Angry Nurse

Nurses Relations

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I am wondering if this has happened to any of you.... I got "talked to" by my Assistant Nurse Manager (charge nurse) because of an incident with a patient. My patient asked for some water, and I went to get it, but on the way to the kitchen, got stopped by another family member stating my one of my other patients had CP. After 30 minutes, I took my patient her water, only to find out her son called community relations saying that his mother was ignored. I apologized, saying that we were short staffed that day, that I had an emergency to attend to. He said there was no excuse for his mother not getting water. Anyway, I got "talked to" because I was not supposed to tell patients and family members that we are short staffed. What am I supposed to tell them, that I a retard? Why do they think that nurses should take all the blame? What do you think?

HI, I totally understand where you are coming from. It is very frustrating when we can't get to our patient's needs as soon as possible. It might not be okay to tell patient's and their families that we were short staffed but sometimes I wonder if you make them aware of what is going on in the hospitals that they might have some influence. If they are aware of short staffing problems they should start getting concerned and they need to take an effort and start writing letters to the hospital administration to let them know of the concerns of patients not being taken care of like they should be. It might have some influence on the hospital. I feel community invovlement could make a difference.

Originally posted by goldilocksrn:

I am wondering if this has happened to any of you.... I got "talked to" by my Assistant Nurse Manager (charge nurse) because of an incident with a patient. My patient asked for some water, and I went to get it, but on the way to the kitchen, got stopped by another family member stating my one of my other patients had CP. After 30 minutes, I took my patient her water, only to find out her son called community relations saying that his mother was ignored. I apologized, saying that we were short staffed that day, that I had an emergency to attend to. He said there was no excuse for his mother not getting water. Anyway, I got "talked to" because I was not supposed to tell patients and family members that we are short staffed. What am I supposed to tell them, that I a retard? Why do they think that nurses should take all the blame? What do you think?

Originally posted by goldilocksrn:

I am wondering if this has happened to any of you.... I got "talked to" by my Assistant Nurse Manager (charge nurse) because of an incident with a patient. My patient asked for some water, and I went to get it, but on the way to the kitchen, got stopped by another family member stating my one of my other patients had CP. After 30 minutes, I took my patient her water, only to find out her son called community relations saying that his mother was ignored. I apologized, saying that we were short staffed that day, that I had an emergency to attend to. He said there was no excuse for his mother not getting water. Anyway, I got "talked to" because I was not supposed to tell patients and family members that we are short staffed. What am I supposed to tell them, that I a retard? Why do they think that nurses should take all the blame? What do you think?

I would like to respond to this problem, because I feel that it reaches other issues that nurses need to deal with in addition to the nursing shortage.

Although I sympathize with your situation, fueling the patient's "fire" is counterproductive. The nursing shortage has been widely publicized, yet, we continue to deal with it in less than effective ways. Complaining to patients about it will only achieve minimal results- most of them will not be able to assist us with this problem.

This is something we're going to have to deal with ourselves.

Unfortunately, nurses are not educated and socialized as part of a dominant professional culture, as I was in law school. No lawyer I know would tolerate the disrespect for their authority that most staff nurses put up with everyday. Let's face it, we are still predominantly a women's profession and acting authoritatively just isn't a part of our nature. We don't demand that people respect our authority when they are admitted. That is saved for the physician, and we are second-class. I think that once we begin to behave as authority figures within our institutions, we will generate the respect that the profession deserves. And nurse managers had better start to support that if they expect to keep their units staffed AT ALL. We need to let people know what OUR expectations of them are.

Don't be afraid of asserting yourself, there is no excuse for the rude comments and actions of this patient's family. Try stating THAT to them next time, and then, kindly direct them to get their own water from now on. Good Luck!

moOHIO

Hope you all had a great TG. I should be on the treadmill as we speak. Have to put my 2 cents worth in. I think incident reports with copies to everyone, including maybe the Governor, are an excellent idea. The problem is by the end of a shift from hell, most of us can't wait to get our weary bodies out of the door and the thought of spending another half hour doing yet more paper work is about as appealing as a high colonic. If we made out an IR each and every time there was a problem related to understaffing, with copies to everyone, I believe it would leave a very impressive paper trail. And if, at the end of each week, we sent just the NUMBER (the vast number!) of these reports to someone in power, or a bunch of someones, like the hospital administrators, the Governor, 60 minutes, if we made a commitment to do this for as little as a month, we would might even surprise ourselves. There is not a real shortage of nurses as we all know. There is just a shortage of nurses who are willing to subject themselves to the worsening conditions under which we work with no real relief in sight. I think most patients know that hospitals are understaffed. Many are reluctant to use their call lights in a timely manner because they don't want to bother us. It's those squeaky wheels that give us fodder for our burn outs. The ongoing interest and response to the original post sure tells us something, doesn't it? Maybe we'll come up with a real plan. Let's be creative.

Originally posted by goldilocksrn:

I am wondering if this has happened to any of you....

Of course this has happened to most of us! You aren't alone in your frustration and anger. There is a constant balance between providing good patient care and codifying administration. Management vs. the humble worker is an age-old problem in any profession.

