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I have been working on my unit since May of last year. At times I feel like I have everything together, and at times I feel like I have no freaking clue what I should do. I would like to think that I have a clue more often than I do not, and I would also like to think that I have the guts to know when to admit that I need to ask for help, knowledge, or other resources.

The situation: Labs drawn on pt. at 445. Hgb came back shortly after 6am reading 7.6. I realize that this Hgb is low. Really low, however the pt had surgery the day before, so one would expect the Hgb to be low, he had a HUGE hematoma evacuated, and he was oxygenating beautifully, and was in no distress whatsoever.

I mentioned his Hgb to my charge nurse at 0615 when it came back. I knew it was low, however, I have had pts with hgb lower than that, that have not been transfused. Considering what this pt had been through over the past 24 hours, one would expect the Hgb to be low. With the Hgb cooming back at 0615 and change of shift for residents and PAs happening at 0630, I did not page the resident on call.

As things turned out, the PA taking care of the patient threw a fit, and demanded to know why the resident wasn't called. The charge nurse claimed that I had never informed her of the lab. When I confroted the charge, she said that I "should have known better" and that it wasn't her job to "save my ass". I asked her why she would rather jeapordize patient safety than throw one of her nurses under the bus. She walked away from me.

I will freely admit ultimate responsibility for pt care. However, if something is mentioned to a charge nurse, and they know that the staff nurse is about to make a mistake, do they or do they not have a responsiblity to step in?

As I said. Maybe I should have called the resident with the lab result. However, it was not a critical low, and I have had several pts with the same Hgb that have NOT been transfused. PAs were going to be on the floor within 30 minutes. However, I feel like this charge nurse saw me making a "mistake" and let me make this "mistake" and then called me onto the carpet in front of the enitire staff. (In the middle of the main hall, during morning report, with god and everybody present)

I freely welcome feedback. You have been doing this a lot longer than I have in most cases.

Am I wrong to feel that my charge nurse should have my back?

Thanks in advance. I freely welcome all feedback, even if you want to tell me I am completely wrong.

I was just blindsided.

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What was his Hg before going to surgery?

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Specializes in Jack of all trades, and still learning.

Of course the senior should have known to report the findings to the doctor. That is why she is a senior. And I figure that is why she walked away from you, because she knew she was also responsible. Also that is why she claimed that you had not told her I think. And she also should have been monitoring the situation if she too knew that there was a risk of a low haemoglobin.

The third person who should carry some responsibilty is the resident. If he was aware that this patient had a risk of having a low haemoglobin then he should have been monitoring the situation as well.

How do you guys find out the result? By computer? Or do the lab ring?

Sure you didn't ring the resident, but you told your boss. So information was passed up the ladder. It is a shame this woman hasn't got the 'guts' to admit her mistake. Have you recorded that you told the charge nurse the information in the patients notes? Also, keep a personal record of the incident.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

I would think about transfering to a different unit, that charge nurse is worthless and dangerous to you! She's a bareface liar, and a coward!!!! :madface:

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Specializes in Emergency.

If I had to work with a charge like that I would definitely report her. Also, as a new nurse myself, I often have to run things by other nurses to make sure I am doing the right thing, or get a second opinion. Any time our pt has a critical value the lab calls us and we must notify the MD (the exception would be something like a heparin drip where we treat as per protocol for a high aptt). I don't really know the situation here, but I would rather have a MD be mad at me for calling, then mad for not calling. You are the pts voice and responsible for their care. I have had several instances where I had to call an MD and they get upset with me, but I stick up for myself and document that they were informed whether they do anything about my info or not. Your charge should have been much more helpful to you, and the fact that she denied that you went to her with this is really wrong. As nurses we are expected to be accountable, and she was not. She was also very unprofessional in the fact that she "reprimanded" you publicly. This is a discussion that should have definitely been private.

It makes me very unhappy when I hear how nurses treat each other in the workplace. We are all working toward a common goal :to give great care to the pt in need, and it makes me sick that in some places there is so much pettiness and vindictiveness instead of teamwork. I guess I am lucky that I work in a hospital that emphasizes that team attitude, and quickly gets rid of the "toxic" employees. If I were in your shoes, I would probably go to my manager, explain what happened, and if you don't get support, find another job.

Amy

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You should definitely try and work in an environment where you can ask questions. The patient is ultimately in jeopardy. As many nurses say...Intuition and Communication is key.

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I would have notified the doc of at HGB that low. Your charge should have told you to notify the doc when you took it to her. She has more experience which is why she is in that position. Unfortunuately there are some people out there, no matter what the profession, that will leave you out there on your own when a mistake is made. They are scum. I learned very early that if I am in doubt, I am calling the doc, even if he gets mad because he got woken up.

