Blow out at the desk, who was at fault? both share blame I think?

[DutchgirlRN]

I was in charge yesterday and when I got there at 0700 I was told we would be getting a patient (a GI doc's receptionist) for 3 units of blood and go home. I assigned the patient and told the nurse that the patient had arrived. At 0815 the BB called to say that the blood was ready and I told the nurse. At 0845 BB called back to say the blood hadn't been picked up yet. (they never do this but figured hey she works for the GI doc) I told them the nurse was almost through making her morning med pass and would be there shortly. Now fast forward to 1100.

The tech comes to me and tells me that the lady in room #_____is really pissed and wants to see the charge nurse. I go down there and she is sitting on the bed in her street clothes, madder than h*** because her blood hasn't been started yet, no IV, no breakfast, no lunch, no nothing. I asked her why she hadn't used her call light, she said "why should I you all have known that I was here." I apoligized to her, assured her I would find out what the problem was and that I would get her food, her IV and blood started. Which I did.

Then I called the nurse to the desk. I said what is the problem? She said well I've been so over whelmed with my other 5 patients I haven't had time for her and I figured she'd be here all day anyway so no big deal, also I blame the night shift for not settling her in.

I said

# 1 whenever a patient is assigned to you for any reason you "always" go in the room within the first 30 mins, even if just to stick your head in, and introduce yourself and see if they need anything. If you don't you may someday find that a patient has been dead for hours.

# 2 If you're ever overwhelmed you come to the charge nurse and ask for help. If I can't help I'll find someone who can even if we have to call the supervisor. In this case I would have been able to help you out, no problem. She said she didn't want to ask for help because it would appear she couldn't handle her job. I said no we all need help sometimes (She been an RN about 6-9 months)

#3 the patient herself bears some responsibility for not using her call light. I wouldn't sit in a room for 4 hours waiting for something to happen, she may be somewhat of a marter.

#4 it is not the fault of the night shift. She arrived at 0700 and assigned at that time and the night shift nurses didn't even know she was there. She got really mad "well my preceptor never told me I had to check on patients at the beginning of my shift", well I'm telling you now you need to, no matter what, at least stick your head in the door.

She raised a fuss, called the supervisor, who backed me up, but then the nurse also talked to the other nurses about me making a big deal out of her not seeing a patient for 4 hours. I'm not letting it bother me because I'm right and I think I handled it right, I'm just needing to vent a little.

P.S. I know this GI doc pretty well. Do you think I should mention to him that she had not used her call light in 4 hours and may have acted like a marter or just apoligize for what happened? Thanks!

[Marie_LPN, RN, LPN, RN]

just like if it was a construction worker that had the flu and you told his foreman about his admission

This is how i see it as well.

[MarySunshine]

I'm a new grad and I know how fast time can get away from you when you are overwhelmed by a patient load (five other patients is a lot!). Her response was wildly inappropriate, however. I would have been devastated, and thoroughly apologetic.

Personality issues aside, I agree with the poster who thought she may need some re-education regarding blood transfusions. That's something she would want to start ASAP -- fifteen minutes after starting the tranfusion, she could have comfortably taken care of other patients, with intermittant checks on the tranfusion pt, knowing that the patient was getting good care -- in other words -- not too hard/high maintanance, it's mostly a matter of time passing. She probably realizes this now.

In fact, my personal philosophy so far has been, once I have established that all my patients are stable, I try to "fix up" the easiest cases first! You know, get everyone where they should be before attempting the 1hr dressing change, 30min discharge teaching....

[DutchgirlRN, ASN, RN]

Well I certainly hope he was her physician for this admission then, because otherwise you violated HIPAA, just like if it was a construction worker that had the flu and you told his foreman about his admission, Thank you.

I've been a nurse for 30 years and clearly understand HIPAA and no I did not violate HIPAA. He is her doc, but thanks for your opinion anyway.

I was on the floor yesterday and was so overwhelmed, really really bad day. I asked for help and I got it. I never mind asking for help. I rarely do, maybe twice a year but I'm smart enough to know when I need to ask for help.

[mtnmom]

While I agree that the new nurse's reaction as far what she told all her colleagues is disturbing and needs to be addressed, what concerns me is the factors leading up to and contributing to this event.

As a neutral observer, I cannot help but wonder if this nurse had asked for help in the past and gotten either no response or a negative response; that might have dissuaded her from asking again. In other words, had she been a victim of "nurses eating their young" by others on the unit previously? Also, what were her other 5 patients like that day? Does acuity factor into staffing in your unit? Was she truly overwhelmed and felt that she had nowhere to turn? And does your unit have techs, NA's, etc....if so, why did one of them not go to greet the new admit?

All that being said, her reaction is troubling...not to mention that she left ANY pt unseen for several hours. She was extremely lucky in this case to have chosen to leave someone alone who had a good outcome....miraculous for anyone needing 3 units of blood, I think.

Maybe the orientation process needs to be looked at more carefully. Maybe new nurses need longer orientation on the floor, or this type of thing (not looking at a patient at all, asking for help, etc.) needs to be covered in the general new hire orientation. just curious...do you have a lot of new grads and do most of them do well?

From what I can tell you handled it well....just trying to brainstorm and analyze for possible "root causes". If everyone learns from this experience (most especially the new nurse) then all is not lost.

[wooh, BSN, RN]

I've been a nurse for 30 years and clearly understand HIPAA and no I did not violate HIPAA. He is her doc, but thanks for your opinion anyway.

Based on how politely you responded to my concerns regarding your OP, I'd be a little leary of asking you for help if I was a new grad. Perhaps the communication gap in this situation wasn't one-sided?

[KrysyRN, BSN]

I've been a nurse for 30 years and clearly understand HIPAA and no I did not violate HIPAA. He is her doc, but thanks for your opinion anyway.

Thanks for clearing this up. I, too, was disturbed at the thought that the patient's care might be discussed with another person not directly involved with the patient's care, doctor or not.

I do disagree with assigning any type of blame or responsibility on the patient for not speaking up about getting blood sooner. The patient showed up at 7 a.m. for her blood. She did her part. To pass responsibility to the patient for not pushing a call bell, or notifying the staff that she was waiting, sounds so unethical to me. The patient should bare NO responsibility for that. Her nurse knew she was there. Her nurse chose to put the patient on the back burner. Her nurse chose not to ask for assistance. The patient did nothing wrong in my eyes. To tattle to the GI doc about the patient not pushing her call bell boggles my mind. And yes, to me, it sounds like tattling.

Have any of you ever signed in at a doctor's office and waited 3 hours for your appointment? Have any of you ever signed in to an ER and waited 8 hours to be seen? Maybe this patient knew it would take time to get set up for the blood, but thought 4 hours was excessive, and that's when she decided to speak up. Or maybe she fell asleep, woke up 4 hours later, and realized no one had seen her yet. So many scenarios... but it still boils back to her nurse's failure to see that patient sooner.

[Tweety, BSN, RN]

I do disagree with assigning any type of blame or responsibility on the patient for not speaking up about getting blood sooner. The patient showed up at 7 a.m. for her blood. She did her part. To pass responsibility to the patient for not pushing a call bell, or notifying the staff that she was waiting, sounds so unethical to me. The patient should bare NO responsibility for that. Her nurse knew she was there. Her nurse chose to put the patient on the back burner. Her nurse chose not to ask for assistance. The patient did nothing wrong in my eyes. To tattle to the GI doc about the patient not pushing her call bell boggles my mind. And yes, to me, it sounds like tattling.

Have any of you ever signed in at a doctor's office and waited 3 hours for your appointment? Have any of you ever signed in to an ER and waited 8 hours to be seen? Maybe this patient knew it would take time to get set up for the blood, but thought 4 hours was excessive, and that's when she decided to speak up. Or maybe she fell asleep, woke up 4 hours later, and realized no one had seen her yet. So many scenarios... but it still boils back to her nurse's failure to see that patient sooner.

I agree 100% that when dealing with this situation, one should deal with the nurse, nurse's support staff and the charge nurse. The patient shouldn't even be brought up into this situation at all.

Maybe this person was giving the staff the benefit of the doubt, and was an amazingly patient person. But the obvious anger at sitting there for four hours tells me that this might not be the case. A mature person might not have stewed for four hours and would have made some inquirers. But to hold her accountable for this situation is not the point at all. I was only wondering.

If I have a doctors/dental appointment, I give them one hour before I get up and ask how long it will be. If I don't like the answer I leave. I've done that before. My doctor and dentist are both talkers and spend are chronically late, but they have an hour or I walk out, and yes I have walked out on my dentist before. I walked out on my haircutter when I used to use one by appointment. Nor would I sit in an ER and wait 8 hours without making frequent checks as to the status of my case if someone wasn't keeping me updated (which the one and only ER trip I ever made the staff did).

That's just me. I can't judge someone who would sit quietly for hours on end, but I don't do it.

[DutchgirlRN, ASN, RN]

As a neutral observer, I cannot help but wonder if this nurse had asked for help in the past and gotten either no response or a negative response; that might have dissuaded her from asking again. In other words, had she been a victim of "nurses eating their young" by others on the unit previously? Also, what were her other 5 patients like that day? Does acuity factor into staffing in your unit? Was she truly overwhelmed and felt that she had nowhere to turn?

Don't read too much into my post. No we do not eat our young on my floor and no she has not been turned down for help in the past. She was afraid that she would look like she couldn't handle her job if she had to ask for help. Simple as that. She understands now, it's ok to ask for help. I sure did yesterday when I was so overwhelmed.

And does your unit have techs, NA's, etc....if so, why did one of them not go to greet the new admit?

We have tech's and yesterday I spoke to the one on that hall. She had offered the lady a gown, she refused, she tried to get her v/s she refused.

All that being said, her reaction is troubling...not to mention that she left ANY pt unseen for several hours. She was extremely lucky in this case to have chosen to leave someone alone who had a good outcome....miraculous for anyone needing 3 units of blood, I think.

Maybe the orientation process needs to be looked at more carefully. Maybe new nurses need longer orientation on the floor, or this type of thing (not looking at a patient at all, asking for help, etc.) needs to be covered in the general new hire orientation. just curious...do you have a lot of new grads and do most of them do well?

I'd say 95% of our new grads do fine. She one has been doing fine also. She had a bad day, got overwhelmed and didn't want to ask for help. I feel sure she now understands how important it is to lay your eyes on each patient early. Her preceptor is wonderful and doesn't understand this either.

From what I can tell you handled it well....just trying to brainstorm and analyze for possible "root causes". If everyone learns from this experience (most especially the new nurse) then all is not lost.

[DutchgirlRN, ASN, RN]

Based on how politely you responded to my concerns regarding your OP, I'd be a little leary of asking you for help if I was a new grad. Perhaps the communication gap in this situation wasn't one-sided?

The gap was one-sided as she was blowing up at me, at the desk, not visa-versa. I am "always" available to help. I have been a student myself and understand how it feels. I love to precept and have been requested to be the preceptor to many of our techs who graduate as nurses.

[DutchgirlRN, ASN, RN]

I do disagree with assigning any type of blame or responsibility on the patient for not speaking up about getting blood sooner. The patient showed up at 7 a.m. for her blood. She did her part. To pass responsibility to the patient for not pushing a call bell, or notifying the staff that she was waiting, sounds so unethical to me. The patient should bare NO responsibility for that. Her nurse knew she was there. Her nurse chose to put the patient on the back burner. Her nurse chose not to ask for assistance. The patient did nothing wrong in my eyes. To tattle to the GI doc about the patient not pushing her call bell boggles my mind. And yes, to me, it sounds like tattling. So many scenarios... but it still boils back to her nurse's failure to see that patient sooner.

I do see your point and and I'm with you. It definately does boil back to the nurse's failure but as a patient, I guarantee you I would have been up at the desk alot sooner asking "am I getting my blood or what?"

[sjrn85]

Wow...this sure is one "interesting" unit! From a new grad who faked a British accent, talked to computers and televisions, and got her job b/c of her influential parents, to this new situation.

One thing's for sure...no shortage of drama there! :chuckle

[Marie_LPN, RN, LPN, RN]

Sounds awful. I like a drama-free place of employment.