i posted about a week ago over an incident that happened at my work. here is the full story:
one man got aggressive with me during his 12am neb treatment. i documented that he was aggressive and refused his neb but wasn't specific about the incident:uhoh3:- i'm rusty with charting and really don't know what the heck to write (new grad, new nurse- my mistake).. he's one we have to chart on because of insurance- we don't chart on everyone on the 11-7 shift.
anyway, two days later, i get a call from the risk manager asking if i know what happened to his toe. i say no, what happened? apparently, it's fractured and they think someone bent it on purpose.. of course, i'm thinking great- i'm new, no one was with me, i charted he was aggressive and i was the last to see him before the toe was discovered... they turned the incident into the state for investigation and i lost sleep over it.
they were trying to blame his injury on that night he was aggressive with me but one of the cna's on the prior shift said "no i found it earlier and reported it to xxx nurse, it's even on the back of my cna assignment sheet that i found a bruised, reddened area on his toe". so here i am, about to be in the spot light there when some other nurse never reported it to the next shift (which was me) and didn't bother to file an incident report:angryfire. this guy has a history of psych behavior and is aggressive about 20 days out of the month. i felt like a scapegoat. even after the cna's statement and assignment sheet showing she did write it down on the previous shift, they still think it happened that night he was aggressive with me. ***i wish i would have charted details- lesson learned***
would you talk to the risk manager to explain things in detail? would you put it in writing for your file? would you talk to the don about it? it's really bothering me that i know it wasn't me and it's very hard to prove you are innocent these days. the cna's sheet proves the injury existed before my shift and 11-7 does not do skin checks at night. how can they continue to assume it was my fault? what happens in an investigation? does this go under my license? how can i protect myself if this happened to someone who doesn't have to be charted on and the cna never discovered it?
then a few days after that, one lady had a fresh bruise on her elbow that was about 1.5 in x 1 in and the same cna reported it to me (she worked a double that day). what was i suppose to do, ignore it? i didn't so i made an incident report to cover my butt. needless to say, i was basically the joke of the day because i filed an incident report over a bruise and everyone commented on how petty the report was over a simple bruise. i don't know if i was right or wrong to do it but i'm not getting blamed for an injury i didn't do.. was i suppose to dismiss the cna's observation? who am i to ignore a bruise? what if the family comes in and asks where the 70 bruises she has came from?
i feel lost and upset with this whole situation. is there a protocol on what is good enough to report verses what can be brushed under the carpet? yes i'm new and i'm going by the book- too many of these people don't follow the "rules" and it's making me question myself. would you look for another job or is this what i get to look forward to in ltc? i only have 1 month experience under my belt so it's not like i'm able to get any job i want. pease offer any words of wisdom you can share! thanks for making it this far!
Kudos, Kyle45! As an RN who did 3 yrs on 3-11 and 11-7 in LTC I was very lucky to have a CNA who would consistently notify me of every skin integrity issue she found.
One noc I was working 11-7 & a 35 yr old dying female pt with advanced lung CA & metz had been admitted by the ADON on the am 7-3 shift.
There was a full skin integrity assessment with Polaroid pics and a diagram or drawing we did on all new admits to document all pre-admit wounds signed by the ADON .
When the night shift CNA turned this new res she called me to the room b/c she found what we thought was a 7 cm decub on her upper back, just below the scapula.
Turns out it was the tumor from her lung CA that had eaten its way right through her back. And all day this poor lady had been positioned so that she was putting pressure on this unnoticed wound site.
When the am staff came in I privately told the ADON about what the CNA had found. Imagine my surprise when the ADON started SCREAMING at me for alerting her to the fact that this dying resident had a tumor breaking through the skin of her back.
Where was her the empathy & compassion for this dying lady's pain? ADON was just embarrassed that the CNA found something she had missed and was only worried about what would happen if state or the BON got wind of it. Sad.
But anyway just wanted to say thanks for caring so much about your residents!
Anything out of the ordinary that I notice when I'm bathing or giving care (bruises, skin integrity, cuts, etc.) I report to the patient's nurse right away. One patient had a history of being combative and aggressive, but when I was bathing him, I found very inflamed and broken skin under his foreskin. Fortunately, while I was cleaning that area, his nurse came in and I pointed it out to her. She looked at it, and said "no wonder he's combative", then left to inform the doctor. I can't chart this since it's not in the nursing assistant's area of charting on the computer, but I'm sure the RN did chart it. I'll continue to notify the nurses until I'm told not to.
nurse15dc
91 Posts
Kudos, Kyle45! As an RN who did 3 yrs on 3-11 and 11-7 in LTC I was very lucky to have a CNA who would consistently notify me of every skin integrity issue she found.
One noc I was working 11-7 & a 35 yr old dying female pt with advanced lung CA & metz had been admitted by the ADON on the am 7-3 shift.
There was a full skin integrity assessment with Polaroid pics and a diagram or drawing we did on all new admits to document all pre-admit wounds signed by the ADON .
When the night shift CNA turned this new res she called me to the room b/c she found what we thought was a 7 cm decub on her upper back, just below the scapula.
Turns out it was the tumor from her lung CA that had eaten its way right through her back. And all day this poor lady had been positioned so that she was putting pressure on this unnoticed wound site.
When the am staff came in I privately told the ADON about what the CNA had found. Imagine my surprise when the ADON started SCREAMING at me for alerting her to the fact that this dying resident had a tumor breaking through the skin of her back.
Where was her the empathy & compassion for this dying lady's pain? ADON was just embarrassed that the CNA found something she had missed and was only worried about what would happen if state or the BON got wind of it. Sad.
But anyway just wanted to say thanks for caring so much about your residents!