Vent...long, you have been warned. - page 2
I had a patient the other day that although I worked my butt off, but I was made to feel like I did a bad job with, and it's still nagging at me. Pt was a sixty-something year old male, lifelong... Read More
Feb 16, '07Joined: Jul '06; Posts: 1,394; Likes: 217Write up the nurse for not at least peeking at him and RT for not going to him when they said they would.
You did nothing wrong, as best I can tell.
You sound like a wonderful nurse and I know I'd feel very confident in your care. God bless you and please do not take this sitting down.
Solutions need to be sought. No one needs to be fired or punished but answers must be found to prevent recurrences.
Ha! Like having sufficient staff is really going to happen. But do try. Keep professional. As you said, let your charting protect you. You might want to keep a copy of that charting, too.
Feb 16, '07Joined: Jul '06; Posts: 1,394; Likes: 217Quote from NurseDiva76She probably has lots to write up but maybe doing so keeps her from seeing her patients in a timely manner.Looking back, yes, there are things that I could have done better. If the pt's respiratory status was that labile, I should have pushed for a bed near the nurse's station, or if he was really that 02 and bedrest dependant, maybe I should have called the pre-code team myself down in the ED. When I inherited him at 7p, I thought he might end up needing ICU, but he responded so well to the meds and treatments that the ER MD and the admitting MD agreed that tele was appropriate. I do feel for the nurses on the floor. 8 or 9 patients is a huge load...That floor is a medsurg/tele, and basically gets dumped on. Lots of total care pts...he might have been the straw that broke her back.
I spoke to my supervisor yesterday before I left for vacation, and she assured me that I have nothing to worry about, the 'write-up' was basically going nowhere. My charting from the ED reflected that pt had been non-compliant with the 02 and had ambulated without assistance twice. I had also assessed the pt and charted vitals 5 minutes before admission, and another nurse had charted on him 30 minutes before admission because she had interacted with him, and had charted that the pt was resting quietly, no c/o pain, RR 22, 02 sat 96%, etc.
So I'm going to take this as a lesson, and be more diligent in the future, and also know to watch myself with this particular nurse, because I was told that she basically writes everything up. I'm just grateful that the patient is okay and didn't suffer any permanent or serious injury.
Feb 17, '07Joined: Jan '07; Posts: 9; Likes: 2at our facility we are always reminded that a write up is about the process not the person. if you submit an incident report it may get management to pay more attention to that floor and their staffing problems and may be able to get them some much needed help. (sounds like you did everything you right at the time.-- good luck!)
Feb 17, '07Occupation: ER Nurse - Pedi and Adult Specialty: 6 year(s) of experience in Tele, ICU, ER ; From: US ; Joined: Aug '06; Posts: 502; Likes: 96I have learned through the sad experience that the nurses on the floor may NOT see the patient the moment the pt hits their bed. Even the CNA may not wander in. Can't tell you how many times me and my tech had to completely set up the patient in their floor bed, with nary any help to be seen, let alone the nurse.
Most times it's because they're swamped too, with 6 other patients, families, etc - but sometimes (only sometimes), they're sitting at the station charting or chatting, and will "get there in a minute".
You charted everything, and even went out of your way to call RT yourself for the tx. How much more could you have done while you had 4 other patients in your zone in the ER?? Probably 5 cause you know the second you get an empty bed, it gets filled!
The only thing I do now, if there's something like a tropo c EKG or a tx pending, I keep them in the ER the extra 15-20 minutes and get it done down there. I do my very level best to make sure there is NOTHING immediately pending when they hit the floor bed. It's the only way I can be sure the patient gets what they need in a timely manner. The result of this is: The floor nurses take my report and my patients with little if any grumbling, knowing I do as much as I can to make their life easier, and when I AM beyond swamped and HAVE to send a patient up with stuff pending, they say "send 'em up and do'nt worry about it - we got your back". It's a two-way street and it doesn't come overnight.
End of the day -we're ALL overworked, understaffed, underpaid... and we AND the patient suffers!
As for the write-up -she's covering her butt, badly I might add. Trust that you did everything you could. You did.
Kudos for being so thorough for that patient!
Feb 17, '07Joined: Oct '04; Posts: 2,334; Likes: 3,476Quote from NurseDiva76I don't understand the reasoning for that, since you have a doctor right there assessing him. What exactly is the purpose of the pre-code team? Isn't that for when you don't have a doctor right there and need help?maybe I should have called the pre-code team myself down in the ED
Feb 18, '07From: TN, US ; Joined: Mar '05; Posts: 76; Likes: 14Quote from MulanIt's not exactly the 'pre code' team, it's more like a medical response team, consisting of two to three critical care/ER nurses, a respiratory therapist, and the nursing supervisor. We call them whenever we have an ICU admission, or the pt has a diagnosis of sepsis, new onset CHF, pneumonia, any of the JCAHO core measure diagnoses. Their role is to expedite room assignments and make sure that BC have been done, antibiotics started in the 4 hour window, basically, they make sure all the appropriate measures for a better pt outcome have been taken in a timely fashion.I don't understand the reasoning for that, since you have a doctor right there assessing him. What exactly is the purpose of the pre-code team? Isn't that for when you don't have a doctor right there and need help?
They also want nurses to call them when something "ain't quite right." Lots of people call them for this purpose, and supposedly another function is for them to intervene BEFORE a critically ill pt codes, and avert it. No doubt this man was sick, and even though technically he had none of the above admitting diagnoses, he certainly received all the workups and was being treated for them.
I always look for things I could have done better with my patients, whether something like this happened or not. Even with the smoothest STEMI, up in less than 25 minutes, I still think, "Damn! I could have given him another warm blanket because that cath lab is COLD!!" Or if I discharge a young female with PID, I wish I had more time to sit and plead with her to be safe, and vainly try to educate her about birth control. Just one of the downsides of being Type A, I guess! Hahaha!
Feb 18, '07Occupation: ER Nurse Specialty: 7 year(s) of experience in Med/Surge, ER ; Joined: Jan '07; Posts: 136; Likes: 9Once you have reported off on your patient, and the nurse on the floor accepts the patient, you are no longer responsible for him/her. It was not your responsibility to make sure that patient received that treatment....it was his primary nurse (the nurse who accepted your report). You should politely remind that particular nurse of that next time you come in contact with him/her. Once the patient is out of your dept, his/her care is out of your hands.
Feb 21, '07Occupation: Quality Enhancement Nurse Specialty: Cardiac ICU and now QA for ICF/MR ; From: US ; Joined: Sep '04; Posts: 9REMEMBER: Can't copy charts, it is a HIPPA violation!