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

daisybaby, LPN · Oct 31, 2005

I'm a recent grad (December 2004) and the FIRST thing I do is see every patient, even for a minute, as soon as I get report. Four hours is really inexcusable. I would have another nurse work with her for a week to help her re-orient herself and make sure she's doing assessments as she should (in my hospital, q shift assesments are to be done on every patient within 2 hours of beginning of shift- if she's not seeing patients for hours at a time, she's not even getting assessments done).

Sounds like you've done all the right stuff, though!

wooh, BSN, RN · Oct 31, 2005

She's the GI doc's receptionist, but for this admission was she the GI doc's patient? Because unless she was, the entire affair is none of the GI doc's business, and doesn't need to be discussed with the GI doc at all.

cjcsoon2bnp, MSN, RN, NP · Oct 31, 2005

Please keep in mind I am only a pre-nursing student but I think it seems logical to atleast give a quick check on your patients as soon as you come into work. But I am not sure how hospital policy works or anything like that so just ingore my opinion.

sjrn85 · Oct 31, 2005

Discussing this with the GI doc would be a HIPAA violation unless he was the pt's attending and asked you why there was a delay. I wouldn't initiate the call, though.

HappyNurse2005, RN · Oct 31, 2005

See, had it been me, i'd have been more likely to defer my other tasks to get the new admit set up. IN fact, last week, I had 3 patients and at 7am was told you are getting a new pt her name is ms. xxxxx she's 60, doctor xxxx, coming from xxxxxxx (little tiny hospital 150 miles away) with CP and positive enzymes. She showed up at 10am, so i had to assess her, do her admission database and call for orders b/c she had NONE. Then, the order included integrilin bolus/drip/ a few now meds,prep and shave, foley now etc.

I rushed my butt off and got her settled in, even htough it made the meds on 2 of my other pt's late. (not crazy late)

Her priorities seem a little screwy, really, you should AT LEAST assess the pt w/in an hour, to see how critical they are. If this is not a monitored floor, your pt could be dead in there!

Tweety, 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.

When I'm a charge nurse, I have five nurses and 37 patients. Assignements are delegated to the nurses. Maybe, perhaps, maybe, the charge nurse might have checked with the nurse "how are the transfusions going" by 11:00. Maybe this was an unfair and unsafe assignment for the floor nurse and the charge nurse is accountable for that.

As a charge nurse I try to be aware of when "my" nurses are in the weeds, but I also expect adult profressionals to tell me as well, because I'm more often in the weeds than they are.

No patient should not be seen in four hours and this nurse should have spoken up.

I'm very guilty when working the floor of staying calm and keeping my stress to myself. But if couldn't perform my duties safely and timely, then I speak up. Certainly, if I couldn't greet a patient in four hours I would have spoken up. I feel for the nurse, to have a full assignment and have an admission wheeling down the hallway when you walk in the door has happened to me the last two days, and it's tough on the floor, the ratios are unfair, and it's overwhelming at times.

I agree, something's wrong with a patient who sits for four hours and doesn't at least make an inquiry into what's going on.

I appreciate that there's no blame game, but there is a such a thing as being accountable for patients under your care. There's plenty of broken promises in the accountability area and blaming and fussing and fighting doesn't get things done.

student4ever · Oct 31, 2005

I think you handled the situation perfectly. You did not say whether or noth you had checked with this particular nurse to see if she needed any help - I'm not a charge nurse, so I can't pass any blame, it just seems as though that would be a good thing to be asking your nurses, especially new grads. However, it is her RESPONSIBILITY as this patients' caregiver to ask for help when she needs it in order to give the patients the care they need. It is NEGLECT to leave a pt in a room for 4 hours simply "because they'll be there all day anyways." And someone in need of blood?????? That's rediculous. JMO

oldiebutgoodie, 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.

I am a new grad and 4 months into orientation. Yes, she should have definitely checked in with her patient, but I like the philosophy above, where the situation is assessed and everyone works together to correct it. Perhaps this nurse has been reamed out in the past for late meds, and was trying to get it all done. I'm not saying she's right, but as a new nurse, I have been reprimanded for so much stuff that one tends to lose their sense of perspective. I begin to think, "What am I going to get yelled at about?" rather than "What are my priorities"? I know it's not right, but it's reality. I agree with a previous poster that a "buddy" nurse could be assigned and help her through this. Just trashing the nurse will destroy her self-confidence, she may quit, the unit is minus one nurse, and yet another addition to the nursing shortage.

Oldiebutgoodie

perfectbluebuildings, BSN, RN · Oct 31, 2005

She's the GI doc's receptionist, but for this admission was she the GI doc's patient? Because unless she was, the entire affair is none of the GI doc's business, and doesn't need to be discussed with the GI doc at all.

I agree with this, too. It's none of his business unless he is a part of her health care team. Just as it would be inappropriate for someone caring for a nurse, to discuss with that nurse's manager about a situation that came up during her care.

