Accepting or not accepting the client which jeopardizes the license the most?

Roland · Jul 16, 2005

As I stated it turned out that the arrhythmia was a problem with the non capturing pacemaker (or at least the way the patient was lying in bed). The client was an 80 something year old, but I don't know his/her history or precipitating condition. She was called by telemetry regarding the arrhythmia, and it is not uncommon on her medical/surg. floor to have patients that are monitored in this fashion (although it is the exception).

She probably should have asked the more experienced nurses for help instead of her classmates. However, she is somewhat uncomfortable with them at this point. She said that she has had several occassions where they completely ignored her (as if she were a ghost) despite asking a question or making a comment.

Is anyone else having an issue with this story?? I work in a level 1 trauma center...however this nurse is working on a med/surg trauma floor? A patient having "emergent arrhythmias" on a med/surg floor? How do they know the patient was having arrhythmias?? med/surg floors aren't monitored...if it was a patient with emergent arrhythmias that she had to monitor, you'd think 1.the patient would have to be on a monitor..and 2.If it was a non-capturing pacemaker..the patient would be in the ICU or a step-down type unit at the very least and have a transcutaneous pacer, or a transvenous floated in anticipation for a pacer replacement...It just doesn't make sense that this type of patient would be on any kind of med-surg floor unless they were a DNR, which would probably still not qualify since it is a non-capturing pacer reversible situation...I'm not saying that there aren't nursing floors that aren't stressful with higher acuity patients and that new nurses don't get dumped on, but some of the patient care situations described sound a little unrealistic to be on a med-surg trauma unit...

barefootlady, ADN, RN · Jul 16, 2005

I agree with Tweety and others who posted here. Your wife was dumped on, should have refused to take the new admit, especially since the experienced nurses had less patients. She should file an incident report, talk with her supervisor regarding fair assignment of admissions, and look for another department to transfer to if she does not want to quit this facility. I wish her luck. I would make it clear to the HN the behavior of the more experienced nurses is bullying, insensative, and unnecessary for maintaining a therpeautic working mileau. Don't expect changes, sounds like this is business as usual on this unit. and the HN knows it.

jdampson · Jul 21, 2005

i work in an er where no patient can be turned away. i have had to nurse over 15 acutely ill patients in the emergency room before. i think this is mere politics because being a professional, i often wonder the quality of care i offer patients under these conditions, nb. i work in a teaching hospital!

lossforimagination · Jul 22, 2005

your wife needs to grow some b***s
pardon the language.
when the 5th admit was being assingned... she should have just said
'there's no way that i'm taking a 5th pt when some here have only 3...nope, it aint gonna happen. you can call the supervisor, the fire department or jesse jackson, i don't care, but it aint gonna happen!'
these 'seasoned nurses' are middle school bullys with gray hair. put your foot down early and they'll stop messing with you.
what's the worse thing that could have happened. they'd get all pissy???? they're already pissy and have been for years. call em on it i say!!! there are over 1000 other jobs out there if you want to leave... they're stuck there bc they don't want to start all over.

Exactly! Sometimes you have to stand your ground and calmly get right in someone's face and say "absolutely not". I realize that can be hard for a new grad because you aren't necessarily sure what is reasonable and what isn't.

Sounds to me the entire floor or hospital is unreasonable; however. None of those sound like Med/surg patients to me. In which case, I'd get the hell out of there fast. I'd be afraid for my license (not for refusing a patient), but because of the acuity and poor staffing on an alledged med/surg floor. Those patients all sound like they should be in ICU!

pie123 · Jul 22, 2005

your wife needs to grow some b***s
pardon the language.
when the 5th admit was being assingned... she should have just said
'there's no way that i'm taking a 5th pt when some here have only 3...nope, it aint gonna happen. you can call the supervisor, the fire department or jesse jackson, i don't care, but it aint gonna happen!'
these 'seasoned nurses' are middle school bullys with gray hair. put your foot down early and they'll stop messing with you.
what's the worse thing that could have happened. they'd get all pissy???? they're already pissy and have been for years. call em on it i say!!! there are over 1000 other jobs out there if you want to leave... they're stuck there bc they don't want to start all over.

Your post was FUNNY!!!!!!!!!!!! But I agree!!!

NYNURSE8000 · Jul 22, 2005

I started back in January working on IMCU... CRAZY....especially for a new grad. Anyone know how to read tele strips??? Anyway... I was hired and told the nurse/pt ratio was about a 4... YEAH RIGHT.... I WISH!!!! We never only have four. Most of the time it's 5. It's becoming 6.... b/c management was so cheap, they decided to discontinue all of the agency contracts!!!!! HELLO??? Are they nuts??? Anyway, my point is this... I only have 7mo. experience. Some nights with 6 pts, I'm the first one done and then other nights, I have 5 pts and I'm the last one done... it all depends on acuity, whether or not your pts are DM accu checks/how many times they push the call light/and how many damn 0600 meds they have!!!!!!! I hate 0600 meds...they can totally put you behind. I used to work days, during orientation and I'm working nights and loving it!!!!!!!!! I actually have a little sanity left on my way home. And I totally agree about you being supportive of her... continue doing it!!! That's awesome that you took the initiative to ask other nurses!

