What would you do?

  1. As many of you know, I am the sole Occupational Health Nurse at an aluminum extrusion plant. We have been really working on trying to reduce our number of recordable injuries by increased safety training and awareness, PPE's, etc.
    Yesterday morning when I arrived, a young man was waiting for me that had been cut on his left forearm approx. 4 inches proximal to the wrist. The cut was only about 1/2 in. wide, but was deep, and gaping. Bleeding was controlled. ROM was good in all fingers, and thumb. However, sensation to the dorsal aspect of the thumb was absent, and the top of the thumb was cold. The underside of the thumb had good sensation and warmth.
    I sent the employee to the ER, with is Supv. I later heard from the employee, who said that the ER Dr. said that the "nerve in his thumb was severed" and that he had an appt. with a hand specialist today.
    Bottom line, I was verbally reprimanded by the HR manager (who is also my manager) for sending this man to the ER! She said that I should have "sat on this" for a couple of days, to see if he "really needed to go to the Dr." She further said that I was increasing recordables and dollar expenditures, and that I might be jeopardizing my job by doing so.
    I told her that I would have been negligent, given the evidence my exam elicited, not to send the person for more definitive care, and that trying to tend an injury like that would have been practicing medicine without a license.
    She said that I was hired to diminish the number of recordables (I have been here 2 1/2 years, and the numbers are definitely improved), and that if I didn't, they might have to decide if having a nurse was worth it.
    I asked her if she was saying that I was more of a liability than an asset, and she quickly siad, no! Then I asked her if I should start packing my things, and she said no. I told her, that given the situation that I had yesterday morning; I would do the exact same thing again, and again she cautioned me about the numbers, $$, and the job.
    My question is this: I know I am right in this situation. However, I need this job, and the insurance. I work 32 hrs. in 3 days, and have full bene's. I have a bad knee and a bad ankle, which prohibit me from doing hospital work any longer. What would you do?
    Thanks for your input... (....for Micro!)
  2. Visit CATHYW profile page

    About CATHYW

    Joined: Nov '01; Posts: 1,418; Likes: 25


  3. by   hoolahan
    Report her to corporate compliance. An employees safety should never be compromised to save a few bucks! Thank God you didn't sit on it. It is obvious you know your job, but the HR bimbo has no concept of anything but $$.
  4. by   WashYaHands
    You did the right thing. If the HR manager brings it up again, I'd tell her that as an RN you operate under the nurse practice act and adhere to RN standards of practice, not under the gross national product. If the numbers in the past 2.5 years indicate that you've improved recordables, then you're accomplishing that aspect of your duties as well as providing appropriate health care for the population that you serve.
    Find out how the accident happened. Perhaps the environment was unsafe and needs to be addressed to prevent injuries in the future. Stand your ground, you did the right thing.

  5. by   aimeee
    Ditto what Hoolahan said. What corporate bull@#$#! If you have to error to one side, it has to be on the side of patient safety. I think it unlikely you would lose your job for practicing good medicine, but if it does happen, have faith that another door will open for you which will lead to something better.
  6. by   it'sallbueno
    I was an OHN/workers' comp nurse for five years. As you know, you absolutely did the right thing by sending that employee to the ER.

    You might remind your HR boss that the claims bill will be infinitely less money than that of the injured employee attorney's bills, should he have decided to hire an attorney for inadequate care.

    OHN's have difficulty quantifying their worth because so much is done behind the scenes. I used to say I did as much PR (public relations) as CPR. Just remember, employee morale is priceless (even if the so-called HR gurus fail to see that). Stand your ground.
  7. by   LasVegasRN
    There's hope!

    With your knowledge and background, you still have many options out there. Consider doing case management in workers compensation, industrial medical clinics, utilization review/management. These all involve mostly office type work and have good benefits. Most of all, employers WANT the background and knowledge that you have! There may be some consulting firms in your area that want nurses to go in and evaluate safety and health programs for employers.

    If you are really ready to consider other options and make a move, you can start by checking out the independent case management firms in where you live. Check out www.cmrg.com and contact the companies nearby.

    I've been in a similar situation where the employer was more concerned with numbers than actual patients and their care. Not a good place to be, and not something you have to stay with!
  8. by   prmenrs
    You are sooo in the right here! Since WHEN does a HR person have ANY expertise in hand injuries, or any other medical problem? If there were to be a lawsuit, who's a** would be in a sling? Not hers!! Document this, and send it upstairs for an FYI.

    And while I'm thinking about it, how long had he been waiting for you? Should he have gone to the ER sooner?

    Maybe you should have a meeting with Ms HR, and other suits to reaffirm your role, i.e., protecting employees' health and preventing LAWSUITS, or saving a few pennies? I'm on your side!! You did the right thing.
  9. by   kaycee
    Ditto what everybody else said. You absolutley did the right thing!
  10. by   leeriza
    You did the right thing. We nurses are patient's advocate. Tell your HR manager to get lost! The expenses he will be spending in the future will be a lot bigger if the patient decides to settle the problem in court.
  11. by   CATHYW
    Thanks, everyone, for your support. It means a lot to have the input from all walks of Nursing. Yes, I am a patient advocate-always have been. I do not frivolously send folks to the ED, or Occ MD.
    As a point of interest, my HR Manager is the only female on the Plant Steering Committee, and most of the men run scared from her. Any other ideas? (-;
  12. by   susanmary
    Cathy, is SHE your boss? Who do you answer to? What does your employment contract say -- are you there to assess/treat or you are there to lower the bottom line (not!) You did the appropriate thing -- sent him to the ER. The ER felt it was significant enough for him to see a hand specialist & I agree. You are NOT a hand specialist -- if you sent him home -- what if he lost movement/function in that finger/hand -- what a lawsuit.

    Instead of reprimanding you FOR DOING YOUR JOB, you should be commended. You shouldn't compromise doing the right thing for your patients even if you increase the number of reportables significantly. If employees are getting hurt, your company should try to figure out why -- is it something the company can remedy by improved training, are employees unsafe in their practice, etc. She's shifting the blame on you. I'd document everything & wouldn't worry about losing my job. If you do, contact a labor attorney -- better yet -- a nurse attorney.

    Kudos for a job well done!!!!
  13. by   CATHYW
    Sue, thanks for the really nice comments and support. Yes, this woman is my Manager. There are no medically knowledgable folks in the plant, except the ones I have trained in CPR and First Aid. Your support, and that of the others, really means a lot.