I do think that nurse needs some time mgmt training... four hours is a long time not to see one of your patients.

timewood · Oct 31, 2005

first of all...this nurse in question has some priority & critical thinking issues that must be addressed by your nm! preceptor or not...it's definitely their responsibility to *know* how to organize one's shift by *this* point of their nursing career albeit six to nine months. this person needs to stop making excuses & take a good look at themself. perhaps a self evaluation is needed?

i'm absolutely am floored that this person felt or thought they were some how wronged in this. they need to take responsibility in this period...displacing blame onto others isn't the key. you were certainly correct in telling them that the night shift had nothing to do with this as well as telling them they should've popped in to assess the patient....which they didn't do & wasn't about to by four hours into the shift. that right there are grounds for neglect imo. how on this earth can this person expect to *know* when their patients' are deviating from their baseline if they don't do an initial assessment! how long would it have taken for them to do so before going to do meds....& how or why would they attempt doing meds if initial assessments haven't been done?

this person is walking on a slippery slope of sloppy & piss poor not to mention...dangerous nursing...imo. they definitely need re-evaluating. i also feel that she needs counseling as well as disciplinary actions. their whole attitude needs adjusting.

the only thing i differ in what you've said was placing some onuses onto the patient. what if this patient had of had a changed in mental status whereby they couldn't ring the call bell? what if the call bell wasn't in their reach? what if this person *did* expire? no....placing blame on the patient is a out for this nurse in question. i do understand your thought process here in that this person probably just sat there deliberately waiting & watching the clock so that they can complain. but really...what would've happened if said patient *did* use the call bell? would she have been transfused any quicker? i doubt it! the nurse in question probably would've put her on the back burner anyway.

this nurse also need to use the auxiliary staff to the fullest as well. why couldn't this nurse have filled-out the bb slip & sent some else to go get the blood? just how hard was it for her to have come to you & say....i'm a bit behind & need assistance? i'm feeling this person probably has skip & shirk loads of tasks & is just getting found-out because this patient isn't going to stand-back or simply disappear without a word. so many patients today don't speak-up for themselves because they don't want to disturb anybody. so they sit & suffer in silence. they don't want to mention anything to their families for fear that they might make a stink...thereby fearing retribution from the hospital staff.

lastly...you shouldn't have to make any apologies to the gi doc just because the patient is his receptionist. that's totally bs! the only person who should receive the apology is the patient....& *that* needs to be done by her primary nurse in question...not the charge nurse.

cheers,
moe

i echo this completely. and i would also like to add that i am a "mere" second year student (who is precepting btw) and even i know that you always assess first. a.d.p.i.e. ring a bell??? i can not imagine letting someone who was admitted for 3 units just sit there. what is even more disturbing to me is this nurse's rank emotional immaturity and lack of professionalism ("my preceptor never told me___")?????!!!! who cares! your preceptor is not the one whose license is on the line or is assigned to that patient now. even if her preceptor did not tell her this...her med-surg textbooks should have helped her to prioritize her job better than that! did she bother reading them? or, does she not feel accountable for this either???? :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire

oldiebutgoodie, RN · Oct 31, 2005

I echo this COMPLETELY. And I would also like to add that I am a "mere" second year student (who is precepting BTW) and even I know that you always ASSESS FIRST. A.D.P.I.E. Ring a bell??? I can not imagine letting someone who was admitted for 3 units just SIT there. What is even more disturbing to me is this nurse's rank emotional immaturity and lack of professionalism ("my preceptor never told me___")?????!!!! WHO CARES! Your preceptor is not the one whose license is on the line or is assigned to that patient now. Even if her preceptor did not tell her this...her med-surg textbooks should have helped her to prioritize her job better than THAT! Did she bother reading them? or, does she not feel accountable for this either???? :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire

Unfortunately, if we just condemn our fellow nurses, we contribute to the nursing shortage. Let's mentor each other.

Oldibutgoodie

Daytonite, BSN, RN · Oct 31, 2005

Wow! What an interesting situation. Here is, basically, a new grad (6-9 months out of school, you said) who made a big boo-boo and then got all sassy about it. This is quite unusual from the normal things posted by first year nurses in their forum! They are usually contrite, embarrassed, appologetic and are holding back tears because they feel like a failure. Those are honest reactions. I'm assuming the "blow up" happened at the nursing station. Wow!

I'm concerned about this young lady talking to the other nurses about your making a big deal of her not seeing a patient for 4 hours. These are dishonest reactions. This sends up red flags all around--this is a trouble maker in the making. Sorry, I can't stop thinking like a manager. Sadder still is that now that she knows she's made a pretty grave error(s) [or, does she? that could be an even bigger problem] she's broadcasting her own failure in an attempt to find some compatriots! Is she so dumb she doesn't have the wherewithall to act horrified at her mistake? I sincerely hope she doesn't find any buddies to support her position since she's trying to establish some power and authority over others, you in particular, that she has no right to.

I would pull this young lady aside and address this broadcasting she is doing. I would tell her it's inappropriate and she needs to come to me instead of talking to all the other staff about something she disagrees that I've done to her. I would also instruct all the other staff, as I run into them individually, not to listen to any of this nurse's whining about this incident. Stop her and tell her to go and talk to me about it, they are not to get involved with the situation. I'm telling you that if this behavior is not nipped in the bud right now, this employee is going to cause a lot of trouble down the road. This is a serious attitude problem.

Insofar as the patient is concerned the only thing I would tell the doctor is that one of the new grads who I assigned to his receptionist made a poor decision and as her supervisor that day I, unfortunately, failed to catch the mistake in a timely manner. Please accept my appology. I'd also be in with that patient appologizing profusely. I disagree with the thinking that the patient has some fault in this because she didn't use her call light for 4 hours. I understood immediately that this patient was playing a game and waiting the situation out to see just how badly things were going to go. Yes, this was wrong of her, but she is your customer, so to speak. And, the customer (patient) is always right in a situation like this. The patient is just taking advantage of an opportunity to exert some pressure over you guys since she recognizes a mistake was made. Let her have her little moment of triumph. I would be more worried about what she's going to tell every person she comes into contact with out in the general public. She's going to be bad-mouthing the hospital for years to come based on this incident alone. And, that's not good. I wouldn't cover up for my staff's failure to provide service expected of them by blaming it on the patient. That only sucks me in to the patient's head game as I try to blow off my responsibility in this just like the new grad is trying to do. I'm better than that. Sometimes you have to eat crow and smile while you do it! You go to the break room and have a fit there where no one else can see you. It goes with being in a leadership position.