Hiding Discharges

Ioreth, ADN, RN · Aug 27, 2022

I wanted to add a few things that didn't really fit above.

I also found the other noncommunicative nurse's phone at the charge station when I came back after discharging my patient. She had gone on lunch break, left her phone, but didn't tell me because I "wasn't there". I told her that she needed to give the phone to me directly or keep it with her. She gave me quite a lot of attitude for that, putting it kindly.

I am always happy to hold phones for lunches, but I need to know that I am covering these patients. I never deny nurses lunches though I often can't take one myself.

I'm not charge terribly often, but when I am, I don't micromanage. I do check in with nurses periodically for needs, breaks, lunches, and discharge times. I do not chart audit or interrogate them on patient care as I hate having that done to me. I only got crickets when I checked in with these two nurses. Generally, if I see that someone is struggling I will adjust loads if possible, facilitate discharges, and try to time admits to their workflow needs. Sometimes I'll even settle a patient for them. I don't understand this behavior at all.

If it matters, one is a just past new grad, the other is very experienced but newish to this unit.

JKL33 · Aug 27, 2022

I did read the whole thing and don't mean to seem like invalidating your feelings but...

Things like this are simple. No this does not sound like bullying.

It sounds like you are one of those people who accepts responsibility and even reprimand while other people (the first of whom is your employer!) straight up opt out.

That is gonna feel like crap all day, every day.

If your manager had the gall to reprimand you while knowing that you were short-staffed, well...look no further. The rest, the details, are unimportant. Sorry, but they truly are.

If your employer isn't perfectly pleased with the flow of things while you are playing charge nurse and shift leader and while scurrying around caring for a patient load, it is 100% within their ability to CHANGE THAT. If their other employees aren't behaving the way they wish they would, they can change that, too.

That is all. That's really the end of the story. You would feel better right now if you would have mentioned that when your manager called instead of spending all of this time stewing about what the other nurses were or weren't doing.

HiddenAngels · Aug 27, 2022

I kind of disagree with JKL. I see this as passive aggressiveness. These nurses knew exactly what they were doing they just didn't want to do any admissions. The manager covered for them, period. And this is exactly why I don't like being Charge.

JKL33 · Aug 27, 2022

6 hours ago, HiddenAngels said:

These nurses knew exactly what they were doing they just didn't want to do any admissions. The manager covered for them, period.

I don't disagree. That still isn't bullying.

And the issue that the OP needs to worry about, the only issue amongst the issues here that s/he has the ability to change, is his/her own reaction to what happen, his/her own place in it.

The OP didn't create the underlying situation and the coworkers didn't, either. Other people saw how the day was teed up and decided to shrug and let the OP figure it out; then decided to call him/her on the phone and criticize while the OP was trying to make the best of it.

THAT is always going to be the #1 problem. And to top it off, we feel terrible about ourselves when we take it!! We know inside that it isn't right for someone to put us in a compromised position and then criticize how we handle it while making a bunch of excuses and STILL telling us that we should be doing better. That's just straight up bull. When we tolerate that we feel like crap.

The answer is to do our best and if others want to criticize invite them to come lend a hand or else stop wasting our time with the phone calls and petty critiques.

HiddenAngels · Aug 27, 2022

4 hours ago, JKL33 said:

I don't disagree. That still isn't bullying.

And the issue that the OP needs to worry about, the only issue amongst the issues here that s/he has the ability to change, is his/her own reaction to what happen, his/her own place in it.

The OP didn't create the underlying situation and the coworkers didn't, either. Other people saw how the day was teed up and decided to shrug and let the OP figure it out; then decided to call him/her on the phone and criticize while the OP was trying to make the best of it.

THAT is always going to be the #1 problem. And to top it off, we feel terrible about ourselves when we take it!! We know inside that it isn't right for someone to put us in a compromised position and then criticize how we handle it while making a bunch of excuses and STILL telling us that we should be doing better. That's just straight up bull. When we tolerate that we feel like crap.

The answer is to do our best and if others want to criticize invite them to come lend a hand or else stop wasting our time with the phone calls and petty critiques.

Agree with you here and I don’t think it’s bullying either. I do think it”s passive aggressive behavior and not just from the nurses hiding discharges (knowing they can get away with that), but also the person who called Charge to criticize. Passive aggressive behavior left unchecked can make someone feel bullied.

LovingLife123 · Aug 28, 2022

That has to be so aggravating for you. I honestly think there needs to be a class in orientation about hospital flow.

I know in my hospital floor nurses hide discharges. And I get they don’t want 5 admissions. It straight up sucks. But instead of having a couple here, a couple there, nothing is noticed until 1600 and all the discharges are released. Then those poor nurses are getting 2-3 admissions at once close to shift change because we are scrambling in pacu.

I truly don’t think they often think about the entire flow of the hospital. If I can’t get my patients to the floor, I can’t accept new recoveries. This makes the OR hold, then starts delaying other surgeries. It’s a whole ripple effect. On top of it ER can’t get their admissions up so they are holding and the waiting room fills up quickly.

I honestly if there was better education on the entire flow of the hospital, there might be a better response from nurses discharging patients.

I also fully believe all hospitals need a discharge lounge. A lot of the time it’s also waiting on a family member to get up there to get their loved one and they are often not in a hurry.

Ioreth, ADN, RN · Aug 28, 2022

I think there are two facets here. As LovingLife stated, there's likely a misunderstanding of hospital flow and these nurses chose to protect themselves from getting admits by hiding their discharges. I am usually a floor nurse, not charge, and it would never occur to me to attempt to hide a discharge.

