I was in charge yesterday and when I got there at 0700 I was told we would be getting a patient (a GI doc's receptionist) for 3 units of blood and go home. I assigned the patient and told the nurse that the patient had arrived. At 0815 the BB called to say that the blood was ready and I told the nurse. At 0845 BB called back to say the blood hadn't been picked up yet. (they never do this but figured hey she works for the GI doc) I told them the nurse was almost through making her morning med pass and would be there shortly. Now fast forward to 1100.
The tech comes to me and tells me that the lady in room #_____is really pissed and wants to see the charge nurse. I go down there and she is sitting on the bed in her street clothes, madder than h*** because her blood hasn't been started yet, no IV, no breakfast, no lunch, no nothing. I asked her why she hadn't used her call light, she said "why should I you all have known that I was here." I apoligized to her, assured her I would find out what the problem was and that I would get her food, her IV and blood started. Which I did.
Then I called the nurse to the desk. I said what is the problem? She said well I've been so over whelmed with my other 5 patients I haven't had time for her and I figured she'd be here all day anyway so no big deal, also I blame the night shift for not settling her in.
I said
# 1 whenever a patient is assigned to you for any reason you "always" go in the room within the first 30 mins, even if just to stick your head in, and introduce yourself and see if they need anything. If you don't you may someday find that a patient has been dead for hours.
# 2 If you're ever overwhelmed you come to the charge nurse and ask for help. If I can't help I'll find someone who can even if we have to call the supervisor. In this case I would have been able to help you out, no problem. She said she didn't want to ask for help because it would appear she couldn't handle her job. I said no we all need help sometimes (She been an RN about 6-9 months)
#3 the patient herself bears some responsibility for not using her call light. I wouldn't sit in a room for 4 hours waiting for something to happen, she may be somewhat of a marter.
#4 it is not the fault of the night shift. She arrived at 0700 and assigned at that time and the night shift nurses didn't even know she was there. She got really mad "well my preceptor never told me I had to check on patients at the beginning of my shift", well I'm telling you now you need to, no matter what, at least stick your head in the door.
She raised a fuss, called the supervisor, who backed me up, but then the nurse also talked to the other nurses about me making a big deal out of her not seeing a patient for 4 hours. I'm not letting it bother me because I'm right and I think I handled it right, I'm just needing to vent a little.
P.S. I know this GI doc pretty well. Do you think I should mention to him that she had not used her call light in 4 hours and may have acted like a marter or just apoligize for what happened? Thanks!
If I needed 3 units of blood I'd be having trouble staying awake, thinking clearly, etc. I don't think we need to be pointing fingers here, esp. at the patient. It IS possible the patient fell asleep & then when she woke up realized it'd been 4 hrs & then asked questions.......the patient is not expected to manage her OWN care.
I agree that no patient should go four hours without seeing the nurse. However--as the charge nurse do you not make rounds on all of your patients. Making rounds first thing in the morning is a must. Granted there are days that all the charge nurse may do is put out fires--but you didnt mention being especially busy. New nurses are often in need of encouragement not scolding.
I'm thinking that perhaps this new nurse isn't ready for a full assignment yet? Yes she didn't do her job correctly and yes she copped an attitude, but why is she made to feel defensive?? I'm sure this isn't the first mistake she's made due to a fulll assignment and lack of experience.
I think it's setting new people up for failure when they don't have the experience to be able to handle a full assignment yet they are given one anyway just because they graduated an accredited school and passed the boards.
I think you handled the situation correctly. However, I wouldn't blame the patient for not using the call light. Yes, she should of, but the responsibility still lies with the staff who didn't assess the or even eyeballed the pt.
The nurse should not blame her shortcomings on her preceptor either. Both are license RN's regardless of the legth of time nursing. I think you learn that you have to eyeball your pt's before even taking report while still in school. In addition, common sense will tell you that these are very sick people and their status can change in a heartbeat. I hope the nurse on your floor is learning from her mistakes and listening to the experiences & advice of the experienced nurses on her floor.
If I needed 3 units of blood I'd be having trouble staying awake, thinking clearly, etc. I don't think we need to be pointing fingers here, esp. at the patient. It IS possible the patient fell asleep & then when she woke up realized it'd been 4 hrs & then asked questions.......the patient is not expected to manage her OWN care.
That is true. The patient could have been much more ill than was stated and the situation could have been much worse. I understand that some feel the patient was to blame, but I personally feel most of the responsibility falls at on the nurses.
I too think that you did the right thing, Dutchgirl. This new RN has a lot to learn IMO. One thing that stood out was she would not accept any of the blame....it was someone else's fault. As mentioned already, checking your patients at the beginning of the shift is just plain common sense. I learned that in nursing 101. Keep up the good responsible work, Dutchgirl!!:) :)
I'm only answering because evidently you want this thread to continue. It doesn't bother me. It feels good to vent about things.
You all may or may not know that I am taking a 6 weeks extended LOA. I am sick of the patients who complain all the time, the rude families, the nurses who refuse to do their share, the techs with attitude. I've been doing this since 1981 and it's time for a change of scenery.
