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.
OK...you WERE definitely thrown to the wolves on that one...give me a freaking break, you knew the Docs would be rounding in 30 minutes, so that is what I would have told them...I have had that happen numerous times, where I just get the lab back and know the Docs will be around shortly, so I wait until they are on the floor...not a big deal and really a professional courtesy, if you ask me. On the other hand, some nurses always operate to cover their own asses and that sounds like what you are expected to do, no matter what a waste of time it is.
I would get off that unit as soon as you can, and I would definitely do whatever you need to do to protect YOURSELF, if you have any lab that is off, no matter what...MAKE THE CALL. You are working in a cut-throat unit, at least that one charge nurse certainly is...she should have backed you up, because to wait for a Doc to round is NOT a big deal in the situation you described. You knew what was going on and you asked ALL the right questions, now you know you have to cover your ass. Really sucks. You deserve to be angry and you were being responsible...you knew the lab was off... I can't fault you for anything. I'm sorry that happened to you. If there is backlash with this situation, be sure to be your own best advocate, don't give in to being bullied!! Hang in there...stay tough! DO NOT over apologize, just explain your thought process and you will be fine.
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.
lol.
but i was a cocktail waitress for 15 years before i was a nurse. *grin*
my bartenders never showed the blatant lack of support for me this charge nurse did.
and when customers ticked me off, i could clock them over the head w/ my tray.
*just kidding*
my sense of humour is a bit twisted after the past couple days.
The charge nurse should not have lied stating she didn't know about the lab. And she should not have made a public scene. But it was not her responsibility in the first place to make the call. The responsibility for your patient lies with you. You should have called the doctor. We can't always use the nursing judgement argument anymore with all the JCAHO regs. that are killing us and the docs now. If you were unsure if you should call the doctor, then you should have specifically asked the charge nurse "Do you think I should call the doctor right now with this lab result?" Since you did not do that, it sounds like the charge felt you were merely passing on info - such as a report to the charge on how your patients were doing - and the charge assumed you had everything covered already. Since you did not tell her that you needed her to make the call, you did not pass the info on and relinquish responsibility for making the call you cannot document that you told the charge and expect to cover your butt for your mistake. If you felt that you were justified in not calling because your patient was stable and many patients don't get transfused anymore due to various blood issues, then you should have charted your reasons and stood up for them. By blaming the charge nurse, you seem to demonstrate that you were not entirely certain that you did the right thing. You made an error in judgement this time. I bet that you won't make this same mistake again. Anytime you are going to lay the responsibility on someone else's shoulders, you must be absolutely certain that you are correct in YOUR actions and that you are certain that the "blamee" is wrong in their actions.
It would be easy to leave the unit and go elsewhere. And in that new place, you have a large chance of someone else who is as bad or worse than this charge nurse. Few charge nurses these days will protect their staff. Yes, I believe that they should - unless the staff is absolutely WRONG - but with so many grey areas, they SHOULD be willing to go the distance. Unfortunately most charge nurses and managers (and everyone else) are no longer willing to put their butts in the line of fire anymore. You should never expect that another nurse is going to back you up. People are almost always going to save themselves - even if it means hanging you out to dry. It behooves you to learn quickly and to CYA without depending on others. Perhaps you can be the one person to show this charge what it means to give support to the staff when they need it.
Apologising just states that u feel badly that a incident occurs,it promotes conversation,deflates a possible confrontation and generally shows that u r an adult and professional. Leaving a unit after one issue shows that u can not deal with conflict,can not resolve issues,and generally run from problems. I just think that problem solving is the answer,non confrontational ways r generally the best. She did make a mistake,yes she got screwed by her charge nurse,but two wrongs have never made a right. We are professionals.lets act like it,even if those in charge may not at times. And anyhow,everyone can have a bad day and make mistakes. Human we r and always will be. ....
OK...you WERE definitely thrown to the wolves on that one...give me a freaking break, you knew the Docs would be rounding in 30 minutes, so that is what I would have told them...I have had that happen numerous times, where I just get the lab back and know the Docs will be around shortly, so I wait until they are on the floor...not a big deal and really a professional courtesy, if you ask me. On the other hand, some nurses always operate to cover their own asses and that sounds like what you are expected to do, no matter what a waste of time it is.
