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.
Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.
If I knew that the PA was going to see the lab for himself within 15 minutes I would have probably not paged him either. It depends on what his Hgb had been running and whether or not it was a major drop from his previous Hgb. If he was hemodynamically stable I think you were okay to wait 15 minutes in reporting to the PA face-to-face. As far as the charge nurse goes that was a bad situation. She should have backed you up. Some charge nurses like to call all the physicians themselves, some like the primary nurse to call the physicians. It just depends on the unit/hospital/nurse. I personally like to call the physician myself so that I can document what I did for my own patient. I think that the best person to alert the MD is the person directly caring for the patient.
Specializes in Community Health, Med-Surg, Home Health.
Your charge nurse should have instructed you to contact the doctor. She should obviously know that you needed some direction, otherwise, you would not have gone to her. With that in mind, I would certainly speak to the provider and apologise, explain how and why you made that decision. Also, keep in mind next time that the next time you see a suspect situation and report it; document who you told. This way, if the fly goes down, they have to also ask the charge nurse. I do feel that the charge nurse should step in when a person approaches them with a problem. They are responsible for delegation, and it would have been a simple thing to say "page Dr. So and So" End of story. Another thing that I learned the hard way...do not assume. Page the powers that be, and let them make the decisions. There may have been other things that the PA was worried about (although, it may be simply that he didn't know for sure, or has his own protocols to follow).
Nurses can be really, really horrible to each other. As long as the charge nurse doesn't write this up, try to escape from this fool's clutches and move away from her.
Dolce, RN
861 Posts
If I knew that the PA was going to see the lab for himself within 15 minutes I would have probably not paged him either. It depends on what his Hgb had been running and whether or not it was a major drop from his previous Hgb. If he was hemodynamically stable I think you were okay to wait 15 minutes in reporting to the PA face-to-face. As far as the charge nurse goes that was a bad situation. She should have backed you up. Some charge nurses like to call all the physicians themselves, some like the primary nurse to call the physicians. It just depends on the unit/hospital/nurse. I personally like to call the physician myself so that I can document what I did for my own patient. I think that the best person to alert the MD is the person directly caring for the patient.