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!

[SarasotaRN2b]

#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.

As much as we would like for patients to take responsibility for themselves, that is not something we should count on. The nurse should have stuck her head in there.

I think that what you've done is what a good charge would do. Don't beat yourself up about it.

[penguin2]

You obviously did not read the posts carefully.

A little confused here-- tell me if I'm missing something here-- but I think spidermonkey meant the PATIENT should have been checked on by you as the charge person that night- earlier- like when the blood bank kept calling, rather than after she'd had a chance to become upset about this.

[penguin2]

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?

Funny, I am sensing some hostility from the OP too, after reading all the posts here & her replies. It's becoming clear as to what the underlying problems on this unit may be...it's hard to ask for help when there is a general feeling of no teamwork and the charge person isn't approachable & becomes defensive to those she's asked for advice. Also, confronting someone at the desk is inappropriate & unacceptable. I would not be so quick to blame a new nurse & call the patient a "martyr" either.

[LoriAlabamaRN]

I also pick up some serious attitude from the poster... I hate to say that but it really seems as if she wants us to tell her she was 100% right and any other responses will not be tolerated... I know that as a supervisor, if I had had the same situation I would have checked on the patient myself. Especially if the nurse was rather new and the issue was hanging blood. I don't think the new nurse was right by waiting so long, not by any means. However, I would have followed up on it myself as well. I certainly wouldn't have decided the patient was just a "martyr" who wanted to be neglected. I would have offered to help that nurse instead of assuming she will be comfortable coming to me and asking my help- especially when the blood didn't get picked up. There are ways to assist without making the new nurse feel incompetent. Maybe you should look into those.

Lori

[ceecel.dee, MSN, RN]

7am is a terrible time for an admit!

sorry, but i'm feeling a bit sympathetic towards this new grad! yes, she should have made a bee-line for this (or any gi bleed) patient's room to initiate the transfusion and get baseline assessment. but...charge nurses are also responsible for the patients, and make rounds on all the patients...don't they?

i do think that the discussion that was had with the new nurse was very appropriate, but there is blame to go around in this potentially dangerous situation.

never trust a gi bleed

[Mulan]

I also pick up some serious attitude from the poster... I hate to say that but it really seems as if she wants us to tell her she was 100% right and any other responses will not be tolerated... I know that as a supervisor, if I had had the same situation I would have checked on the patient myself. Especially if the nurse was rather new and the issue was hanging blood. I don't think the new nurse was right by waiting so long, not by any means. However, I would have followed up on it myself as well. I certainly wouldn't have decided the patient was just a "martyr" who wanted to be neglected. I would have offered to help that nurse instead of assuming she will be comfortable coming to me and asking my help- especially when the blood didn't get picked up. There are ways to assist without making the new nurse feel incompetent. Maybe you should look into those.

Lori

Agree with above.

[Thunderwolf, MSN, RN]

Enough said.

[jennyanydot]

definitely, you did the correct thing (in my opinion). hard to believe someone would go to such lengths to justify their actions for such an obvious mis-step. six to nine months is not a lot of experience no matter how much schooling you've had. i'm sure you all agree that many things come up on the job that you were not exactly schooled for. she should have been grateful for the correction and knowledge for the future.

the only thing i disagree with is the martyer bit. as a patient, no one wants

to be labeled a 'pest' so we (patients) refrain from ringing the buzzer (but not quite 4 hours!). i have been in rooms with patients who ring it constantly for what i call 'maid' service and therefore i am myself always reluctant to ring for anything (only recently when one arm was tied up and the other hoisted up high on an iv pole and i could not reach it to release the velcro so i could go to the bathroom - i pushed the botton and in came

the male nurse with more attitude than i felt well enough to deal with).

so sometimes it is just reluctance to hit that button because you don't want to be stuck in a place where people are annoyed that you did push the button). sorry, just my recent experience and again, i totally agree

you handled the situation correctly - she/he just didn't like being corrected.

