When you're done. Just done.

Farawyn · Feb 12, 2016

Were you in fast track? Why did the charge want the stable patient and not the sickest patient? Isn't that what triage is?

I'm sorry.

Lev, MSN, RN, NP · Feb 12, 2016

I think the charge RN felt like you were overstepping your bounds. And I think you were. You are a relatively new RN. The senior RNs decide on the flow of the patients. Maybe they didn't think you could handle that patient and they wanted to find somewhere else for them to go. Maybe another consult was coming in a couple minutes who was even sicker. Maybe the doctor had requested no more critical patients for a while. You don't know all these things. I think writing up the charge RN was a bad move. You are relatively new in the department and don't want to be known as the tattletale. Yes your job is to advocate. You give your idea to the CHARGE RN and that is where your responsibility ends. They are called Charge for a reason.

TheCommuter, BSN, RN · Feb 12, 2016

I think the charge RN felt like you were overstepping your bounds. And I think you were.

Yep...some charge nurses and supervisors are annoyed as hell when dealing with a subordinate who continually refuses to defer to the charge nurse's expertise and, instead, skips the chain of command.

Nonetheless, there's a pertinent saying that applies to the OP: "Praise in public and criticize in private." The charge nurse was flagrantly unprofessional for hollering at someone publicly, IMHO.

jadelpn, LPN, EMT-B · Feb 12, 2016

Your charge should not have reprimanded you in public. That is poor form.

However, I don't understand that if one is having labs drawn (where, in triage?!) what you are to do with a critical. In most facilities, a critical lab value is to be relayed to the MD within a strict time frame. Did you do this? If so, document it, and do what the MD says. If the procedure is to report to the Charge RN, then that is your responsibility AND TO DOCUMENT same. "Lab value received HgB 5, reported to ABC, RN per protocol at 1800 hours" or "reported to MD XYZ at 1900 hours, no new orders"

Here is my issue with this. NO, one shouldn't sass the charge RN. However, if you are an RN who is having to take critical lab values (and on patients who have yet to be roomed) you need to know what you are to do with that information, and the protocol going forward. At the end of the day, it would look as if the lab called you (and they do have "reported to ____RN" in their records) and that you chose not to do anything with that. Which the liability for prudent nursing action is required. If the charge RN would like to take responsibility for this, awesome sauce, it needs to be documented. CYA. You did your due diligence.

And yes, by doing an incident report, it covers your liability in this, and maybe (eh, maybe) it will stop a practice of doing all kinds of tests before rooming patients and then not reacting appropriately to criticals.

nutella, MSN, RN · Feb 12, 2016

You are most likely overstepping.

The charge nurse is responsible for flow and coordination and such.

As somebody else mentioned, there may be things going on that you do not know. The charge looks at the bigger picture.

There is a process in place to assign beds and move pat through the hospital - that has to happen in a specific sequence. If you jump in between and call everybody known to mankind you cause chaos.

Of course you should advocate for your patient and I am not saying if somebody keels over you should ignore it. But there is a difference between going to the charge nurse and make them aware of a pat condition and frantically call people because you think the pat needs to get admitted. In terms of flow - while one pat is waiting for something another stable one can be seen and squeezed in between because you can not have any "empty" time....

iluvivt, BSN, RN · Feb 12, 2016

I think your assessment was absolutely correct and that the patient should have been seen before a stable patient. I think the charge nurse believed they were not being listened to and got upset and inappropriately yelled at you.

I would have pulled the charge nurse aside and told them,"While I respect that you are in charge I respectfully disagree with your decision to being back a stable patient.My assessment indicates that this patient needs to be seen because of xyz. If the charge nurse still holds their ground I would them inform them I will be documenting my assessment,my nursing recommendation and that I have reported that off to you and then what your decision was. Perhaps the hot headed person in charge may have taken pause and listened and perhaps not but I believe this would have been a better approach.

imintrouble, BSN, RN · Feb 12, 2016

Nursing is full of no win situations. If the OPS patient has a bad outcome, because of not being seen in a timely manner, it's not just the charge nurse whose judgement is called into question. Somebody's going to ask why somebody didn't advocate for the patient.

The OP is at the bottom of the food chain, and we all know what happens to those at the bottom.

ProgressiveActivist, BSN, RN · Feb 12, 2016

It's not the job, it's not you, it's them.

You will never regret advocating for a patient.

ER nursing has changed a lot and not for the better.

Stick it out for a year then get the heck outta there.

**NickiLaughs, ADN, BSN, RN** · Feb 12, 2016

I think the charge RN felt like you were overstepping your bounds. And I think you were. You are a relatively new RN. The senior RNs decide on the flow of the patients. Maybe they didn't think you could handle that patient and they wanted to find somewhere else for them to go. Maybe another consult was coming in a couple minutes who was even sicker. Maybe the doctor had requested no more critical patients for a while. You don't know all these things. I think writing up the charge RN was a bad move. You are relatively new in the department and don't want to be known as the tattletale. Yes your job is to advocate. You give your idea to the CHARGE RN and that is where your responsibility ends. They are called Charge for a reason.

But she's the triage nurse and that pt shouldn't be in the waiting room. I'd be fighting too because a symptomatic pt with a hemoglobin of 5 is a level 2 and that gets higher priority than the 3s and 4s.

I think she was cya because what happens if that pt bleeds out in the waiting room? I've encountered many situations where the charge nurse did not have my my back despot asking for help. You and I both know that if she didn't chart all these things and the pt died when the review comes out that quality is going to look at everything.

If she wasn't symptomatic then I'd be assuming more of a chronic anemia which can wait a bit.

Yes sicker pts may be coming in but why take stable 3s to the back and leave this triage nurse watching a sick pt that she can't do anything for? She is not trying to handle the pt she's trying to get the pt roomed because they're sick which is what a good triage nurse does.

Also yelling in public is not an appropriate charge nurse move. I'd be weary to work at this facility any longer.

VANurse2010 · Feb 12, 2016

Your charge should not have reprimanded you in public. That is poor form.
However, I don't understand that if one is having labs drawn (where, in triage?!) what you are to do with a critical. In most facilities, a critical lab value is to be relayed to the MD within a strict time frame. Did you do this? If so, document it, and do what the MD says. If the procedure is to report to the Charge RN, then that is your responsibility AND TO DOCUMENT same. "Lab value received HgB 5, reported to ABC, RN per protocol at 1800 hours" or "reported to MD XYZ at 1900 hours, no new orders"
Here is my issue with this. NO, one shouldn't sass the charge RN. However, if you are an RN who is having to take critical lab values (and on patients who have yet to be roomed) you need to know what you are to do with that information, and the protocol going forward. At the end of the day, it would look as if the lab called you (and they do have "reported to ____RN" in their records) and that you chose not to do anything with that. Which the liability for prudent nursing action is required. If the charge RN would like to take responsibility for this, awesome sauce, it needs to be documented. CYA. You did your due diligence.
And yes, by doing an incident report, it covers your liability in this, and maybe (eh, maybe) it will stop a practice of doing all kinds of tests before rooming patients and then not reacting appropriately to criticals.

At my hospital, critical lab values are paged to the MD - as it should be.

QTBabyNurse, BSN, RN · Feb 12, 2016

Sadly, no good deed ever goes unpunished!