Getting stuck with the blame

[3fins]

I'm a new night nurse, 3 weeks in, starting off in the ICU and had this situation arise yesterday .

Patient was transferred to ICU from telemetry and nurse knew barely anything about the the patient except he was admitted for exacerbation of a pulmonary issue. I took report and it was mentioned in passing that approx 4 days ago (prior to admission), he had experienced some unilateral weakness with trouble breathing, had been to see his pulmonologist, and was sent home with a bronchodilator after the doctor said he "didn't think the patient had a stroke" and should just work on the respiratory issue. A day later the patient came to the ER with worsening SOB and was admitted tele.

I didn't see any signs of the said weakness (patient was in no real condition to effectively assess for weakness anyway) but relayed this info to the day Nurse A. during report. At the time it was mentioned, I wasn't sure I had Nurse A's full attention, but she's very difficult to read and somewhat moody . I cared for the patient the following night. The doctors had been to see the patient during the day but no new orders were given.

The following morning when the Nurse A arrived I told her in report that I still hadn't really noticed the unilateral weakness that had been reported to the pulmonologist, but documented the pulmonologist was aware of the problem days earlier. Make a long story short, Nurse A insisted I never relayed any such information about weakness to her during first report wanted to why I hadn't already notified the attending physician of the problem. "Nurse A." then contacted the attending who called neuro for the case, but I was later told by "Nurse A" the patient indeed had a stroke days earlier and was declining, and that the decline was basically my fault because I hadn't made anyone aware of a potential neuro issue.

Being a new nurse, I learned three lessons through it:

1) Attitude significantly effects how effective communication is - the message obviously didn't make it to the receiving day nurse.

2) Everyone will always claim they had no responsibility - docs, nurses, whoever - and it's often your word against another's.

3) There will always be something you don't know, simply because of lack of experience with the situation, and you will learn these things the hard way. Today and 20 years from now. It's the nature of the game, and as a nurse your expected to know EVERYTHING but you really can't. In my case, I wasn't aware there is ZERO communication between docs, they will allow a potentially major issue to go unaddressed (like what happened before the patient was admitted to the hospital), and that an attending physician is the only doc who can write a for a consult. Therefore it's always best to call the attending when you're transferred a patient from any part of the hospital and give a full rundown of the situation, because things get missed or not addressed. Even if your thought, like in my case, that they had been. You will get stuck with the blame.

[DixieRedHead, ASN, RN]

I have very good assessment skills. I had a patient on telemetry. One day I noticed that he was looking out the window. He looked out the window all day, leaned toward the window. I propped him up with pillows many times. He was alert and oriented with good vitals. While I was taking very good care of this man, he stroked just as plain as day and I missed it. I had no idea when his symptoms started but they were there when I came on.

Your patient had the stroke, no you. People have strokes. The nurse can't always catch it and it cannot always be fixed. Laying blame will not have any a effect on the circumstances. If you have any part in the blame, you have no more or less than the MD or Nurse A. She's and ICU nurse too and is responsible for her own assessments.

As a nurse you will encounter many sets of circumstances that you might have done differently. That doesn't mean that everything you could have done differently would have made them better. Chin up.

[poopprincess]

This is NOT your fault. You didn't make that patient stroke and the assessment you did is your opinion of what you saw. This patient was seen by many people who also didn't catch it-the origional nurse, Nurse A, Doc's....

Nurse A didn't have any right to blame you completely for this. That is downright hateful IMO. If they continue on I would be asking for specifics as to what you should have noticed that no one else did. You can't possibly know every single tiny thing that is going on with the patient. Just turn this into a learning moment and try to move on from it. Sounds to me like Nurse A is toxic and if I were you I would avoid her. Continue to be the professional that you are and only speak to her when absolutely necessary. What she said only creates turmoil and it splits the team. Nursing is a 24 hr. job and it does not stop with one person. It is a team effort. Period. I hope that things get better for you.

[Meliss214]

At least you weren't suspended like I was for failing to notify the attending. I left that toxic work environment since my supervisor believed the nursing is an autonomous job even though my charge nurse and I were equally responsible for all the patients on the psych unit. Living and learning...