Manager mad RN followed policy and procedure!

  1. There is a manager who wanted an RN to overlook policy and procedure, and got mad when other RN's voiced their opposition to this request. Who is wrong here, the manager or staff RN's. Situation was pt on floor gi bleed in need of multi unit of blood. pt had unit hanging and was taken to gi lab, blood sent in hospital is done by secured tube system. manager wanted RN to send the blood to gi lab after receiving it on the floor. Problem is it can not be securely sent from floor to another unit, so blood would be in tube system "unattended". Two staff RN's voiced their opposition to this request. "Newer" RN, said "he told me to send it and he would take the heat for it". "New" RN decided that her co-workers were correct and then had the blood hand delivered to the gi lab to be hung. Mananger had charge RN "council the two RN's that voiced their opinon. Who is in the wrong here? Isn't pt safety the number one goal. Manager stated "pt needed blood right then and it was best to not have followed the policy and procedure". Just asking.
  2. 23 Comments

  3. by   netglow
    Sheesh. Patient safety first.

    IMHO, get the blood to the patient. Were you saying that your NM wanted it tossed back in the tube system and sent to GI? If so you guys already received it in hand. I don't know what the policy is where you work, but I'd ask the blood people what the policy is in this situation... I am sure they can clarify. If they wanted to reject the blood, it would have had to go back to the blood bank, and the process started all over - which is stupid.

    IMHO, I'd have involved my charge to watch my patients for a sec while I deliver the blood hand to hand sign off on receipt, as the patient in GI is my patient and the drug (blood) is signed out to me (in my hands). I am sure this patient was in dire need of the blood, and why don't people understand this. People move emergently all the time from one place to the other, you are going to have meds in hand signed out of pyxis and ready to hang and push many times... think of the patient first.

    I'll add that doing it by hand assures it gets there, and doesn't get stuck. I'd be sprinting down the stairs and down the hall to assure it gets there.
    Last edit by netglow on Nov 3, '11
  4. by   elfinM
    Yes, the NM wanted the blood tubed down to the gi lab. Blood bank stated that unless it can be secured, meaning someone has to present a badge to receive, then it does not go back in the tube system. This tube system is new (operating for 4 weeks), so previous policy would have been to walk to blood bank receive blood and walk it to the gi lab, which is near the blood bank. The nm wanted the rn to receive the blood on the floor, by swiping her badge, then place it in another tube, and send it to the gi lab. No one would have had to swipe a badge to receive. Pt had another unit hanging when left floor. Should have called bb and had them hold blood there or take to gi lab directly instead of tubing to floor.
  5. by   dudette10
    I'm going to reiterate what you said to understand the situation.

    Pt in GI lab with blood hanging, and a new unit of blood was needed.

    The new unit of blood was already on the originating floor. The problem was how to get the new unit to the GI lab safely.

    Manager says to send it through an "unattended" tube system. P/P says it needs to be attended at all times with responsibility for proper transport falling on the originating unit. A disagreement about transport of the blood ensues.

    I'd like to know how long the disagreement unnecessarily prevented the blood from getting to the patient. If the manager was involved because the GI lab had called saying they needed it NOW, someone (maybe even the manager) should have grabbed the blood and paperwork and run it down to the lab! Problem solved.
  6. by   elfinM
    Mananger and charge took pt to gi lab. passing blood bank on the way, however floor nurse told them to tube it to floor. NO time was lost to this disagreement as an RN walked the blood to the gi lab! Patient safety was the important point, as with the blood being able to be removed by anyone, sent to wrong floor, or getting lost in tube system, there was more harm possible to the pt. RN caring for pt remained on the floor.
  7. by   elfinM
    More info. Pt was on floor, manager and charge rn took pt off floor BEFORE said unit arrived.
  8. by   SuesquatchRN
    Blood goes with a human. Period.
  9. by   elfinM
    No issue that pt needed blood. No issue it needed to be done right then. Issue is nurse manager talking to rn who voiced what they would do, and no blame on the RN that ACTUALLY made the choice to not listen to manager and follow protocol! Should the two rn's be held accountable for the choice of the RN taking care of the pt. Do we no longer ask our co workers what they would do?
  10. by   systoly
    So this is not about pt safety or safe transport of blood, but rather about interfering with chain of comand (as I'm sure the manager would put it ). I believe a senior nurse always has the duty and obligation to mentor and educate a junior nurse. I also believe a prudent manager would look at the situation and device a workable plan for the future, rather than looking for blame.
  11. by   imintrouble
    Whenever there is a lapse in procedure, there is the potential for disaster.
    Policies are created to ensure the safety of the pt.
    I'm not advocating mindless adherance to policy, when there is an emergency, but that doesn't seem to be the case here.
  12. by   netglow
    Unfortunately, if a NM ever told me to do something I knew was not necessary and legally problematic for me, and then also said to me, "I'll take the heat for it" I probably wouldn't do it.

    Sucks that you cannot trust people who have given you their word. Too many today don't know what means, and never intend to abide by the promise they've made. I mean unless I had many, many years professional working experience with the guy.
  13. by   TrafalgarRN
    Did you say you guys tube blood through the pneumatic system? Are there no checks between the blood bank tech and the person picking up the blood? As to who was right; i would say whoever was following the written policy and procedure. As for tubing the blood ; i have never heard about such a system and as part of a Quality council i would be against that...blood needs hand over from one human to another.
  14. by   maelstrom143
    The nurses who voiced an objection to tubing the blood unsecured were correct and the mgr wanting to overlook protocol would be the one in hot water if push comes to shove. Neither the nurse following protocol nor those supporting her should have been called to account for doing the right thing. It is not personal, it is just the right thing and the manager should know this, otherwise why did he/she become manager?
    We use tube systems and have a lock whereby we must unlock the system when it alerts us to the arrival of blood. If it has to be taken elsewhere after its arrival on the floor, the blood would have to be manually taken and handed off or hung as needed.
    No one can practice under another nurse's license and saying, "I will take the heat for it" will not cover the nurse if an issue arises.
    Your manager was wrong.