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If I had to work with a charge like that I would definitely report her. Also, as a new nurse myself, I often have to run things by other nurses to make sure I am doing the right thing, or get a second opinion. Any time our pt has a critical value the lab calls us and we must notify the MD (the exception would be something like a heparin drip where we treat as per protocol for a high aptt). I don't really know the situation here, but I would rather have a MD be mad at me for calling, then mad for not calling. You are the pts voice and responsible for their care. I have had several instances where I had to call an MD and they get upset with me, but I stick up for myself and document that they were informed whether they do anything about my info or not. Your charge should have been much more helpful to you, and the fact that she denied that you went to her with this is really wrong. As nurses we are expected to be accountable, and she was not. She was also very unprofessional in the fact that she "reprimanded" you publicly. This is a discussion that should have definitely been private.

It makes me very unhappy when I hear how nurses treat each other in the workplace. We are all working toward a common goal :to give great care to the pt in need, and it makes me sick that in some places there is so much pettiness and vindictiveness instead of teamwork. I guess I am lucky that I work in a hospital that emphasizes that team attitude, and quickly gets rid of the "toxic" employees. If I were in your shoes, I would probably go to my manager, explain what happened, and if you don't get support, find another job.

Amy

the charge nurse "justified" the situation by saying that I should have known better. I agree. However, if i am unsure about something, who else shoud I go to, besides the charge nurse. I'm confused, I'm uncertain, andI can guarantee that I will not be proactive at treating a situation.

I want to quit.

I don't want to be a nurse when it is such a cat eat cat situation.

I'm done.

I'll be a cocktail waitress, thankyouverymuch.

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Documentation is your best friend... not the Charge Nurse. Chalk it up as a lesson learned. If in doubt at all, call and document the outcome of the call ie: 'No new orders' or 'MD aware'. The Charge Nurse in this case appears to be a useless appendage. I would consider an 'end around run' anytime this CN is on.

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Specializes in Trauma ICU,ER,ACLS/BLS instructor.

1) Depending on the way ur floor runs, most chanrge nurses are just coordinators and resourse people. I am sure at that time of the day her plate was full . Not defending her cause she sounds like a brat,but she filed the info and that was it. Then she just passed the puck to u when someone got mad.(she should haved defended u )

2) I might have done the same considering the time and someone was coming in shortly,if I was going to be there to report it to the PA. You seem to have had a handle on ur pt and there hemodynamics,u did ok.

3) Next time you see this PA,go to them,apologise and state why u thought it was ok to wait. Ask if there was something u did not know that made it emergent. Also,go to this charge nurse privately and do the same. It makes u look professional and willing to learn from ur mistakes.

4) It is always the nurses ultimate responsibility to report labs and such. Do not depend on ur charge nurse,remember they have the whole floor to remember. A good fyi is to know if ur pt has been typed and crossed and if blood is available. If they need a new sample for txc ,then do it for the next shift. This way it looks as if u have done everything to prepare for any new orders.

5)Do not quit,this is one small bump in a long road ahead. We all make mistakes and we all piss people off. Sometimes they have just had a bad few hours and take it out on whoever. That PA may have just gotton reamed by someone else. Put ur chin up and start fresh! Good luck!

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Specializes in ICU.

i want to quit.

i don't want to be a nurse when it is such a cat eat cat situation.

i'm done.

i'll be a cocktail waitress, thankyouverymuch.

so you think that is the answer?............and that being a cocktail waitress is gonna be any easier with non-paying customers, customers that don't tip....etc.

tsk, tsk......:trout: you get into this profession because you should want to make a difference in someone's life. there are back-stabbers and people worried about covering their butts in every job.

if you stick it out then one day you'll be the charge nurse and another nurse will come to you and ask the very same question of you. now you know what it is like on the other side you won't make the same mistake your charge nurse did.

life is a journey........you can either learn from it and drive it towards your desires, or just ride the bus and let it take you where it wants to.

one thing is for sure............40 years down the road you'll end up somewhere, the question is, will it be where you want to be. if you let something like this stop you then maybe you ought to just get a ticket and find a seat..............as for me i'd rather be driving my own bus.

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The HGB falls into one of those gray areas. It is not urgent enough to call a rapid response, but not something to ignore. What to do?

As a new nurse, one of the hardest judgement issues had to do with issues like that. I think you were looking to your charge nurse for help deciding, and she let you down.

This is where text paging a doc is helpful. You relay the message, document, and follow up as needed.

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