I don't understand what is the big deal with the blood bank calling twice?
They NEVER EVER call but once. The BB could care less how long it takes before a nurse comes to get the blood. Sometimes it's several hours after blood is ready before I am able to start blood. The difference is that I keep in touch with the patient and let the patient know what's going on and when the blood will be started. Patients are usually very accomodating when you keep them infomed.
She had the patient on either side of the forgotten patients room. How hard is it to stick your head in the door as you go by. Her excuse to the supervisor was "well she was going to have to be here all day anyway so I thought whats the big deal? Please.
Being in charge I cannot possibly know who is overwhelmed unless they let me know. How am I to know she didn't start the blood? BB didn't call back? Patient didn't complain? RN didn't ask for help?
We are professionals and I cannot hold their hands. They have to come and ask me for help. I was asked for help at least 8 times today by nurses who have been RN's for years. There's no shame in that. We all help each other out.
I do not make out the assignment for the day shift. The nurses are expected to take a full load. If they can't cut it they ask for help.
I understand about talking to her in another room but I had no clue that she would blow. I'm not a mind reader. Sorry, none of us is perfect and yes I did learn not ask what the problem is at the desk ever again.
It happened again yesterday with a tech. I pulled her aside. What did she do? Ran right out in the hall raising her voice. Sometimes you can't win for losing. I simply asked her to help me move a bed into another room. She said "no". I tried to talk to her about it in an empty room, she raised her voice in the hall "I'm a tech not a damm moving man"! Being in charge is very challenging. I think I deserve combat pay! If you haven't been in my shoes please don't judge me.
I don't understand what is the big deal with the blood bank calling twice?
If you haven't been in my shoes please don't judge me.
No judgements, just opinions. :)
When the BB called the 2nd time to tell you the blood hadn't been picked up you said it would be picked up short after morning med pass. Therein comes your accountability in this situation. IN MY OPINION.
But trust me on this you have my deepest regard because as I've said I've gone running and screaming from charge nurse positions for exactly the things you describe. You sincerely deserve combat pay when your a charge nurse in a busy med-surg unit. Been there and done that and won't do it again.
Things may be differently where you work. As a charge nurse I am only aware of what the staff brings to my attention. I can't know 37 patients and 12 nurses and techs comings and goings.New nurses know when I am in charge to come to me with problems and difficulties and I will help gladly. But I'm not following around a nurse with six to nine months experience to check on him/her. He/she is off orientation with a license of their own. Maybe you, or where you work, the charge nurse role is different. But it's not like that where I work.
Yes of course your opinion is accepted, you have offered it politely and I can politely disagree.
I think you handled the situation correctly. However, I wouldn't blame the patient for not using the call light. Yes, she should of, but the responsibility still lies with the staff who didn't assess the or even eyeballed the pt. The nurse should not blame her shortcomings on her preceptor either. Both are license RN's regardless of the legth of time nursing. I think you learn that you have to eyeball your pt's before even taking report while still in school. In addition, common sense will tell you that these are very sick people and their status can change in a heartbeat. I hope the nurse on your floor is learning from her mistakes and listening to the experiences & advice of the experienced nurses on her floor.
I too think that you did the right thing, Dutchgirl. This new RN has a lot to learn IMO. One thing that stood out was she would not accept any of the blame....it was someone else's fault. As mentioned already, checking your patients at the beginning of the shift is just plain common sense. I learned that in nursing 101. Keep up the good responsible work, Dutchgirl!!:) :)
Thank you for understanding. Tweety, you've stood in my shoes and you're right, there is no way to know the comings and goings of all the nurses and techs on a 45 bed floor that is acute med/surg telemetry, peds and surgery. Combat pay is sounding better all the time! What you say we start a petition? !
Thank you for understanding. Tweety, you've stood in my shoes and you're right, there is no way to know the comings and goings of all the nurses and techs on a 45 bed floor that is acute med/surg telemetry, peds and surgery. Combat pay is sounding better all the time! What you say we start a petition? !
:chuckle MED SURG CHARGE NURSES OF THE WORLD UNITE FOR COMBAT PAY!!!
I say while we're at it to patient for a uniform allowance. Those armored suits are expensive. :roll
i think you were right to set her straight. every nurse on our shift assesses her patients immediately after report. we do team nursing so the rn and lpn go together to assess the patients. once we had a nurse complain to us that our cnas had left a patient dirty and it was dried on. we asked her what time she went in the room to check the patient. she said 10:30! a lot can happen from 7 to 10:30. i am curious to know why she didn't feel the need to check on the patient until 3 1/2 hours until her shift.
nickola
250 Posts
If I needed 3 units of blood I'd be having trouble staying awake, thinking clearly, etc. I don't think we need to be pointing fingers here, esp. at the patient. It IS possible the patient fell asleep & then when she woke up realized it'd been 4 hrs & then asked questions.......the patient is not expected to manage her OWN care.