Not my job, but I got involved!

[MAISY, RN-ER, BSN, RN]

So, can't go into detail....just in case BUT, got INVOLVED and it wasn't my job!

Had an emergency come to a specialty department and was IGNORED...went ahead and triaged....advised the necessary parties and charge RN of lack of respoinse/urgency.....another nurse whose job it was picked up from me and continued....UNTIL....patient went into respiratory distress and then to OR! OMG!

Original party (who should've been responsible) told me no charting between by unbelievable triage and respiratory distress! "Let's face it I didn't lay eyes on them, and felt no lack of urgency." WHAT!

*Symptoms that any nurse would recognize-similar to CP in a patient with cardiac history-NOT TO BE IGNORED!

Re opened chart to find huge missing area-they'd closed the chart without advising us....our notes nowhere!

Now we have late entries, I have quoted responses received from RNa-including my trip to Charge RN. Other RN who helped-charted her stuff and change in condition that occurred prior to arrest. What does this mean if it goes to court! Others really p******off they were quoted and that charge RN had been advised. Thank God I had the presence of mind!

Meanwhile, the patient though a little worse for the wear, is fairing okay.

While it goes against my grain when people don't help, I am angry my name is now associated with a near death! I believe I did the right thing, but my co-workers who were WRONG IN THEIR LACK OF URGENCY, threw me and the other RN who helped under the proverbial bus by not allowing us to review the chart prior to signing it off in our computer systems.

What do you all think? Has anyone ever done this to you?

Still really angry at the possible outcome.

Maisy

PS Managment backed me to the hilt and reprimanded the other nurses involved! When questioned I provided the whole ugly story...

[Mulan]

Were you working in the specialty department?

Was this a patient coming in for an appointment?

Just trying to get a picture.

[MAISY, RN-ER, BSN, RN]

For that day my job was not direct patient care, more of a coordinator of care. The department is a specialty under the umbrella of my entire ER department. I occasionally rotate into the area, but it is not my specialty and an area in which I have only average comfort.

I am sorry to be so cryptic, but you understand if anything occurs I'd rather not be specific.

Maisy

[northshore08]

Picture is still real cloudy, but from what I can surmise, here goes.

No matter what, you should still be able to document on a patient, even after the chart has been "closed." If it was documented later and went to court, I think a jury would understand you cannot be typing/writing in the midst of an emergency.

You can only document your side of an issue and what happened from your point of view. And it does no good to be angry that your name is on the chart; you were involved and did what you could. If it does go to court, the fact that you were not originally assigned to that area will be discussed as well, and also that you noticed the problem and stepped in to help. That doesn't sound like a bad thing.

What if you had not been there? From what you have said it sounds like it might have been worse. And in my experience, "not my job" is not an option at any time with any patient.

(I may be way off base, but this is the best I can do from the information given.)

[MAISY, RN-ER, BSN, RN]

In my opinion, it was no different than seeing someone collapse and everyone walk past. I am still fuming over the lack of urgency that occurred with regards to the situation.

I am angry that I had to do a late entry, instead of my co-workers huddling and having the complete picture. In my mind its great that the patient is okay now, what's not great is that the others involved closed that chart down without checking to see that it was: complete, told the whole story, and provided an accurate account protecting not just the nurses but the hospital. I hate to think that they thought it would be swept under the rug and not reviewed by me...actually the other RN who assisted, had given a verbal report to the specialty nurse and none of it was written in the chart. It was the most disappointing lack of teamwork I've ever seen. I really believe we were left out to dry...and I just don't get it!

Maisy

[northshore08]

I am angry that I had to do a late entry, instead of my co-workers huddling and having the complete picture. In my mind its great that the patient is okay now, what's not great is that the others involved closed that chart down without checking to see that it was: complete, told the whole story, and provided an accurate account protecting not just the nurses but the hospital. Maisy

1. Don't count on other nurses to document for you. They will never include all the info you would.

2. Next time do not wait to review it later; if you do it or are involved enough for it to require documentation, document it. It's evident the co-workers did not have the complete picture you did.

Sorry this happened to you....:redpinkhe

[northwestwind]

I know you can't disclose the details, but without the details, it is a bit difficult to comment. Except to say that you ran straight into the culture of silence in hospitals these days. This will pull at your heartstrings, and give you good reason to think alot about this ethical and practice dilemma well into the wee hours. Unless you have strong leadership from the CNO which filters down to Directors and Managers, creating good feedback communication loops for you, you will be seen as the black sheep. Sad, but true. You have some decisions to make: continue to take this scenario up the chain (not recommended), document everything in a time chart with who responded when and why, who did not respond, etc., (recommended) or drop it (not recommended). While the patient was OK this time, next time it may turn out differently. Your license is the most important thing you need to protect. So let's say you do a time chart. Give this to your Manager, and keep a copy. This document will support nursing practice and your State Nurse Practice Act. Whether the manager chooses to do anything this time is not your problem. Next time however, if a patient has a bad outcome, and you get caught up in a real mess, you still have to do everything possible to inform those direct caregivers to get involved, and you need to document in the chart the name of the people to whom you reported the problem. Part of the issue here that is gray is that you responded while the direct caregivers did not, if I am reading this correctly. Makes no difference in court - if you knew about it, and did nothing, your a-- is on the line. If the people you document as having information from you do nothing, then you are free and clear; they are the ones who the lawyers will go after.