first of all...this nurse in question has some priority & critical thinking issues that must be addressed by your nm! preceptor or not...it's definitely their responsibility to *know* how to organize one's shift by *this* point of their nursing career albeit six to nine months. this person needs to stop making excuses & take a good look at themself. perhaps a self evaluation is needed?

i'm absolutely am floored that this person felt or thought they were some how wronged in this. they need to take responsibility in this period...displacing blame onto others isn't the key. you were certainly correct in telling them that the night shift had nothing to do with this as well as telling them they should've popped in to assess the patient....which they didn't do & wasn't about to by four hours into the shift. that right there are grounds for neglect imo. how on this earth can this person expect to *know* when their patients' are deviating from their baseline if they don't do an initial assessment! how long would it have taken for them to do so before going to do meds....& how or why would they attempt doing meds if initial assessments haven't been done?

this person is walking on a slippery slope of sloppy & piss poor not to mention...dangerous nursing...imo. they definitely need re-evaluating. i also feel that she needs counseling as well as disciplinary actions. their whole attitude needs adjusting.

the only thing i differ in what you've said was placing some onuses onto the patient. what if this patient had of had a changed in mental status whereby they couldn't ring the call bell? what if the call bell wasn't in their reach? what if this person *did* expire? no....placing blame on the patient is a out for this nurse in question. i do understand your thought process here in that this person probably just sat there deliberately waiting & watching the clock so that they can complain. but really...what would've happened if said patient *did* use the call bell? would she have been transfused any quicker? i doubt it! the nurse in question probably would've put her on the back burner anyway.

this nurse also need to use the auxiliary staff to the fullest as well. why couldn't this nurse have filled-out the bb slip & sent some else to go get the blood? just how hard was it for her to have come to you & say....i'm a bit behind & need assistance? i'm feeling this person probably has skip & shirk loads of tasks & is just getting found-out because this patient isn't going to stand-back or simply disappear without a word. so many patients today don't speak-up for themselves because they don't want to disturb anybody. so they sit & suffer in silence. they don't want to mention anything to their families for fear that they might make a stink...thereby fearing retribution from the hospital staff.

lastly...you shouldn't have to make any apologies to the gi doc just because the patient is his receptionist. that's totally bs! the only person who should receive the apology is the patient....& *that* needs to be done by her primary nurse in question...not the charge nurse.

cheers,

moe

[Overland1, RN]

While shift-change time may be a terrible time for an admission, there is really no choice in that matter. People come to the ER at any time (sometimes as one of several simultaneous arrivals), regardless of shift change or other things. The fact that the patient works for a GI doc should have no bearing on the quality of her care - all patients where I work are to be provided the best care possible at all times....... no "celebrities"; all are equal.

As for priorities, the new nurse needs to learn this right from the start. Inserting the IV after getting the patient "gowned up" is a good beginning. A quick intruduction which ends with, "is there anything I can do for you right now?" helps immensely. Letting the patient in on the big secrets (i.e., when the blood will be ready, and what to expect during the process) helps to ease the tension, too. My rule with patients is: "No secrets either way."

We also encourage our charge nurses to round on patients upon arrival/admission. They introduce themselves and also offer to help.

[DutchgirlRN, ASN, RN]

Funny, I am sensing some hostility from the OP too. It's becoming clear as to what the underlying problems on this unit may be...it's hard to ask for help when there is a general feeling of no teamwork and the charge person isn't approachable & becomes defensive to those she's asked for advice. Also, confronting someone at the desk is inappropriate & unacceptable. I would not be so quick to blame a new nurse & call the patient a "martyr" either.

I respectfully tell you that you have absolutely no idea how busy my floor is. Being in charge is a challenging job to be sure. We have plenty of team work on our floor and generally function very well. The nurse who didn't approach me didn't do so because of her own insecurities. She did not want to be perceived as not being able to handle her assignment on her own. When I called her to the desk to ask "What's up with room _____.?" She is the one who blew up, not me. At that point it became inappropriate.

