Charge nurse asking me to lie

[julz68]

The other night I had a pt admitted that had a trach. I'm a new grad and have only been off orientation 5 weeks. The ER nurse told me in report that this pt has had the trach for a while and knew how to take care of it himself as he lived at home alone. Only thing was he had MRSA in his trach site so I would have to set up isolation. It was a busy night and this pt was my 5th one. I wasn't quite sure what I needed for a pt with a trach and went looking for my CN to ask her. I could not find her, she wasn't at the desk and her portable phone was also sitting at the desk so it did no good to call her.

My pt came up, I settled them in, did the admission assessment and the 5000 questions you have to ask and then had other things to do with my other pts. I looked for my CN a few more times to enquire about my admission, but found her busy helping another nurse in an iso room. I told her I had questions regarding my admission and to please help me when she was able.

Well, 3 hrs later she came down to my end of the hall to get updates. When I told her about my pt having a trach, she freaked out. She said our floor (medical floor) does not take trachs. I had no clue! She had to call the supervisor to try and get that pt placed elsewhere. Then she took me aside and started saying, "You have to do what I say so you don't get in trouble. You need to say that the ER nurse didn't tell you about the pt having a trach and you found it on assessment. You also need to say that when you saw it you tried to call me but my battery was dead on my phone and I was busy so I didn't know about it until later. You need to say exactly what I told you or you will get in trouble and I don't want to see that happen. You're new and you didn't know." I was shocked and dumbfounded! This conversation took place right before end of shift.

After I punched out I went straight to my managers office but she had the day off. I called a coworker I could trust and talked to her about it on the way home. She told me to get a hold of the NM asap even if it means to call her at home and tell her everything. First of all, I will not lie about this. Especially to throw the ER nurse under the bus! No!!! She told me about the trach on report so I'm not gonna lie about that! I think the CN wants me to lie about everything so SHE won't get in trouble. I did not know and was never told that our floor could not take trachs.

So I did call the NM right when I got home and told her the whole story and apologized for taking a trach admission and that I didn't know I wasn't supposed to. I did not, however, tell her the conversation between me and the CN and her telling me to lie. I have to work with this CN a lot since she's on my weekend rotation and I don't want to be on her bad side. She has put me in a very difficult position and I do resent her for that, but I also don't want a hostile work environment.

Would you have told the NM about the conversation? I'm torn on that one. What if the NM asks the CN what happened and she tells her that the ER nurse did not give the trach info on report? I don't want that nurse to get in trouble for something she didn't do!!

Advice please! This happened Tues night/Wed morning and I don't go back to work until next Tues. I haven't been able to enjoy my days off since this whole situation is eating me alive!

[julz68]

Anyone? This is really bothering me....

[jadelpn, LPN, EMT-B]

This is a tough one. However, who assigns patient admissions to the nurses? That would be up to that person to tell the ER that the admission is not appropriate for your unit. I would first off ask for clarification regarding why it is you don't take patients with trachs, and if there is any other types of patients that you do not take. Not to debate the issue, just to have some understanding if there's no rhyme nor reason behind someone besides the admission nurse on the unit knowing what you are getting. That is not the greatest practice in the world, however, if that is how it is done, you need to be mindful so it doesn't happen in the future.

The CN was entirely unprofessional in her conduct. That is astounding that the conversation between her and you even occured. However, it could get into a he said/she said/I did/that is not what I meant issue. I would be abundantly clear with the NM that you did not know that your unit did not take trached patients, that the charge nurse was very busy with other admissions so that by the time you had completed your assessment and looked for her to answer questions the patient was already admitted.

This all sounds like a hot mess, and I wouldn't hesitate to call your risk managment department to discuss. Even the most seasoned nurse should not be put in a position where they are given an inappropriate admission and then are asked to lie to cover it up.

The point is, you, as a new nurse, a unit nurse, and not in any "power" should not ever have to think about if the admission is appropriate or not. That is the job of your charge, the house supervisor, case management, whomever it is that decides which admitted patients go where. This is not your issue. So I would choose not to make it your issue, and maintain what you have said here--that you had no idea that the admission you were getting was inappropriate for the floor.

[julz68]

When I talked to the NM, she assured me that I would not get in any trouble as I did not know that was our floor policy. She thanked me for calling and telling her what happened and said she would discuss it with the CN. I'm just worried that the CN will go ahead and tell her fabricated story and expect me to back her up, which I will not. I can't in good conscience do such a thing. And if that does happen, the CN may make life at work a living hell for me. She's been there for 20 yrs. It just pains me that she put me in this situation.

[mclennan, BSN, RN]

I suggest you break up that wall of text with some paragraph breaks or shorten your story somehow. A lot of members see a block of uninterrupted text like that and won't read it. I didn't. Too long and daunting and time consuming, sorry. Be considerate of your reader to be a good writer.

[julz68]

Also, the NM told me that our floor does not take pts with trachs because most of the RNs on our floor has had no formal training with them. And if this is our floor policy, I would think Bed Management would know this and not assign that pt to our unit. And I think the CN was trying to cover it up because she was not available to me for hours when I kept trying to find her for questions. I also think she is supposed to get a mini report before accepting pts before assigning them to us floor nurses, which she did not do.

I'm relieved that I will not get the heat for all this, I just hate the position my CN put me in asking or rather telling me to lie. I just hope she doesn't go ahead and tell the NM her "story".

[julz68]

I suggest you break up that wall of text with some paragraph breaks or shorten your story somehow. A lot of members see a block of uninterrupted text like that and won't read it. I didn't. Too long and daunting and time consuming sorry. Be considerate of your reader to be a good writer.[/quote']

I'm sorry, posting from my phone. Didn't mean to be inconsiderate. Sheesh. :/

[julz68]

Jadelpn, thank you for your reply. Could you please delete this thread so it doesn't bother other readers? I sincerely did not mean to be inconsiderate with my terrible writing. From where I see it from my phone, it looks fine.

Just wanted some advice on my situation and I didn't realize that writing such a long post was bothersome. I apologize.

[crussell]

Don't worry about your thread - it was perfectly readable. Good luck with everything!!

[stephanie.]

I suggest you break up that wall of text with some paragraph breaks or shorten your story somehow. A lot of members see a block of uninterrupted text like that and won't read it. I didn't. Too long and daunting and time consuming sorry. Be considerate of your reader to be a good writer.[/quote']

For real? Seriously?

[stephanie.]

Jadelpn, thank you for your reply. Could you please delete this thread so it doesn't bother other readers? I sincerely did not mean to be inconsiderate with my terrible writing. From where I see it from my phone, it looks fine.

Just wanted some advice on my situation and I didn't realize that writing such a long post was bothersome. I apologize.

Don't apologize for someone's personal opinions. If they don't want to read it, they won't. You aren't a bother. People with bad attitudes are the problem.

[Rose_Queen, BSN, MSN, RN]

I'm surprised there are med/surg floors out there who don't take trach patients, with the exception of those truly needing critical care. If this guy was living at home alone, obviously this is a long-term, healed, stable trach.

Either way, if the patient was not appropriate for your floor, someone (bed supervisor, whoever was notified that the patient was coming, etc) should have picked up on that long before the patient arrived. Be honest with your nurse manager, because it sounds like the charge nurse needs a little discussion about appropriate behavior- if she's in charge, she either needs to carry the phone and answer it, or pass it off to someone else. And the whole lying thing? Wow, jeopardizing someone else's livelihood is insane!

As for the comment about the wall of text, don't let it get to you. Yes, there are those who will skip over those posts, but then there are others who will read and respond. Most of those in the first category just have the manners to close the thread and not jump on the poster.