The biggest problem as I see it here is that you may be in an organization who does not have strong nursing leadership. By the way, was the doctor ever informed, and when, by whom? Ultimate responsibility is with the doctor, too, and a good doc will not like hearing your story about this incident. Be careful though, because you do not ever want to, on your own, inform the doctor re. all events without your Manager's knowledge. There is a chain of command that is very, very important, and extremely inflexible. This is both good and bad.

Protect your license, bottom line. This is a good scenario for Quality Committee review. You might ask your Manager about that, too.

Hope this helps. You are experiencing one of the most difficult challenges about being a nurse, and trust me, this will happen again, more than once. You must learn to appreciate the culture and the chain of command, and how you can most effectively balance both. You also must be very clear about your own boundaries within your job scope. You might ask your Manager, as you hand off your time chart, how you could have handled the situation differently. Put it in Management's hands. Stay positive, stay involved, and protect patient advocacy all at once. It takes years to do this right....each event is a learning opportunity. Finally, keep a watch on your emotion of anger about this. I would be angry too, but after 26 years of doing this, I would turn my anger towards standard of practice, and best practice, and especially take the opportunity to become closer to my manager, who can serve as a mentor. No one can ever fault you for doing the right things for the right reasons. But you must learn to differentiate between the two in the context of culture, your role boundaries, the makeup of your unit management, and passing off responsibility to those responsible at the right time, documenting such, and then LET GO. Stay away from emotional cat and mouse games with your colleagues - you will never win. Some are very good, and some simply are not. Take the high road. You are a professional; prove to everyone and especially yourself over time that you know how to handle these situations. It will take a huge load off your shoulders!

As I mentioned, you may not have management who will support you, but you still have to do everything I mention. You never know - poor management sometimes results from floor nurses who are not willing to take anything to the next step, and they become demoralized. Help them out, you know?

[grandee3]

I know you can't disclose the details, but without the details, it is a bit difficult to comment. Except to say that you ran straight into the culture of silence in hospitals these days. This will pull at your heartstrings, and give you good reason to think alot about this ethical and practice dilemma well into the wee hours. Unless you have strong leadership from the CNO which filters down to Directors and Managers, creating good feedback communication loops for you, you will be seen as the black sheep. Sad, but true. You have some decisions to make: continue to take this scenario up the chain (not recommended), document everything in a time chart with who responded when and why, who did not respond, etc., (recommended) or drop it (not recommended). While the patient was OK this time, next time it may turn out differently. Your license is the most important thing you need to protect. So let's say you do a time chart. Give this to your Manager, and keep a copy. This document will support nursing practice and your State Nurse Practice Act. Whether the manager chooses to do anything this time is not your problem. Next time however, if a patient has a bad outcome, and you get caught up in a real mess, you still have to do everything possible to inform those direct caregivers to get involved, and you need to document in the chart the name of the people to whom you reported the problem. Part of the issue here that is gray is that you responded while the direct caregivers did not, if I am reading this correctly. Makes no difference in court - if you knew about it, and did nothing, your a-- is on the line. If the people you document as having information from you do nothing, then you are free and clear; they are the ones who the lawyers will go after.

The biggest problem as I see it here is that you may be in an organization who does not have strong nursing leadership. By the way, was the doctor ever informed, and when, by whom? Ultimate responsibility is with the doctor, too, and a good doc will not like hearing your story about this incident. Be careful though, because you do not ever want to, on your own, inform the doctor re. all events without your Manager's knowledge. There is a chain of command that is very, very important, and extremely inflexible. This is both good and bad.

Protect your license, bottom line. This is a good scenario for Quality Committee review. You might ask your Manager about that, too.

Hope this helps. You are experiencing one of the most difficult challenges about being a nurse, and trust me, this will happen again, more than once. You must learn to appreciate the culture and the chain of command, and how you can most effectively balance both. You also must be very clear about your own boundaries within your job scope. You might ask your Manager, as you hand off your time chart, how you could have handled the situation differently. Put it in Management's hands. Stay positive, stay involved, and protect patient advocacy all at once. It takes years to do this right....each event is a learning opportunity. Finally, keep a watch on your emotion of anger about this. I would be angry too, but after 26 years of doing this, I would turn my anger towards standard of practice, and best practice, and especially take the opportunity to become closer to my manager, who can serve as a mentor. No one can ever fault you for doing the right things for the right reasons. But you must learn to differentiate between the two in the context of culture, your role boundaries, the makeup of your unit management, and passing off responsibility to those responsible at the right time, documenting such, and then LET GO. Stay away from emotional cat and mouse games with your colleagues - you will never win. Some are very good, and some simply are not. Take the high road. You are a professional; prove to everyone and especially yourself over time that you know how to handle these situations. It will take a huge load off your shoulders!

As I mentioned, you may not have management who will support you, but you still have to do everything I mention. You never know - poor management sometimes results from floor nurses who are not willing to take anything to the next step, and they become demoralized. Help them out, you know?

:yeah::yeah: