When you're in charge and you have to report a friend? Then what?

[DutchgirlRN]

Yesterday was a bad day on the floor. I work on an acute care med/surg telemetry floor. Everyone was having trouble keeping up and I called the NM and told her we needed more help and that I had taken it upon myself to call in the O/C nurse. I wasn't asking for permission just letting her know. She was very cool with it. When I do charge the nurses always tell me that they appreciate me because I always do look out for them. We all work together very well and I consider all of them my friends but of course you get closer with some than others. One of my closer friends was having a really bad day. She had a new admission who tested positive for the flu and in the next room she had been taking care of a 2 year old post-op T&A admitted for complications. I told her not to re-enter the 2 year's room since she had been in the room with the flu patient (not yet placed on isolation) and explained to her why and told her I was switching that 2 year old patient with another patient/nurse. She said I'm keeping the 2 year old, we have bonded, I'm not taking that other patient in 319. I also changed the techs assignment to keep the 2 year old safer from the flu and the tech were cool with it. I tried again explaining it to her and then I went in and explained it to the 2 y/o's mother. She was cool with it. I caught the nurse going into the 2 y/o's room. I grabbed her arm and looked her in the face and said "no", come I need to talk to you. I told her in an empty room that I knew she was stressed and that I was willing to do whatever she needed me to to get her caught up but that she had to understand that I was in charge and I meant what I said. She said I promised the child I would be the one to give her her medicine. She started out of the room toward the child again and I grabbed the medicine out of her hands. I said "no". Do not go in that room. She huffed off. I called my nurse manager who came and talked with her. The rest of the day she was calm but would not look at me or talk to me. I feel like "too bad" I was right and you were wrong but this is the first time that I have had to report a friend when I was in charge. I know I handled it correctly. I plan on just letting it go because I feel like after a day or two she'll see how wrong she was. I hate to lose a friend over this. I'm not really asking for advice, just need to vent, thanks for listening.............Have you ever lost a friend over being in charge?

[canoehead, BSN, RN]

I agree that if you have made a decision as charge that she needs to respect that.

But I don't agree that reassigning her was the correct choice. If you are following precautions correctly the flu bug is left in the room with the first patient. I can see making assignments to avoid crosscontamination just to be extra safe, but if a relationship has already been established why disrupt care in the middle of the shift? If the nurse has already been in and out of both rooms several times? Isolation is proven to work if done correctly, or we wouldn't use it.

[Tweety, BSN, RN]

I agree that if you have made a decision as charge that she needs to respect that.

But I don't agree that reassigning her was the correct choice. If you are following precautions correctly the flu bug is left in the room with the first patient. I can see making assignments to avoid crosscontamination just to be extra safe, but if a relationship has already been established why disrupt care in the middle of the shift? If the nurse has already been in and out of both rooms several times? Isolation is proven to work if done correctly, or we wouldn't use it.

I started to bring that up, but since she had the support of her manager, I figured it was just their floor policy that she had to enforce, especially if it's a surgical pediatric patient. I know some surgical floors don't allow the same nurse to care for a surgical patient and an isolation patient at the same time. Our cardiac unit is like that. The open hearts aren't cared for by the medical cardiac nurse if he/she has an infected patient on iso. My unit is such a mish mash of patients the same nurse can have both, as long as proper precautions are followed, it's probably not a big deal. But we don't have pediatric patients.

[jeepgirl, LPN, NP]

On my floor, as long as we have the staff and it is practical, we would try to keep them separate. However, sometimes on my particular floor it would be unreasonable. As long as you're using strict precautions and using handwashing and masks, you should be okay.