I come here to vent and to get differing opinions. Perhaps I'm not seeing a situation the way I should because I'm upset at the time. It's been a week and I'm still seeing the situation quite clearly. There have been times that I've thought, gee wish I hadn't done that. Not this time.

I also pick up some serious attitude from the poster... I hate to say that but it really seems as if she wants us to tell her she was 100% right and any other responses will not be tolerated...

I know I handled the situation correctly. Sometimes I don't , but I don't need anybodys approval to validate myself. I do however very much appreciate the commrodery and support that I receive from my friends here on allnurses. If you disagree with me that's fine. You have the right to your own opinion.

I do have a problem with other posters reading things in my posts that are not there. It's like taking 50 people and passing the story along and it changes as it goes through each person. It can really get out of hand and blown way out of porportion.

As a supervisor had I had the same situation I would have checked on the patient myself. Especially if the nurse was rather new and the issue was hanging blood

If you were the supervisor you wouldn't have known anything about it. Our supervisor oversees the entire hospital and is only called if there is an issue. She was called and she did speak to the nurse. The issue was the nurses insecurity about not wanting to ask for help.

It is not at all unusual to hang blood on our floor., There are days I work the floor and have 2 or 3 patients getting blood. We have two nurses verify the unit and then go to the room and verify the patient with the blood bank number and two nurses when the blood is spiked. Hanging blood is not taken lightly but it is done routinely.

The blood usually takes at least 2 hours before it's ready. I suppose this persons blood was put on a rush because of who she works for. (which is wrong) If I tell the nurse that the blood is ready, then I have fulfilled my obligation. It is then up to the nurse to follow through and if they need help to let me know. I simply do not have the time to check up on the nurses. They are professionals as well and responsible for their patients and responsible to come to me if there was a problem. When I did learn of the problem I promptly started the IV and the blood.

As charge nurse I am resposible for 45 acute care med/surg Telemetry patients. I have a steady flow of nurses, doctors, resp therapists, CT techs, lab staff, cath lab and others coming to the desk. Never a dull moment. The nurses know that they are respobsible for their patients, whether that assignment be 4,5 or 6 patients. They are told to go to the charge nurse if there is a problem. If I can't handle it, I go to the supervisor. If I don't know there's a problem I can hardly handle it. This is where I would have appreciated the patient using her call light and asking where is my nurse? There is absolutely NO excuse for a nurse not sticking her head in her patients room at the beginning at the shift and at least introducing herself and there is absolutely NO excuse for a nurse yelling at me at the desk " I knew the patient would have to be here all day anyway so I figured big deal". Now that's inappropriate as well as unprofessional.

There are patients who are martyr's, don't kidd yourself. We see them everyday. I just wanted an opinion...did my allnurses friends think she might be a martyr? I didn't ask to be beat up over it, just an opinion or be able to discuss it.

Why would I bother to answer these accusations? Because again, I need to vent. If you have not walked in my shoes you shouldn't be so quick to judge.

[DutchgirlRN, ASN, RN]

A little confused here-- tell me if I'm missing something here-- but I think spidermonkey meant the PATIENT should have been checked on by you as the charge person that night- earlier- like when the blood bank kept calling, rather than after she'd had a chance to become upset about this.

READ CAREFULLY, I wasn't there on the night shift! gees

[neennernurse, BSN, RN]

You did the correct thing, but should have been done behind closed doors so no one could hear, or talk about the incident. I have been yelled at from behind closed doors and in the nurses station, i prefer away from nurses station, so the patients and other staff wont hear it. Its more professional. If a patient heard that conversation, he would loose trust in his nurse, and break the patient/nurse relationship. I have found that it is better away from the nurses station, say in break room, and try and do it calmly. If the nurse was that over whelmed, she should have come to you for help, or delegate tasks, to pca's for instance. I also go by rule of thumb with patients......treat them the way you would want to be treated or your family member. Introduce yourself and explain the plan of care and give them a time frame, if unable to keep time frame, explain to patient that you will be in as soon as you can.