My advice to you is that if you are ever in a similar position (and sooner or later you will be), to apologize for not getting back in a timely fashion. I don't believe in offering excuses or reasons. I don't feel that I should have to explain to anyone when I am being pulled in too many directions at the same time. If the "customer" (and let's get real here -- this isn't a "customer" this is a PATIENT), becomes dissatisfied with the "service" they are "purchasing," then they can get their excuses and explanations from the management that put you in that position in the first place! And, if that "explanation" even hints of them suggesting incompetence or lack of support for you, then you need to find a new employer FAST! You don't want to be there if something more serious comes up.

As for you and how you handle it, remember that YOUR first priority is to protect your own license, which is the same thing as giving good patient care. You must prioritize and go to the most critical need at that moment. Consider for a moment the complaint that you'd have received if you had been wandering the hall with ice water instead of tending to the more important matter first! That complaint would have been far worse for you than a "politically incorrect" statement about staffing!

And, finally, if you can't live within the expectations of your facility, find another job. You can walk away knowing that you have your license intact and that you gave good care and made sound nursing judgments. We just don't have to be put-down and misused. It is precisely the "shortage" that allows you to pick and choose your employer. If your nurse manager/management/facility can't treat you with respect, then get out of there FAST!

BobL,

I couldn't disagree with you more. I do believe that a nurse's first obligation is to his/her patient, but the only way to meet that responsibility is to have a reasonable workload.

We can't be SuperNurse and do everything we'd like to when we have to take care of WAY too many patients, and the only way hospitals will improve staffing levels is if PATIENTS complain. The nurses at our hospial in the ICU were demanding more staff for AGES and got nothing. The first patient's family who threatenned a lawsuit (one member of the family happened to be a doctor) and presto, management decided we needed more nurses. Gee, thanks administrators, why didn't we think of that?

Originally posted by fergus51:

BobL,

I couldn't disagree with you more. I do believe that a nurse's first obligation is to his/her patient, but the only way to meet that responsibility is to have a reasonable workload.

We can't be SuperNurse and do everything we'd like to when we have to take care of WAY too many patients, and the only way hospitals will improve staffing levels is if PATIENTS complain. The nurses at our hospial in the ICU were demanding more staff for AGES and got nothing. The first patient's family who threatenned a lawsuit (one member of the family happened to be a doctor) and presto, management decided we needed more nurses. Gee, thanks administrators, why didn't we think of that?

Originally posted by Chellyse66:

I disagree I think as a Nurse (we are not waitresses here)You were right to state the truth about the staffing.IN Florida,In Long Term Care a law was passed making the institutions Post in a visable location Staffing for the Day/night/evening.

Responsibiltiy should lie upon the employer,if you were short staffed the consumer deserves to know that you are.I believe you can go to the ANA website under legislation to view this law.Maybe you could have worded it different....like "I apologize I had another patient needing immediate attention and ancillary staff were unavailable""your family member was not intentionally ignored"

But now way should you carry the burden of blame!!!

About a month ago my mother had to have surgrey. As a CNA,I know the staffing issues.

When I offered to do things for my mother that I felt I could do(get her freah water,help her up in bed,etc. nothing out of

my scope).I had some (well alot of staff) act like I was trying to take their job from them!! I was only trying to help with these simple tasks,so that the staff would not have to tend to them. Now I read these posts and families do not do enough! And I know first hand what goes on and I tried to help.

Gosh what do Nurses want? (Dumb question I guess.)

Originally posted by cinny071:

Originally posted by Chellyse66:

I disagree I think as a Nurse (we are not waitresses here)You were right to state the truth about the staffing.IN Florida,In Long Term Care a law was passed making the institutions Post in a visable location Staffing for the Day/night/evening.

Responsibiltiy should lie upon the employer,if you were short staffed the consumer deserves to know that you are.I believe you can go to the ANA website under legislation to view this law.Maybe you could have worded it different....like "I apologize I had another patient needing immediate attention and ancillary staff were unavailable""your family member was not intentionally ignored"

But now way should you carry the burden of blame!!!

About a month ago my mother had to have surgrey. As a CNA,I know the staffing issues.

When I offered to do things for my mother that I felt I could do(get her freah water,help her up in bed,etc. nothing out of

my scope).I had some (well alot of staff) act like I was trying to take their job from them!! I was only trying to help with these simple tasks,so that the staff would not have to tend to them. Now I read these posts and families do not do enough! And I know first hand what goes on and I tried to help.

Gosh what do Nurses want? (Dumb question I guess.)

Hi. I agree that you should be able to participate in the care of your mother. In fact, I strongly endorse it. Perhaps you informed the staff up front that you are a CNA, and their responses were simply a defense mechanism. They may have felt that you were judging them as being inadequate in their care. There are many other reasons. In rare instances, I have faced this. In my case, I would escort and stay with a family or friend not making anyone aware of my background as a nurse. Nevertheless, my family would blurt out my occupation or someone from the facility would recognize me. I would explain I'm only present to support the patient, and I am willing to assist with basic care anyway I can. Usually, this has worked for me.