And tell her that she worked too, too hard for her license, to lose it b/c she has a quiet voice. Speak up!! There are soooo many jobs out there... MOVE ONWARD if they give you the boot! :coollook:

sjukskoterska · Jul 22, 2005

I had a discussion with my wife this morning concerning a situation she faced last night. She is a relatively new nurse with six months RN experience on a med/surg trauma floor at a large urban hospital. Last night they gave her four initial patients two of which were heavy loads with hourly meds, and barrier isolation. About three hours into her shift she was already slammed running late on two of her meds, several assessments, and a Q4h accucheck at which time they added a fifth new admission to her load. Note, that there were several much more experienced nurses on the shift who only had three clients, and even those three were of the easier non isolation variety. In the morning she was chastised during report for running late on her accuchecks and meds. She was also told that she needed to spend more time reading the patient histories (she didn't even have time to take a lunch or break during her 12 hour, which turned into a 13.5 hour shift). Although, she did not feel that she could safely take a fifth client she said that she had been taught in nursing school that her license (not just her job) could be in jeopardy for refusing an assignment under the doctrine of patient abandonment (she even detailed the scenario they had discussed in nursing school of new ICU nurse losing her license for refusing to take a third client during a mass trauma situation). I told her that our nursing instructors had taught us just the opposite, specifically that your license was most endangered by agreeing to a task or assignement that you knew (or should know) exceeded your abilities to safely undertake. Which interpretation (if either) if the most accurate or does it vary from state to state?

I think your wife was a victim of dumping. Two isolation patients plus the other two that sounded fairly heavy is quite a load for someone in their first year. It's tough working with older, seasoned nurses. I have had to deal with battle-axes and it's very stressful and difficult to assert yourself. As I understand it, you have abandoned your patient only after you have accepted your patient. She would have done well to not accept the patient. I am disappointed with her supervisor for chastizing her for getting out late. Looking at the patient loads that were unequally ditributed in both number and acuity, the charge nurse who made the assignments deserved the talking to. If this is the mangament style of this facility, it may do well to consider swtching departments or even hospitals. As to delegating and asking for help - that is something that nurses are not good at. We can do it all, all by ourselves....

Cricket02 · Jul 22, 2005

Hi Roland, Your wife should not have been expected to handle the patient load that she was assigned. The more experienced nurses were taking advantage of her inexperience and loading her to the max. It is my understanding of the law that applies to n urse's licensure, if the assignment is out of the range of safety for both the nurse and the patients, she should refuse to take the assignment. It is not abandonment of patients if she refuses an unsafe assignment. I've been an RN for over 25 years, and I would never have expected a new nurse to take such a patient load. Those other nurses or the nursing supervisor that makes the assignment should all be written up. Make sure that she keeps a written record of anything that transpired. It does come in useful in a lot of instances. I've even worn a concealed microphone and taped conversations that are questionable. Although this may sound a little like a knee-jerk reaction, it has saved my license on more than one occasion. Knowing how 'hard' I've become, it would be those other nurses sitting around gossiping that would be taking the isolation patients and the new admits. Your wife is a professional in every sense of the word and she needs to stand up for herself or she will come to hate the profession of nursing and quit altogether. There are good places of employment that have policies in place for patient workload safety. Tell her to not get discouraged, she's got a lot of fellow nurses thinking of her. OK?

I had a discussion with my wife this morning concerning a situation she faced last night. She is a relatively new nurse with six months RN experience on a med/surg trauma floor at a large urban hospital. Last night they gave her four initial patients two of which were heavy loads with hourly meds, and barrier isolation. About three hours into her shift she was already slammed running late on two of her meds, several assessments, and a Q4h accucheck at which time they added a fifth new admission to her load. Note, that there were several much more experienced nurses on the shift who only had three clients, and even those three were of the easier non isolation variety. In the morning she was chastised during report for running late on her accuchecks and meds. She was also told that she needed to spend more time reading the patient histories (she didn't even have time to take a lunch or break during her 12 hour, which turned into a 13.5 hour shift). Although, she did not feel that she could safely take a fifth client she said that she had been taught in nursing school that her license (not just her job) could be in jeopardy for refusing an assignment under the doctrine of patient abandonment (she even detailed the scenario they had discussed in nursing school of new ICU nurse losing her license for refusing to take a third client during a mass trauma situation). I told her that our nursing instructors had taught us just the opposite, specifically that your license was most endangered by agreeing to a task or assignement that you knew (or should know) exceeded your abilities to safely undertake. Which interpretation (if either) if the most accurate or does it vary from state to state?

mari31666 · Jul 27, 2005

since i got to l&d as a new grad i usually get the heavy patient load. supposedly you are supposed to have 2 laboring pts and not more. well a lot of the time they are the pts who are pre-eclamptic on mag sulfate on 15 min checks and hourly i&o and then i'll get another pt who is new admit, fully dilated no paper work pushing and screaming and the room isnt set for delivery cuz our 2 evening techs are always on break, then after that pt delivers the pre eclamptic usually ends up a c/sect and you have to run to the or and thats just great fun, counting bloody laps doing newborn care, baby paperwork, count the instruments, call nursery hook up new suction, count instruments and bloody laps for the second OR count clean pt then give report to nursery nurse, help move pt to strecher then recovery room and give report and hopefully finish your paper work in under 15 mins. come back out of OR then get the next admission and make sure you catch up on the postpartum checks and do peri care of your other pt cuz no one had time cuz they were busy!!!! then you get sent to break and when you get back 45 mins later you get told you have a new admission and oh by the way nurse a & b are going on break so you are now watching 3 or 4 more pts. and you get left by yourself and then all of a sudden triage sends another fully dilated woman who ends up delivering in the hallway because she was pushing and screaming instead of breathing while you and a resident are rushing her to a birthing room (which also isnt set, tech still on break) and when you call for supv you get told there is no one to help so you pray that no one else delivers until their nurse comes back. that is just a small picture of reality that you dont know until after you signed a contract! talk about stress!!!!!!!!11