Co-worker issue

[weluvoands]

Sorry guys, this is a boring co-worker issue but I’m conflicted on what to do.

I recently started a new job as a Case Manager at a community health center. This facility has a walk-in clinic and on this particular day my mom sent me a text telling me she had come through the walk-in and told me what room she was in and asked me to come see her. When I went in the room a floor nurse was doing vitals. I chatted with my mom until she did the BP. I noticed that the BP cuff was too small and almost popped off when she was inflating it. When she was done she asked my mom if her BP was always high to which she said no but maybe because she was in pain. I spoke up and said she needed a larger cuff. The nurse said the only one larger was a thigh cuff and I said what about the red cuffs in the other rooms and she said this was the largest besides the thigh cuff. I dropped it after that and that was the extent of our conversation. She finished with her charting and said the provider would be in in a few minutes.

I come in the next day and get pulled aside by one of the NP’s who says that I was out of line for “calling her out” in front of a patient and I should have pulled her aside outside the room. I tried to explain that the patient was my mom and I know her history and I wasn’t in there as a nurse but as a concerned family member. She wouldn’t let me say much and said I needed to apologize to the nurse that was in the room. I was more stunned then anything and just said ok and walked off.

I don’t work with this girl and we barely ever cross paths. I don’t even know her name. But I did try to find her after speaking with the NP and couldn’t so went back to work. As the day went on I replayed the scene in my head thinking where exactly was I in the wrong. I even asked my mom if I sounded rude or anything to which she said not at all.

So here I am needing some outside opinions. I don’t think I did anything wrong. I merely was advocating for my mom, which is what I go to every appt with her for, because that BP wasn’t correct. On the outside looking in, I wouldn’t have said a damn thing if I would have known it was going to blow up into this. Should I just suck it up and apologize or stick to my guns that I didn’t do anything wrong?

[JBudd, MSN]

I'm on the fence here, since you do work for the place it is conceiveable the nurse was embarrassed to be called out.

On the other hand, having a wrong BP noted in your mom's chart is worse. And a nurse that doesn't know how to fit a cuff & claims there isn't one that fits, should be more embarrassed about that than getting called out on it.

So, talking to her about it privately is a good thing, aplogize for accidently embarassing her, but not for pointing out her technique was wrong.

[TriciaJ, RN]

"I'm sorry for calling you out in front of a patient, even if it was my mom. You still need to use the correct size cuff for blood pressures. An inaccurate blood pressure is no better than no blood pressure."

[JKL33]

It is so not difficult to use the correct cuff that this issue does make me crazy and I address it every time I see it. I do think there is an additional dynamic involved because it was your mom. Were it a patient unknown to you and you happened to witness this, you could very casually/pleasantly just say "we could try the regular cuff." I've done this many times myself without any interpersonal difficulty or hurt feelings ensuing. But, if it is clear this patient is your family member and you come in and make comments involving others' work, I would think embarrassment would be increased since the coworker knows that you and your mom will be able to discuss this (or her) later (whether you actually do or not is beside the point).

Alternately, you could have approached the nurse privately (like when she stepped out of your mom's room) or approached the provider and simply state what you witnessed and request the provider to recheck w/ correct cuff or in some other way address the inappropriate reading.

(Were it me) I would find the nurse and apologize for not addressing it privately. And if it makes you feel better you could also follow up through other channels with the fact that education is needed (and also possibly supplies) so that patients' blood pressures are taken appropriately.

[K8e]

Because you were at work and on company time, the best thing for you to have done was talk to the nurse outside your mom's room. If you were there as a family member while you were not working, then it would have been more appropriate.

[2BS Nurse, BSN]

I would have not been offended at all! We have family members come in with staff on a regular basis and I'm willing to have completely honest discussions with them. It makes me look much better if I say "you know, you're right. Let's see if the bigger cuff makes a difference!". If this was a RN there is just no excuse for using the wrong cuff size. Seriously??? This is not about RN education. We learned this the first week of nursing school!!

[LibraSunCNM, BSN, MSN, CNM]

Yeah, any registered nurse who is stupid enough not to know a.) how to tell if a cuff is the correct size and b.) that a too-small cuff will result in a falsely high BP, does not get a free pass or an apology from me about that. I would have called her out too. The NP who thought you were in the wrong in that scenario puzzles me as well.

[Oldmahubbard]

Pretty much we should be able to eyeball who needs a larger cuff. It has never been rocket science.

This is a common error in my experience

[Davey Do]

What we have here is someone who sees the reality of a situation, a victim and an enabler.

A non victim would have discussed the situation out front and dealt with it in a realistic, professional way.

[Wuzzie]

I agree with others. What you said wasn’t wrong but how you said it made me think “oof”! I’ve run into this exact situation a time or two or one hundred. I would have said something like “ya know this Velcro doesn’t seem to be holding. They do get worn out. Let me go get another cuff for you.” Then skedaddle to another room and get the right size cuff. Professional face saved, proper BP reading obtained and you wouldn’t be in hot water. Unless the patient is in imminent danger or you are assigned to instruct the nurse this kind of education should be done away from the patient. You definitely should apologize for embarrassingly her. A simple “ I handled that badly” should suffice.

That being said what the heck are they teaching in nursing school when it come to taking manual BPs these days? It seems like all I see are people slapping on whatever cuff is handy, positioning the arm any which way and pumping the cuff up to a random number not even remotely related to what they are hearing. ?

[Nurse SMS, MSN, RN]

Nobody should ever be corrected in front of a patient by a coworker unless immediate intervention for patient safety is warranted. While this was your mother as the patient, it was also your coworker as the nurse. It would have given the nurse in question some grace and dignity in the error as well as a better forum for you to educate/advocate and it would have kept from taking a chink out of your mother's confidence in that nurse.

All that being said, it is definitely stunning that anyone would not know how to tell if a cuff is the wrong size.

[brownbook]

I get very exasperated when nurses use the wrong size BP cuff. I think I would have done exactly what you did. Saying you thought she needed a bigger cuff....then suggesting the red cuffs in the next room...then you "dropped it", was not over reaction or "calling her out".

I don't support what the NP said at all. It sounds like the NP said you were out of line before she even asked about what actually happened...listened to your side of the story.

A good (I'm not sure why the NP was even involved?) but a good charge nurse or office manager, would hopefully have better people skills, better management skills, and listened to your side of the story. Understood why you did what you did, acknowledge that the other nurse was wrong but you should apologize to her for questioning her skills in front of the patient.

I keep imagining if you were a NP or a MD would the NP have reacted the same way...told a fellow NP or even a MD to apologize to the nurse?