when the budget is more important than patient safety

[icyounurse, BSN, RN]

So I had a pretty interesting day at my work yesterday. I work in a float pool and this particular day was working ICU. I was having a rough morning, one of my patients was a homeless schizophrenic man who was going through alcohol withdrawal and my other pt had alot of tests/ procedures that required me to leave him alone while I left the floor. He was getting really antsy and pulling stuff out (IV's, monitor lines, ect) when the doc came in that morning and she saw I was struggling with him. Anyways I had to go downstairs to take my other pt to a test so I left the side rails up, set the bed alarm, and had another nurse watching out (he was very near the nurses station) and told him not to get out of bed without calling us first. So I come back with my other pt and he has put down his side rail and fallen on the floor, hit his head and pulled out his IV and lying in a bloody mess on the floor. Sigh. I immediately call the doc while some other nurses watch him and get him back in bed and am getting orders. The doc asked me if I thought he needed a sitter and I was saying I think a sitter would be fantastic since he just gets really agitated and upset when you try and restrain him, I the read the other orders back and hang up. When I turn around this lady is way up in my personal space and HIGHLY upset with me. She informs me (in a very loud and rude voice in front of everyone at the nurses' station) that she is the new team leader and goes on to say that she knows I dont usually work here but I should NOT have gotten an order for a sitter and that they cannot justify it in the budget since it is only for suicide precautions, and how it was very presumptuous of me to do that and so on.........She went on for a while and was visibly upset. I said well if you dont want me to write the order I wont, and I will just explain it to the doc when she comes in.

By the way, I have actually worked on that floor for a couple of years as a staff nurse unbeknown to this new team leader and we got sitters all the time for patients who were a danger to themselves and others, you just get the order and call staffing and they send some one. It had never been a big deal before. I was shocked at her hostility towards me and didnt feel like she really helped me find any other solutions. She even accused me of leaving the side rail down and was trying to say that was why he fell.

So what could I do?? I gave him what meds I could, but I was not going to endanger myself by forcibly restraining him and could only do what I had done before. I left the side rails up, begged him not to get up without assistance, turned on the bed alarm, and had other nurses watch him when I left the floor( which was alot unfortunately, my other pt was pretty busy and had alot of road trips). I documented all this and wrote the incident up for the manager to review. I was pretty frustrated the rest of the day.

When the manager came in he told me he had read the write up, and walked to the pt's room to check him out just as he was pulling out his IV (again), bleeding everywhere, ripping his leads off and throwing them in the trash and standing (more like wobbling) around the room hitting the walls and pulling his pants on. The manager was like, well maybe we CAN justify a sitter..............hmmm.

Well this team leader was sooooo nasty to me for the rest of the shift and it was noticed by other staff members (who I used to work with) and I was told that its not me and just not to worry about her. I have never had problems with any management before and I really dont know what on earth I did to this lady.

Most of all I am soooo shocked that they would rather let this guy hit the floor over and over again because they dont want to pay someone 9$ and hour to sit in there. Seems like thats alot cheaper than a lawsuit, but maybe they are betting because the guy is homeless they wont get sued. He really did fine as long as someone was in there talking to him and only got up when he was by himself, and I really think he would have benefited from a sitter tremendously. But maybe I am wrong, who knows, I am just a float nurse after all and maybe management simply knows better than me.

Anyways I am done with my rant, thanks to anyone who takes the time to read this I know it was long:coollook:

[BEDPAN76]

Team Leader was OUT OF LINE !! Write it all up. No one deserves to have a shift like that. You were doing your best to be the patient advocate. I would try to refuse to float to that unit again if that witch is on duty!!

[ANH_RN]

That's pretty ridiculous. We have a whole team of sitters that are called upon when someone really needs one. Sometimes they're not always available which is really crappy but you do what you can -- put the bed alarm on, put them at the nurses station, etc. If they're pulling on things (I had someone try to yank out their peg tube once) then you may just have to get an order for soft restraints. Sometimes it seems like hospitals WANT us to lose our licenses.

[Magsulfate, BSN, RN]

I agree with the other posters, you really need to write up the incident on how she was talking to you and how she was treating you. Use quotations. Definatly! Turn it in, because if she did it today, she will do it again....

