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.
