Blow out at the desk, who was at fault? both share blame I think?

Long Term Care Columnist / Guide · Oct 30, 2005

It's scary to think that this new nurse is already doing such poor work.......what's she going to be like in six to nine YEARS, when she's getting burned out and her back and feet ache like the devil after a long shift? :angryfire

I was taught from day one of nursing school that the very first thing you do when you get out on that floor is make sure your patients are breathing.....you don't have to jump in and do baths or feed them or even wake them up if they're still asleep, just make sure they're ALIVE.

You handled this situation correctly. That nurse is fortunate that I'm not her manager, I'd have chewed her a new one AND written her up.......not just for neglecting her patient, but for her attitude. The average first-year nursing STUDENT knows better than to leave a patient alone for four solid hours, especially not one who needs three units of PRBCs. Shame on her.:stone

babynurselsa, RN · Oct 30, 2005

This young lady's responses were soooo very troubling. If she cannot se that it is a problem that a patient went for 4 hours without her EVER laying eyes on her did she actually see and assess all of her other 5 pts in that time?????

I personally don't see someone in need of 3 pints of blood completely stable. That is a signifigant amount of blood to need infused.

If her preceptor never told her that she needed to see each of her patients at the beginning of the shift (I hope to God this is not true) then maybe this preceptor also needs her practices scrutinized also.

This young nurse may need a little close following for a while to see what is going on with her and possibly some remediation or even to be placed back onto orientation.

As far as the patient waiting 4 hours to let somebody know that this was going on I believe I agree with you. Obviously, if she had called out earlier something could have been done more expediently as you would have been aware of the situation.

live4today, RN · Oct 30, 2005

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!

Your advice and suggestions to that nurse were right on target. I'm sure your tone of voice reflected professionalism and caring as well :) ...especially since the nurse is relatively new as a nurse.

Also, I would have taken her aside in private and questioned her in regards to what she learned or didn't learn during her orientation to the unit from her preceptor when it came to the admission of patients, and the timeliness in touching base with each patient at the beginning of each shift. Six to nine months out of nursing school is still early in the game, and perhaps she needs further orientation. Maybe you can give her a "Buddy Nurse" who can check on her for a period of one week to see what areas she may be weak in, and need more training with?

Just some suggestions. :)

live4today, RN · Oct 30, 2005

P.S.........another thought would be to reassess her knowledge of giving blood. Perhaps it is an area that she is not confident in performing, and was afraid to ask for help (being that she has been out of orientation for six to nine months)????????? Perhaps she was hoping another nurse would step in and give the blood. Sounds like some additional "training" is definitely needed.

Our needs aren't always visible, and neither are our fears. She needs a very caring and assertive staff nurse to share her fears of nursing with, and any areas in nursing that make her feel uneasy. I would be willing to bet her fears of not doing something right is the culprit here.

SouthernLPN2RN, MSN, RN, APRN, NP · Oct 30, 2005

Does your floor have a policy regarding the amount of time a new admit can be on the floor waiting for assessment? When I used to work the floor, the pt had to have at least vitals and a quick assessment within a certain amount of time.

DutchgirlRN, ASN, RN · Oct 31, 2005

:smackingf It shows far more wisdom to acknowledge that you need help and ask for it. Even when I was a new nurse I never hesitated to ask questions, hey, it's one way we learn.

I've been a nurse for 30 years and I still ask questions all the time and I ask for help when I need it. It just goes with the job. The only dumb question is the one not asked IMO.

BTW, as a patient, I wouldn't have waited 4 hours to find out what was going on.

Thank you ! I would have waited maybe an hour before I would be at the desk asking "what is going on here, have I been forgotten". Her H & H were 8.5 and 25.8. So not too bad but hey could have been fatal had they been lower. We had one last week with a Hgb of 3.1 ! She got 9 units, more than the body holds at once! Yikes!

DutchgirlRN, ASN, RN · Oct 31, 2005

I wonder how she would have felt if she ahd sat in a room for 4 hours and had never seen a single staff member? Or if this had been her mother?

GREAT POINT ! Wish I would have thought of that while talking to her.

DutchgirlRN, ASN, RN · Oct 31, 2005

Does your floor have a policy regarding the amount of time a new admit can be on the floor waiting for assessment? When I used to work the floor, the pt had to have at least vitals and a quick assessment within a certain amount of time.

We have to get vitals within 30 minutes, Assessment within 2 hours and the History within 4 hours. If they are on telemetry the assessment must be in 1 hour. I'm talking actually charted assessments. I usually do mine right away but sometimes it takes me an hour or so before I actually get it charted.

This particular nurse was precepted by the best. She is a wonderful nurse and is the one who precepted me and we went and checked on every patient before doing anything else at the beginning of the shift. This new nurse just acted very defensive. I think maybe because this all went down at the station and the super was there and also her co-workers and some docs but hey I was going to pull her aside, she's the one who decided to blow up at the desk. I'll be interested to see what my NM has to say tomorrow and if I see the GI doc. I'm sure, knowing me, I'll discuss it with him and I'll let you guys know.

meownsmile, BSN, RN · Oct 31, 2005

You brought up the right points to her, wonderful.. However, i think i would have had the conversation in the privacy of the conference room and not at the nurses desk. Could it be that others heard and were questioning her about what was going on and that is what stemmed her "talking about it" to others? I wouldnt worry to much about that,, if she was talking about it, she was trying to find support for her situation, which she probly didnt find anyway.

Bless that patient for having the patience she did. 4 hours, she could have had almost a unit and a half of that 3 administered and she probly knew it if she was a frequent flyer for blood. And thats running it slow!

I agree, offer some help with her organizational skills and priority setting skills, that is the first place we notice new grads/nurses falling short. In the long run shell appreciate it

unknown99, BSN, RN · Oct 31, 2005

I do not mean to sound harsh, but as charge nurse, you also have the obligation to oversee that patient's care. There is truley no excuse for the blood not to have been started within 20 minutes of the lab calling the first time. The patient also should have used her call light to find out why the blood had not been started yet. Things like this do happen, but excuses should never be made, and blame should never be placed. At the hospital where I work, we have a "No Blame" policy. When an event such as that happens, no blame is placed; the situation is dealt with accordingly and everone works together so an incident like that does not happen again.

DusktilDawn · Oct 31, 2005

I do not mean to sound harsh, but as charge nurse, you also have the obligation to oversee that patient's care. There is truley no excuse for the blood not to have been started within 20 minutes of the lab calling the first time. The patient also should have used her call light to find out why the blood had not been started yet. Things like this do happen, but excuses should never be made, and blame should never be placed. At the hospital where I work, we have a "No Blame" policy. When an event such as that happens, no blame is placed; the situation is dealt with accordingly and everone works together so an incident like that does not happen again.

Sagarcia, when I am Charge nurse where I'm at, I will have the same number of patients as the rest of the nurses. I don't know if this is the case here, but there is no way I could oversee the care of all patient on the unit when I am Charge. I think we one needs help, they have the minimal responsibility of asking for it (it's not always obvious when someone needs help). I also believe that if we can assist a colleague we also have the responsiblity to do so.

I do like the idea of people working together to prevent future occurences. I do think we should own up to our responsibilities when we are at fault, I don't think it should necessarily merit a punitive response when we do.

spidermonkey · Oct 31, 2005

NO blame should be placed on the patient, regardless of the fact that she worked for a doctor. W/an H&H low enough to require 3 units of blood she may have been too tired/weak to make sure the nurses were doing their job! :angryfire Responsibility needs to be taken by the nurse assigned to her care, and to the charge nurse for not checking on her when the lab called the 2nd time.