Help regarding nursing priorities in regards to patient care

  1. I had a situation in which I was giving a patient K-ryders for a potassium of 2.8. A seperate patient requested my care specifically to clean her because of a bowel mov't. At the time, I felt unavailable to do both and asked an aide to clean this patient and the patient refused the care due to him being a male staff member. I felt the priority in this situation was to finish giving the medications. A supervisor reprimanded me yesterday stating that patient care was more important than hanging medications and stated specifically "that there are no priorities in nursing" and that the patient who was unclean was more important than giving the medications at that time. This goes against everything I have been taught in school. I just graduated in May of this last year and am looking to find if anyone else thinks I was wrong in this situation. Any advice is appreciated. please help I have never heard of anyone losing their license for a wet bed but I certainly have for medication negligence.
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  2. 23 Comments

  3. by   Sgt_Chunk_Spelunker
    I would have done the exact same thing that you did! Waiting 10 extra minutes to be cleaned up will not cause skin breakdown or major trauma...it can wait! Your supervisor has no backbone. Had the patient not complained, you'd have been commended for you prioritizing. It's strange how we're taught to do one thing (by the facilities as well), yet when the patient complains we're always in the wrong regardless of how irrational it is. Nurses need to be like the Shiva with 20 bazillion arms!
  4. by   talaxandra
    I don't know what K-ryders are, but I imagine they're some kind of potassium replacement. While I agree that leaving a patient unwashed post-bowel movement isn't optimal, it's not like it will kill her to wait a bit. You can't confidently say the smae about a patient with hypokalemia.
    I agree with the superviser that there isn't a strict "A always outranks B" order of priorities in nursing, but the most life-saving option always ranks higher than important-but-not-life-saving. no two ways about it - you were right.
    Maybe you need to whack her (superviser, not patient ) over the head with a computer monitor - displaying this thread, of course!
  5. by   chris_at_lucas_RN
    Quote from talaxandra
    I don't know what K-ryders are, but I imagine they're some kind of potassium replacement. While I agree that leaving a patient unwashed post-bowel movement isn't optimal, it's not like it will kill her to wait a bit. You can't confidently say the smae about a patient with hypokalemia.
    I agree with the superviser that there isn't a strict "A always outranks B" order of priorities in nursing, but the most life-saving option always ranks higher than important-but-not-life-saving. no two ways about it - you were right.
    Maybe you need to whack her (superviser, not patient ) over the head with a computer monitor - displaying this thread, of course!
    I agree on almost every point (me with my big two weeks of experience).

    There certainly are priorities in nursing. If one task is more or less dealing with a life threatening or potentially life threatening situation, then that's where you go/what you do.

    Maybe the supervisor misspoke? Maybe she meant something like all patients are equally important? Because certainly we give our best care regardless of who the patient is, but my gosh! No priorities? How about going for ice water versus calling a code?

    And I think I'd've stopped short of the whacking. I like my computer too much. LOL

    Good luck, OP! Thanks for this thread....
  6. by   Fun2, RN, BSN
    Quote from chris_at_lucas_RN
    No priorities? How about going for ice water versus calling a code?

    Well, according to her DON, if the pt complained about not getting any ice water, she would get written up even though she had another pt coding.

    That DON must have been PMS'ing or had a chewing out by the dirty pt or the pt's family. If so, the DON needs to stand up for his/herself and tell the pt that medicinal priorities come first. The pt had a chance to get cleaned up, but decided that her dirty butt wasn't an emergency enough to have a man clean it.

    Sorry this happened to you, tterri22.
  7. by   USA987
    It doesn't make sense to me. There are indeed priorities in nursing...ie. the ABC's that we all learned in nursing school. I would consider hanging potassium as ordered as more important as K+ is essential for cardiac functioning.
  8. by   Dixielee
    No priorities in nursing???????????? As stated above..it is all about priorities. Your supervisor is nuts! If the patient was lucid enough to refuse care from the CNA, then they were well enough to wait. YOU can only be in one place at one time doing one thing. You did the appropriate thing...you delegated an appropriate procedure to the appropriate person when you were unable to do it yourself. You should be commended, not reprimended! A K of 2.8 could very well be life threatening. The K could have dropped farther since the blood was drawn as well. You did the right thing. Just because someone is a supervisor does NOT necessarily make them right, or knowledgable. Stick to your own good judgement, you sound like you are doing fine.
  9. by   talaxandra
    Quote from chris_at_lucas_RN
    I agree on almost every point (me with my big two weeks of experience).
    Almost every point? Well, when you've been on the floor longer than two weeks you'll learn that my every utterance is a glistening pearl of wisdom, to be admired, cherished, and obeyed! :chuckle
  10. by   GingerSue
    next post (wrong key)
    Last edit by GingerSue on Jan 21, '05
  11. by   GingerSue
    Quote from tterri22
    ...Any advice is appreciated. please help I have never heard of anyone losing their license for a wet bed but I certainly have for medication negligence.
    I agree with your decision. The patient who needed to be cleaned could have waited.
  12. by   begalli
    tterri22,

    I would have just said to the supervisor, "in my professional judgement,..." and been firm about it.

    You absolutely did the right thing. Just remember when it comes right down to it, it's your nursing judement that comes into question when things go wrong and ultimately, it will be you explaining your rationale for why you did or didn't do something if your practice or license ever came into question.

    By definition, "A Standard of Care" holds a person of exceptional skill or knowledge to a duty of acting as would a reasonable and prudent person possessing the same or similar skills or knowledge under the same or similar circumstances.

    So, as evidenced by the replies in this thread of reasonable and prudent nurses, you are not guilty.

    Protect your patients and yourself first...always. That supervisor and your hospital will be no where around for you if your standard of care ever came into question.
    Last edit by begalli on Jan 21, '05
  13. by   Jabramac
    Quote from tterri22
    I felt unavailable to do both and asked an aide to clean this patient and the patient refused the care due to him being a male staff member.
    :angryfire Being male, I get infuriated when pts feel there small problem is an emergency, "oh, but I don't want a male" or "I don't want so and so." If a person is that picky they can wait. And wait. I would have done the exact same thing, hang the K, and ask the aid to attend the BM. Even one further it would have been fine to hang the K, then clean the BM your self after hanging the K. It only takes a couple minutes to hang a med. As for nursing not having priorities, I have always been taught the exact opposite. In school and on the job, I have always been told "nursing is about prioritizing." It is true that priorities don't always come in ABC, but that is why we are nurses, we have been taught and the experience to evalaute and prioritize different and unique situations.
  14. by   dekatn
    There is another thread going on right now about "what is some of the major problems in nursing" IMHO, part of the problem is this exact thing. The pt. had an aide available to take care of him/her, but that aide wasn't who they wanted, (male vs. female). Our facilities force us to cater to pt. like we are servants, a pt. can say, do or act out any way they want to and know they can get away with it because mngmt. backs them up and knocks us down! I think your priorities are exactly where they should be and had I been in your shoes, would have done the exact same thing. Wouldn't you just love to tell a pt. one time, "if you don't like it here, you can go somewhere else". Guess you can tell I just got off work after kissing family and pt. butt all day long!!!!! (not to mention managements also).

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