Specializes in Critical Care,Recovery, ED.

We have all worked in understaffed conditions and have taken the dissatisfied comments from both managers and patients. (I don't think any RN would refer to a patient as a customer, but I have heard administrators and board members refer to them that way). The real question is how to get adequate staffing? Intellectually I agree that the public is slowly realizing that there is a Nursing shortage but until they are directly affected by it the usual American response is to ignore it. If the the RN doesn't tell the patients who will? By telling them at the point of service (a nice managed care term) it then becomes real for them. It willl not become real to the administaors of health care facilities untill they can no longer replace the RN's that are leaving their facility. And then they will try to replace the RN's with unlicsensed assistive personel.

Originally posted by fergus51:

BobL,

I couldn't disagree with you more. I do believe that a nurse's first obligation is to his/her patient, but the only way to meet that responsibility is to have a reasonable workload. >>

Oh, I think we do agree completely. I have fought too many battles over this kind of thing at one institution or another. I am remembering an incident where I got 'talked to' because a family member complained:

I was working in a long-term care facility, and the only licensed person in the building with 100 patients. One of my patients was vomiting bright red blood with a significant decrease in blood pressure and an increase in pulse, also the pulse-ox was showing a drop in oxygen. Does this spell an emergency to anyone?

While I'm on the phone to the doctor and ambulance, another patient fell. Family came up to the desk to tell me Dad was on the floor while I literally had two phones in my hands, one up to each ear! I said something like, 'I have an emergency, I'll be there as soon as I can,' with the corresponding wail of an ambulance siren in the distance. Duh! Didn't this mean anything to the family? Nope! Their concern was for their Dad, and rightly so! They deserved to have immediate attention, too! But, I couldn't give it. I sent two CMTs to stay with the patient on the floor until the crisis was over.

In the meantime, another family member came up to the desk complaining that I hadn't changed mother's dressing yet.

The next day, I was in trouble because of the family members who had complained about me. You see, admin wasn't interested in saving a patient's life who was bleeding out, unless a family member complained! They weren't interested in me doing the right thing. They were interested in public relations and happy family members.

Not only was I not supported, but I was in trouble, over this unfortunately true situation. Did admin recognize the need for more nurses because of this incident? Nope! I was to blame because I didn't make nice-nice with family members.

Also, I don't believe there is a real shortage. I think there are plenty of nurses and staffing in the community. But, admin all over the country has cut wages and benefits and increased workload so that the quarterly profit, bottom line, is higher. I know of two nurses who left the profession because of this: one is now a manager at a QuikTrip, the other is a line person at a fast food joint.

And, like your observation, nothing changes until it costs the corporations more in lawsuits (and Division of Aging fines) than the potential savings they are forcing on the nurses and patients by the cutbacks.

The community isn't ignorant. They can see that Mom didn't get her ice water, that no one was there to pick Dad up off the floor. And their complaints don't mean anything, either, unless they say the magic word: lawsuit. Unfortunately, that means that the nurse ends up in court, too!

So, I continue to say that the nurse must NOT try to be SuperNurse, as you said. Find a job that is less stressful and where you can practice in good conscience. Otherwise, the nurse is the one who gets blamed for the shortage, for not being in three places at once; and eventually, it's the nurse who pays for the "bean counters." No one nurse can reform health care. And, we aren't organized enough to demand it, either. Until this country recognizes the nurse for the vital role that we play in health care, in wages, staffing, and respect, then our only alternative is to speak by leaving. Well run institutions won't suffer the "shortage" and the ones who don't respect the nursing staff will "wake up" when they can't provide care, gets sued, and the census drops because of it (and it costs them money).

Sorry to clutter the air waves with more of my jammering. But, I did want to mention one more thing.

When I called the Missouri State Board of Nursing and spoke with an attorney there about short-staffing issues a couple of years ago, their position was that the nurse is responsible for the care; and that if a nurse accepts an assignment knowing that she is unable (for whatever reason: staffing, her own limitations, etc.) to provide the necessary care, then that nurse is legally liable! Yes, the institution can be sued, too. But, the nurse, by her acceptance of the assignment, is equally to blame for not providing the necessary care to the patient. That's a tough parameter, and very sobering. We can't blame our institutions when we willingly accept ridiculous assignments. The advice I got from the Board was to refuse to take the assignment. Of course, I said that I'd be fired. Their answer was that I might not have a bad job anymore, but I'd still have my license so I could get another one!

Today we work in a world based on customer service, and staffing issues need to be taken up with the nurse manager, not the patients. We must hide problems concerning staffing issues from our patients, as this can cause anxiety and guilt, which we do not want. It is not any concern of the patient that the unit is short staffed, so we make up another excuse that you attended an emergency or delegate. In your case, you needed to attend to an emergency and you were right. Unfortunately living in a consumer world, creates patients and families that are picky and will complain, but we need to be one step ahead of them.... You were not wrong to say what you did, you just said it to the wrong person.........

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