However, the thing that makes me wonder about bullying is that for the two nurses that hid their discharges, this is a continuation of similar behavior on days that I am not charge. Both women are cliquish, they have coworkers they like and coworkers they don't like, and both have decided that they don't like me. This bothers me, but I don't have to be friends with all of my coworkers. However, it is becoming more and more difficult to have a simple collegial relationship with them.

For example, both women refuse me (but don't refuse others) to help with witnessed wasting of medications, narc count at the end of shift, turning and 2x assist with patients, "code browns", or really anything else I can ask for. Both women will have catty remarks when I am speaking to someone else, remarks that are intended to embarrass me. Both women have withheld information from me that could cause problems, never something that would impact patient care, but always things that would leave me embarrassed or unprepared. Catty remarks and withholding information were certainly the mode for the day I was charge in the original post.

I don't know if this is related, but I did precept both of these nurses. Both had trouble accepting correction. This wasn't with a difference of opinion on technique, but major patient safety issues that is spelled out in policy, stuff that would result in an incident report (and no I did not write them up when correcting them). With the younger of the two, she was rebellious with all her preceptors. The experienced nurse had a shorter orientation, so I may have been the only preceptor. I also never correct an orientee in front of a patient or colleague, but always in private and in a way that doesn't make them feel like a "bad nurse" but that things are done differently here.

I am not ready to leave this job because I want to get reimbursed for a class I am taking right now. It goes against my grain to leave a job because of a coworker. But I am starting to dread being on shift with them. I can generally ask for the help of others when I am a floor nurse, but when I am charge I can't avoid them. Also we've lost a few full-time charge nurses recently and another 1 or 2 will be leaving soon. The fact that I will be charge more often going forward is inevitable.

allnurses Guide · Aug 30, 2022

On 8/26/2022 at 8:07 PM, Ioreth said:

I'm trying to process a situation I was in recently and would appreciate feedback. Sorry for the book.

TLDR: Floor RNs hiding from Charge that patients discharged. Poor patient flow ensues, Charge is reprimanded for holding up PACU. Bullying or "self-protection"?

I was charge with my own full patient load on this day. It is a post-surgical unit, and we started with a full house, short 1 nurse (hence my full load), and expecting surgeries. I was also expecting several discharges, so wasn't too concerned. After settling my own patients, I checked with the case manager and reviewed the discharge planning for the day. Two of the nurses were expected to have some early discharges, so I checked in with each of them when these discharges would happen so I could manage beds. Both told me they were not discharging anyone.

So I started hustling. 2 of my own patients were discharging which would make being charge more manageable if I had a half load, but if I absolutely must I could take the post-op patients myself. Still not ideal. I also got working calling around other floors to see if anyone could take a stable-but-not-discharging patient.

My first discharge wasn't until just before the first surgery was to come out. When I was taking my patient downstairs, I saw one of the nurses that had told me she wasn't discharging anyone. She was discharging another patient. I came upstairs to find 4 vacated rooms and no word to me when these patients had left. As I was sitting down to clear the rooms for cleaning and turnover, I got a call with a verbal reprimand from my manager that I was holding up PACU.

I asked several times to just tell me when they are starting a discharge at least, but for the remainder of the day neither nurse would tell me when patients left. If I didn't have my own patient load I might have caught them rolling out, but since I was in my own patient rooms, I often didn't see them leave. This is despite my asking them several times the status of discharges and practically begging them to tell me when patients left.

The day ended a mess. Instead of a "light" surgery day, the one nurse that was communicating well ended up with an overly heavy load and the two other nurses ended up with half loads. We were overstaffed for the census, and someone probably should have been sent home but wasn't. We could have taken some load off the Emergency Department, but since I was told "not discharging" then "surprise! discharge!" I was unable to take those patients.

I was furious and talked to my manager several times. She told me that she spoke to the nurses and said it wasn't malicious, just self-protective and that they didn't want to promise something they couldn't deliver. It doesn't feel that way to me, but I'm not sure I can prove it was bullying.

However, with both of these nurses, this is not the first time I have had issues with them, never as charge before but generally other things like catty remarks and setting me up for problems in general.

So where I work the RN discharging the patient notifies bed control by taking the patient out of the. System once the patient is discharged. If an audit is done and shows the discharging nurse did not perform this task that nurse can be written up, suspended or terminated depending on the pattern if one exists.

nursej22, MSN, RN · Aug 30, 2022

leaving the unit without handing-off verbally to another nurse seems like patient abandonment to me.

JKL33 · Aug 30, 2022

On 8/28/2022 at 12:28 PM, Ioreth said:

However, the thing that makes me wonder about bullying is that for the two nurses that hid their discharges, this is a continuation of similar behavior on days that I am not charge. [...]

Well that's certainly some more information...

They sound special.

However...why is your manager making excuses for them?

Ioreth, ADN, RN · Aug 30, 2022

1 hour ago, hppygr8ful said:

So where I work the RN discharging the patient notifies bed control by taking the patient out of the. System once the patient is discharged. If an audit is done and shows the discharging nurse did not perform this task that nurse can be written up, suspended or terminated depending on the pattern if one exists.

I know both of them know how to do this, because that is how I trained them. Unfortunately, it isn't policy at my hospital. Charge can get in trouble for not clearing the room after a discharge in a timely matter, but the primary nurse isn't held accountable. I very much wish we had this policy.