting & watching the clock so that they can complain. but really...what would've happened if said patient *did* use the call bell? would she have been transfused any quicker? i doubt it! the nurse in question probably would've put her on the back burner anyway.

    this nurse also need to use the auxiliary staff to the fullest as well. why couldn't this nurse have filled-out the bb slip & sent some else to go get the blood? just how hard was it for her to have come to you & say....i'm a bit behind & need assistance? i'm feeling this person probably has skip & shirk loads of tasks & is just getting found-out because this patient isn't going to stand-back or simply disappear without a word. so many patients today don't speak-up for themselves because they don't want to disturb anybody. so they sit & suffer in silence. they don't want to mention anything to their families for fear that they might make a stink...thereby fearing retribution from the hospital staff.

    lastly...you shouldn't have to make any apologies to the gi doc just because the patient is his receptionist. that's totally bs! the only person who should receive the apology is the patient....& *that* needs to be done by her primary nurse in question...not the charge nurse.

    cheers,
    moe
    Last edit by SKM-NURSIEPOOH on Oct 30, '05
  9. by   Fun2, RN, BSN
    I'm not even a nurse yet, and common sense would tell you that you should not leave a patient waiting on you for 4 hours!

    I think she forgot. She is a new nurse.

    However, to make a fuss about it, and make excuses was ridiculous. I guess she was probably embarrassed by it, and to put the blame on someone else was by instinct.

    I think you did the right thing.

    On the other hand, I wouldn't have waited for 4 hours before finding out what the heck the hold up was!!!!!!! I sure wouldn't be there for 4 hours steaming about it...at least after 2 hours, if not after 1 hour, I would have found something out, just to make sure I wasn't forgotten about.

  10. by   SharonH, RN
    #1. You did everything right.


    #2. I wouldn't bring this up to the GI doc, it's not necessary and while you do owe the patient an apology, I wouldn't apologize to the doc or offer him an explanation unless he asked for one.

    #3. New grads often have difficulty with setting priorities and organizational skills. Many of them also have issues with maturity also. YES, it may seem like common sense but let's remember that they are easily overwhelmed and may lose sight of what may seem to the experienced nurse or even the student nurse to be the only logical thing to do. It's been almost 15 years since I was a new grad but I haven't forgotten what that was like. 6-9 months is really not that long to be past making the overtly dumb mistake and I would just keep that perspective and keep an eye on her.
  11. by   DusktilDawn
    I think you handled the situation appropriately.
    Optimally, you should see all of your patients within a reasonable time frame from the start of your shift (within the first hour of your shift if possible). Defnately you should see a new admit within 30 min if not sooner, at least to introduce yourself and to verify stability.
    I figured she'd be here all day anyway so no big deal
    Not a very good attitude, especially since the patient had already been there almost half the day at that point. Gee, the patient could have already had unit #2 infusing.
    She said she didn't want to ask for help because it would appear she couldn't handle her job. I said no we all need help sometimes (She been an RN about 6-9 months)
    :smackingf It shows far more wisdom to acknowledge that you need help and ask for it. Even when I was a new nurse I never hesitated to ask questions, hey, it's one way we learn.

    I'm not sure why she called the supervisor, Dutchgirl. I don't see how she could have even considered that she was in any way in the right in regards to this situation or that a supervisor would back her. Sorry, I don't know about others but my nursing instructors did teach me that my patients needed to be seen in a timely fashion, 4 hours is in no way remotely timely. I think you went through the valid points of the situation with her, it doesn't seem like she was very receptive.

    I doubt the others she complained to thought her complaints were valid.
    BTW, as a patient, I wouldn't have waited 4 hours to find out what was going on.
  12. by   babynurselsa
    I wonder how she would have felt if she ahd sat in a room for 4 hours and had never seen a single staff member? Or if this had been her mother?
  13. by   JentheRN05
    Quote from SharonH, RN
    #1. You did everything right.


    #2. I wouldn't bring this up to the GI doc, it's not necessary and while you do owe the patient an apology, I wouldn't apologize to the doc or offer him an explanation unless he asked for one.

    #3. New grads often have difficulty with setting priorities and organizational skills. Many of them also have issues with maturity also. YES, it may seem like common sense but let's remember that they are easily overwhelmed and may lose sight of what may seem to the experienced nurse or even the student nurse to be the only logical thing to do. It's been almost 15 years since I was a new grad but I haven't forgotten what that was like. 6-9 months is really not that long to be past making the overtly dumb mistake and I would just keep that perspective and keep an eye on her.
    I totally agree with this. I am only out of school by 6 months now, and only at my current job 1.5 months. I have made mistakes before. But I would NEVER allow a patient, no matter how busy I am, to go without seeing me for 4 hours. But I can completely understand what it's like to be overwhelmed. I however know how to prioritize. If she would've started that patient when she first started her shift, she could have had alot more done. But that's just me. Needing 3 units IS a priority, and a patient receiving blood IS a priority during throughout and after the blood. I realize this takes times, but some people haven't quite grasped how to organize their day. Maybe some help with organization skills or a brush up on prioritization would be helpful. Just a thought.
  14. by   VivaLasViejas
    It's scary to think that this new nurse is already doing such poor work.......what's she going to be like in six to nine YEARS, when she's getting burned out and her back and feet ache like the devil after a long shift? :angryfire

    I was taught from day one of nursing school that the very first thing you do when you get out on that floor is make sure your patients are breathing.....you don't have to jump in and do baths or feed them or even wake them up if they're still asleep, just make sure they're ALIVE.

    You handled this situation correctly. That nurse is fortunate that I'm not her manager, I'd have chewed her a new one AND written her up.......not just for neglecting her patient, but for her attitude. The average first-year nursing STUDENT knows better than to leave a patient alone for four solid hours, especially not one who needs three units of PRBCs. Shame on her.:stone

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