[icyounurse, BSN, RN]

I actually did write it up, I wrote a QAR which is how the manager knew about it when he came in. I didnt mention much about her in it though, I probably should have.But nothing really came of it except the team leader was openly hostile to me for the rest of the shift. When everyone else there had 2 patients a piece and we had an admit coming another nurse offered to take the admit since she wasnt busy and the charge wrote her name by the new admit on the board. The team leader came in and erased her name, wrote mine in, and informed me that I would be getting the new admit. The other nurse was sitting at the nurses station twiddling her thumbs while I was running around like crazy. I felt like she was really targeting me:down:

[annmariern]

does the budget allow coverage for you personally should you be sued for malpractice, negligence? Will they pay your legal fees, fight to protect your license? You were asked your professional opinion, you gave it. The doc ordered a sitter. You hit the ball back, now its their turn to deal with it. Too bad its costing them money, given few other options to take care of someone like this pt. You did your job to prevent any further injury to him or to other staff. I would write this up and file a complaint for the treatment you got in return for doing just that, unprofessional at best. On your end good job for doing your best to protect your pt. Your "team leader" should be working for McDonalds not in healthcare, sure she'd end up being sued there too eventually. Great example of what we are up against. Highlighted for me after spending 30 mins being grilled by "friendly' lawyers re a fall I just went to help after the fact. Woke me up to just what could be around the corner given managers like this.

[GadgetRN71, ASN, RN]

There used to be someone who posted here..had a great signature. It said..(I'm paraphrasing)

"Being a good nurse and being a good employee are not always the same thing.":yeah:

Op, you did the right thing. Look at it this way, you are there for the patients. And I'd rather have my employer mad at me over the budget, than have my BON ready to take my license. You can always get another job, should it come to that. You lose your license, you're screwed.

[thinkin' about it]

Sorry about your day. I think it's an even tougher situation since you float, because you probably don't know the politics of the unit well (which sucks, but we all know the difference between real leaders who maybe could've helped and the leaders on paper).

Anyway, the only thing I would have done differently is to go ahead and write the order for the sitter, even if you knew one wasn't available. If something came down the pipe about it later, you'd get blamed for not taking down an order the doc stated, plus making it clear in the chart that you tried your best to get the sitter...for example, documenting order for sitter per MD but none available.

You sound like a great nurse who did the best you could in a lousy situation. Yes, it seems like it would be cheaper to get a sitter than worry about the liability...and the cost of the IV's/lines he was pulling, and the cost of the X-ray or CT when he falls and may hurt himself, and so on.

[miko014]

I love the title of this thread. The answer is all the time. They will make you gown up for every patient in order to "prevent the spread of MRSA" on pts who are only colonized, but they won't pay for a sitter until AFTER someone falls (and in your case, not at all). How much money are we wasting with those gowns - not to mention the extra time to suit up and take it all off every time you go in the room? There is physically no possible way to be in 5 (or more or less depending on pt load) places at once, so there is no way to prevent every fall unless every pt has a sitter, and even then, I bet you'd still have falls. They say frequent checks are good enough, but I have caught people out of bed and about to fall within 5 minutes of me checking on them. I love when they can disable their own bed alarms.

Anyway, all I am going to say is this: I feel no loyalty whatsoever to my employer, because with all their BS talk about "safety safety safety", when it comes down to it, the care we give now is not safe for patients or us nurses (or other employers). Most of us are stretched so thin that we can't even help each other out, everyone is stressed, and that is just asking for mistakes and injuries. If I am able to find a new job that I want, I'm not going to feel bad about taking it. They'll get my 4 weeks notice, and that's it. No way they're going to make me feel bad!

[tridil2000, MSN, RN]

Two things are in play here and worth reporting.

No team leader should EVER discourage writing a legal telephone order that was given by a physician to an RN because it's inconvenient. That's encouraging an RN to falsify the patient's record and puts the hospital, nurse, patient AND themselves at risk.

The other concern that I would report is this leader's inability to assess the situation fully and make the best informed decision after learning the facts about the situation at hand. The question must be asked: does she or he approach every challenge like this?

This leader's actions and poor judgement are of great concern.

[FireStarterRN, BSN, RN]

The hospital I work for is a for profit hospital, and we use sitters frequently. It's cheaper than having a patient fall. Next time remind her about the new medicare rules regarding reimbursement after a patient falls.

Not only was she rude, but she needs to go back to economics 101. She sounds like a knucklehead to me...

[JBudd, MSN]

two words:

CONTROL FREAK!