dream'n, BSN, RN 11,241 Views
Joined Aug 28, '06.
Posts: 956 (58% Liked)
Ok, what is the real issue here? You've posted this same thing twice. Are you trying to find something wrong with this nurse? Several posters have already explained that this nurse was probably correct, but you're still not satisfied? I'm getting a freaky-dink feeling about all of this. I think you probably need to back off the nurses and do whatever it is you're hired to do.
I felt it in my early 40s. Really, really felt it
It was really tough call. I couldnt justify a 911 EMS transfer as the pt is stable.
Some physicians become extremely irate if you make a judgment call in non emergent situation like transfer to ER for CT. I've many times had MDs refuse an ER transfer even if pt on a weak bloodthinner if pt is otherwise stable.
I also was not direct caregiver for this pt. I was only supervising RN which was another factor i considered, there was another primary RN reporting to me.
I have no knowledge if pt intends to proceed. My understanding is the proximate nurse is directly responsible. Also for facility to be liable delay of care must result in harm to pt. Since the pt was stable and suffered no change of condition, opting for a 911 EMS transport didnt seem like good step. Now if the pt was reporting pain, if the minor bleeding or hematoma worsened, or if neurological deficits from baseline occurred, i would have obviously called 911.
TBH i do think I did what was appropriate, i'm just concerned this may end up in court room because that's the nature of medicine and society. My main question is,would I be considered responsible for the actions that night, or would it only be the primary RN?
My opinion is to go finish high school. I find it hard to believe that you're taking college pre-requisite classes without a diploma or GED, or even being enrolled in high school.
I haven't seen CNAs in the psychiatric inpatient facilities I've worked, although I think I did see them in Geri-psych clinicals while in school. What I've regularly seen are Behavioral Techs that quite often already have a Bachelor's degree of some type (ie: Psychology, Sociology, BSW, and Criminology) and are working on Graduate degrees.
It's also not a good idea to strongly "relate to patient" suffering. Boundaries are of BIG importance in psychiatric care for both the patient and the staff. Empathy not sympathy is important, as many of the patient's psychiatric conditions display in unhealthy manipulative behaviors.
Living at home with no housing expenses? I'd go 24 months for that (and 10,000 dollars cheaper).
My anxiety just went up looking at your course list I do not miss those days! Personally, for me, myself, and I, I would have found that much science all at once too much. I'd drop the not yet needed Pharmacology course and take something less strenuous.
I have a close relative that works as an RN from home with an insurance company. She seems to enjoy it, but some of the cons are that she never really leaves work...it's easy to start charting, etc at 11pm after working all day when your office is just down the hall. She and her coworkers are also very closely watched for productivity and are ruled by the numbers; ie: why did you only make 4 calls this hour or only do x, y, and z in the past 1/2 hour, so they are always having to account for every moment. And at least in her case, she has the wonderful task of keeping multiple state nursing licenses up to date within each state's different guidelines.
I do know that at least in her case, she couldn't have a baby in the room with her. Her office has to be HIPAA proof and even a dog barking in the other room is a no-no.
You had seen the pump and bag running before this incident. I would have grabbed a supervisor, written an IR, and after my shift never went back to that unit due to safety concerns. I also would have raised **ll.
The fact that you say a new Heparin bag was ordered by you from pharmacy makes me think that maybe your pump beeped and some idiot just disconnected and trashed your empty Heparin bag without checking what drug it was or even letting you know. And they were too cowardly to fess up.
I understand that the family is upset, but do you think you acted like a prudent nurse? If the assessments and vitals were negative and charted often and the patient was always neurologically intact, I don't see where you could of done much differently. The Dr. never called back and you had no abnormal findings to report anyway, except for a hematoma which I'm assuming did not worsen throughout the shift. Hopefully the patient was not on blood thinners as that would make this a different case altogether. You can not tell the future, do not have a CT in the facility, and can't send every patient fall to the ER. If the hematoma was small and the fall was not hard, I doubt I would have sent the patient to the ER if all other assessments were negative, although I would watch them carefully. But check your policies at your employer for the actual protocols. It's hard for me to Monday quarterback your actions though as I don't work in your setting and am not recently familiar with LTC norms. In acute care, we have Drs always available and would have been able to notify one of them. And our CT is right downstairs.
I also have found Relias not user friendly. It took longer figuring out what was due and how use the program, than on the training itself. Also make sure staff has the time to actually do the training. It's not fair to tell staff to find time while on the floor to get the training done. Make sure staff has relief covering their duties for a bit so they can focus on completing the training.
I'm on the more realist (some may say pessimistic) side. I have a low tolerance for bull****. That's me and that's who I am. The smiley, always cheerful people drive me bonkers. It looks and feels fake to me. And I think being fake is a really bad character flaw. So I guess we'll just have to agree to tolerate each other.
I agree with the other posters. I need my quiet alone time much more now. I think it's because in nursing, people always need something of you. It's the nature of the profession, but it can be draining to give, give, and then give some more. There are times that it is hard to give anymore of myself to family and friends.
I think I'm grumpier too, but it could be my aging
Danger to self or others is among the common gold standards for determining competence.
what do they do instead?
Loved reading your article. As a cat lover, I've spent much time and money on helping with our feral/stray cat situation around my neighborhood. TNR programs are great! I've also seen a couple of cat bites that became very bad, very quickly. I'm glad you had the knowledge to get yours treated right way. Cat bites are like a syringe of bacteria being injected deep into the tissues. Sending good thoughts to you.
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