I would get off that unit as soon as you can, and I would definitely do whatever you need to do to protect YOURSELF, if you have any lab that is off, no matter what...MAKE THE CALL. You are working in a cut-throat unit, at least that one charge nurse certainly is...she should have backed you up, because to wait for a Doc to round is NOT a big deal in the situation you described. You knew what was going on and you asked ALL the right questions, now you know you have to cover your ass. Really sucks. You deserve to be angry and you were being responsible...you knew the lab was off... I can't fault you for anything. I'm sorry that happened to you. If there is backlash with this situation, be sure to be your own best advocate, don't give in to being bullied!! Hang in there...stay tough! DO NOT over apologize, just explain your thought process and you will be fine.
Specializes in ER, Occupational Health, Cardiology.
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.
Exactly correct! I would add, to always, always, trust your gut instinct. If there is the slightest doubt in your mind that something might not be right, go with what your instinct is telling you. You can always be fussed at for calling, but that beats being fussed at and reprimanded for NOT calling. Everybody is right about that Charge Nurse-she shouldn't be in that position if she couldn't have at least asked you to run it by the MD!
So..how long was the delay in notifying the PA? If it was just a matter of minutes until they were up on the floor, I'm lost as to what's the problem.
Sometimes with PAs it's like kicking the dog. They sort of feel like they should be on the same status as an MD, they are on the bottom rung of primary care providers, so they pick on nurses to build up their egos. Like I say, it's like kicking the dog.
I'm not a nurse yet, but I can tell you this kind of "cattiness" happens in every profession! Try hard not to let this CN get to you--even if you have to force yourself to not obsess (I know, it's tough). But you've learned a lesson from this person and situation. Ultimately you'll be a better nurse.
Write up the Resident for rudeness and disrespect and demand an apology. Let your Charge and her higher-up know you know she lied.
Your actions were reasonable, given the short 30 minute time frame that this issue was not "addressed", but even so, you did tell the Charge Nurse! She is making you a scapegoat for her "error", which was not really an error, as nothing happened bad (did it?) and it was only a freaking half hour, for God's sake!!!! Lots of times, docs don't even answer a page that fast. And if one had answered and was going off duty, he'd have probably just told you to tell the oncoming one! Is your Charge the one who's supposed to call docs? Why did she not? Any witnesses to you notifying her? In the future, always try to have someone witness everything just so stuff like this can't blow up in your face.
Actually, disregard the first paragraph. I said that because I'm in a bad mood. but do courteously, verbally let the Res and Charge, maybe their bosses, too, know that you do not appreciate the Res having a fit or the Charge lying. Take it higher if you don't get satisfactory responses. Keep a written record of the whole event. How fast are you required to let the Res know about problems?
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!
deeDawntee, RN
1,579 Posts
OK...you WERE definitely thrown to the wolves on that one...give me a freaking break, you knew the Docs would be rounding in 30 minutes, so that is what I would have told them...I have had that happen numerous times, where I just get the lab back and know the Docs will be around shortly, so I wait until they are on the floor...not a big deal and really a professional courtesy, if you ask me. On the other hand, some nurses always operate to cover their own asses and that sounds like what you are expected to do, no matter what a waste of time it is.
I would get off that unit as soon as you can, and I would definitely do whatever you need to do to protect YOURSELF, if you have any lab that is off, no matter what...MAKE THE CALL. You are working in a cut-throat unit, at least that one charge nurse certainly is...she should have backed you up, because to wait for a Doc to round is NOT a big deal in the situation you described. You knew what was going on and you asked ALL the right questions, now you know you have to cover your ass. Really sucks. You deserve to be angry and you were being responsible...you knew the lab was off... I can't fault you for anything. I'm sorry that happened to you. If there is backlash with this situation, be sure to be your own best advocate, don't give in to being bullied!! Hang in there...stay tough! DO NOT over apologize, just explain your thought process and you will be fine.