burn patients

[canoehead, BSN, RN]

I recently triaged a patient with 10% burns to her face and neck, mostly 1st degree with a couple spots of 2nd degree. The areas were bathed with cold water in triage and then she went to registration. I met her at the registration desk and brought her into a room, bypassing a waiting room full of people.

As I walked with her to the room I could hear exclamations of horror from one of the nusres behind the desk saying "OMG she's burned bad, she needs ice and cold compresses, she should have been brought right back." That nurse came in the door of the room as I was coming out and said "she needs ice!" I stopped her saying " I've been told not to put ice on burns." So she turned around and started crabbing to the 2 nurses, secretaries and EMTs at the desk about how the patient needed ice and didn't have it, and "I can't believe she waited, she should have been brought right back" All audible to everyone at the desk and the patient who had landed in a room next to the desk.

I said "she didn't wait" and got the reply "yes she did, I'm putting ice on her," as the nurse got up again and went to the door. I stopped her and said "what are you doing?" and she explained again about how the pt should have come straight back from triage, gotten ice on her burns, and started to go in the door again. I said "would you let me do it please?" so she walked away and I went in. (with about 8 people watching the whole show, and thanks guys, for helping me out on this one... )

Once I got in there I realized that I knew ice was not called for and could actually do damage, and that I was going to do this because I wanted to avoid the pressure and embarrassment. So I took a breath and walked back out. She was STILL out there going on about how the poor patient had been neglected. I walked over to the desk and said in a low slow voice "_____Shut up."

She started to yell, don't tell me to shut up! I've been a nurse for ___ years and I know what needs to be done!" Again, I repeated myself looking her straight in the eye, and she started to yell back. Thankfully one of the EMT's shouted over her, for us to cut it out, go elsewhere, etc. She left the unit, and I stayed.

When the doc came out I confirmed with her that she didn't want ice on the area and made sure my pt was the next to be seen. The crowd dispersed, and actually the two pts I had were especially nice to me (bless them) and life goes on.

Except 20 min later and administrator came in and asked me to come with him, not to complete giving pain meds to my burn pt, just come to the office. They took my keys and my badge, escorted me to the timeclock, got my coat and purse for me and escorted me to the door. The head of security was outside the office as we left. I was suspended with pay, pending my manager returning on Monday. I had spent a total of about 45min inside the hospital that shift.

Of course I was upset and went home and looked up the standard of care from the ENA, and apparently what I did was EXACTLY what they recommend. But no one in the crowd watching backed me up, and in fact one of the M/S nurses got on the phone during this party and asked for STAT unbleached linen for this pt. When I explained the burn was on the pt's face and she wouldn't be needing the linen she rolled her eyes - but why was she getting involved in the first place???

I am so angry at how I was treated, my job is in jeopardy, and NOONE helped me, I can't believe it. I loved where I worked until this incident, what now???

[madwife2002, BSN, RN]

Oh my god you poor thing what an awful thing to have happened to you. I know nothing re burns but to have been treated like that and sent off the premises, I just cannot imagine anything more horrible or humiliating.

Who do you go to now, do you have a Union? They cant do such a thing here in UK, so i have absolutly no idea where you can go or what you can do!

Except give you my support via this thread.

[RPN_2006]

OMG! How horrible for you. I'm truly sry, and praying for your timely vindication.

[ERNurse752, RN]

That is TOTAL BS.

I hope things get straightened out when your manager comes back, and I hope they have to crawl on their knees to you, begging for your forgiveness. After you file a formal complaint, that is. :angryfire :angryfire :angryfire

[canoehead, BSN, RN]

I don't think I need to worry anymore about losing my job (although I was in tears on leaving because I was sure that was what would happen). What do I say to the people who sat/stood at the desk and assumed that I was completely wrong, and didn't tell the other nurse to back down. What about the MS nurse who got in the middle of it even though it wasn't her unit, wasn't her patient, wasn't any of her business in the first place? These are my coworkers...and they hung me out to dry.

Even if I had been wrong I was treated cruelly.

And I SO appreciate the people here that are replying and giving me a boost of confidence. We are lucky to be able to reach out to one another. I remember the first day I found this site and finally didn't feel so isolated by sucky admin policies (did everyone feel that way once?)

[NRSKarenRN, BSN, RN]

sorry this has happened to you.

1. sounds like only one side was heard from by administration. prepare for the nm meeting by writing up your accounts now while memory fresh.

include names of staff on duty.

2. you already have ena sources. here's some more:

emergency treatment of burns

immediate burn treatment:

http://www.burnsurvivorsttw.org/burns/ibt.html

3. you were triage rn and placing patient in er room. who would then be assuming care of this patient? would it have been this other rn or another member of staff?

4. "poor patient being neglected" is this rn's rant. make sure documentaion includes what treatment you did do for client, quick doctor assessment,

"doc came out i confirmed with her that she didn't want ice on the area and made sure my pt was the next to be see"

5. from your accounts both of you lost your professional demenor. apologize for loosing it and that upon reflection could have handled situation better but overriding concern was patient harm that could have occured from ice application as duty to protect patient paramount in this situation.

6. admit that you were wrong for telling another professional to shut up but that you felt you had no recourse. better response was to have notified charge rn pronto "but didn't get the chance". be willing to accept counseling re handling confrontational situations as part of "corrective action" usually goes long way in employee's favor.

7. you usually have a right to have another colleague with you for support/witness in managment meetings. time to dig out that employee orientation manual to see what grievence procedure is. go over your account several times verbally speaking into tape recorder to make sure the way you voice concerns --"tone reflection" is how you want to be heard.

good luck!

[canoehead, BSN, RN]

there is no assigned triage rn, we rotate as registration calls that someone needs to be triaged. by taking the pt into the room i was her nurse, and another nurse was interfering with the care of my pt. there is no charge nurse either...as usually we only have two rns on duty and an md. in fact the nurse that i am speaking of was officially "off" at the time this happened, and was just finishing up, i was her relief.

i agree "shut up" was not one of my more articulate moments... i think "we all heard you the first four times " would more express how i felt.... if i had left the unit i know that someone would have gone in there with ice and although it wouldn't have caused the world to end i was determined at that point that my patient would get the right care, not be left to a bunch of mouth breathing, ignorant, clodhoppers (but there, i'm being inappropriate again :0

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ok i'm better now. thank you karen for all the great resources.

[ERNurse752, RN]

I agree that it's equally bad that no one else jumped in to see what was really going on. And they didn't even bother talking to you about the confrontation with the other nurse - they just called security to have you removed. Grrr.

You're too good to work there!

[dspring, RN]

I hate to say it, but I think you were perfectly justified to tell her to shut up. She not only needs say she is sorry to you, she needs to do it publicly. Then you can say your sorry to her. I also think the administrator owes you an apology.

[z's playa]

OMG..what a witch!!!! What happened to her? I was in the same situation but not in a hospital setting. She got to stay and I was escorted of the property. It made me so angry I just wanted to yell at every person who stood around watching the drama unfold. :angryfire

I'm still angry come to think of it.

What goes around comes around.

what happened to the witch? Nothing? Her word against yours? So not fair. I dont understand how she did it.

Good luck.

[danfif]

Canoehead,

As has been stated before, you know that your actions were the correct ones to be taken, and you will come out on top in the end of this whole darn mess.

You knew that by the time this pt got to your ED, that the initial heat source was gone (I am presuming the burns to be thermal in nature), and that the only thing that ice would do is to cause more damage to the underlying tissue. You got the Dr.s confirmation on their desired treatment plan, and followed it.

So as I said in the header, take several more hundred deep breaths, get the shotgun out and load it for bear, and realize that there are alot of really stupid people running around out there that just what to here themself make noise.

As Z's said what goes around comes around!

On your side, Take care,

Dan

[jeepgirl, LPN, NP]

I was taught to NOT put ice on large burns.

This causes even more warmth loss than just loosing that extra layer of skin does... which is a LOT.

You can cause more harm than good by putting water, ice, etc on them. I remember this from nursing school. For instance, you're better off wrapping a burned kiddo up in a clean, dry sheet when transporting them and bring them to the ER (if coming from home, for instance). If you start throwing water on the wounds, you're causing even more heat loss... one of the skin's major functions is regulating temp. That's why they usually want to get temps right away on burn patients because they become hypothermic very rapidly. at least, that was what i was taught! not an ER or burn nurse either.