During my 7p-7a shift, confused pt becomes combative when myself and care partner are trying to help her to the BSC. I reached out to help her and she grabs both my arms and scratchs me (took off the skin, small bleeding). After the patient is safe per security, family, and doctor intervention, I become concerned about myself b/c then it dawns on me that this is a VRE and MRSA positive patient with a history of alcholol and drug abuse. I've only been at this hosptial for 2 months, so I start asking how do I fill out an incident report. Everyone gives me the blank stare. I eventually get an incident report. I call the charge nurses giving end of shift report, they tell me that they have to page the house supervisor and they'll be out in about 20 minutes, but to wash my arm. I believe that is too long, therefore I call the house manager and report it, then go to the charge tell them what has happen, give my 5 patients to the charge and go to the ED. I'm in ED for about 4 hours, return to the floor and take my patients back.
Was a scratch worth the report and ED visit? Also, during this event the charges never stop report to assist (the patient became very combative needing security, a call to family who rushed in and the md)
Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.
Here is the situation:
During my 7p-7a shift, confused pt becomes combative when myself and care partner are trying to help her to the BSC. I reached out to help her and she grabs both my arms and scratchs me (took off the skin, small bleeding). After the patient is safe per security, family, and doctor intervention, I become concerned about myself b/c then it dawns on me that this is a VRE and MRSA positive patient with a history of alcholol and drug abuse. I've only been at this hosptial for 2 months, so I start asking how do I fill out an incident report. Everyone gives me the blank stare. I eventually get an incident report. I call the charge nurses giving end of shift report, they tell me that they have to page the house supervisor and they'll be out in about 20 minutes, but to wash my arm. I believe that is too long, therefore I call the house manager and report it, then go to the charge tell them what has happen, give my 5 patients to the charge and go to the ED. I'm in ED for about 4 hours, return to the floor and take my patients back.
Was a scratch worth the report and ED visit? Also, during this event the charges never stop report to assist (the patient became very combative needing security, a call to family who rushed in and the md)
Do you work in LTC or a hospital?
If it were me I would have washed my arm very well with soap and water. I would have also filled out an incident report. I probably wouldn't have gone to the ED, but it sounds like your manager prompted you to do that. I'm sorry you were so unsupported in this situation. You should have had leadership telling you what to do, especially because you are a new nurse. I hope everything turns out for the best.
I probably would have tended to the cleaning and care of the scratches myself, filled out an incident report and reported to employee health first thing in the a.m. (Our Employee Health Dept requires we be seen for incidents within 24 hrs of the 'event' to be valid.)
If I strongly felt that I needed to be seen by the E.R. or have E.R. documentation, then I'd have asked for "professional courtesy" to have the E.R. staff keep my place in the triage queue, but allow me to return to my duties on the floor until they were ready for me and called me or paged me to come be seen. Don't know if that was even a possibility for you though - don't know what type of facility you are working in.
If hindsight finds you feeling you didn't make the best decision (who'd know it would take 4 hrs anyway) then just learn from it. When we know better, we do better. When we don't make such a good call, then just owning it and moving on is the best we can do.
Worst case scenario if I felt I really over-reacted, I'd probably be very generous with extending a hand to my co-workers whenever possible - bring plenty of chocolate to share for a while too. :)
Had the charge and the supervisor been more supportive and offered more guidance in this situation, then a trip to the ED might not have been necessary.
Typically a trip to the ED for a scratch would seem like overkill but it's that one in a million chance that something might have developed as a result of that scratch that might do you in. God only knows what was under that person's nails.....Does your facility have employee health? Those would have been the folks to call; they could have documented your injury which would have offered protection in the event that something happened as a result of that scratch.
Overall, I wouldn't feel too bad about it. Next time you'll know.
Actually I might have gone to ER depending on your facility policy regarding things like this. Where i use to work we would have had to go to ER in case something did happen to prove that it wasn't there before we went to the ER on that day so work comp would cover.
I worked as nursing supervisor/er nurse (a combined role at my hospital) and policy is you must be seen by a doc in case of workmen's comp issues.
So, depending on your hospital policy, no . . .you may not have over reacted.
Most of my employers have had a contract with occupational health and mandate that the employee receive a medical assessment for all on-the-job injuries. If minor, a non-emergency paramedic/EMT is called to the job site to assess and provide follow-up
Our hospital's policy is that you fill out an incident report and get seen in the ER (which doubles as our occupational health station) within X number of hours -- sorry, don't know off the top of my head. That's what that handy dandy policy and procedure manual is for.
You may or may not have overreacted. Your nurse manager should have been able to provide you with better guidance and information. Typically, unless it is emergent, our people don't go down until a slow time in the shift when the ER can get them right in, or after their shift is over.
I actually applaud you for standing up for yourself even if it make you look like you "over-reacted". Some might think its overkill but hey it's your butt on the line. If you contract something you won't get compensated if you didn't follow protocol, and my employee health is only open business hours-so anytime in between and its the ER. Yes its a big inconveniance for the other staff (blah, blah, blah), but again nobody else is looking out for you there so that duty falls on you. Its better to look like an "over-reacter" for one day than to live w/ the results forever.
I think you did what you thought needed to be done at that time under those circumstances. Everyone would react differently depending on a lot of factors. Whats done is done. Better safe than sorry, I think.
Actually I might have gone to ER depending on your facility policy regarding things like this. Where i use to work we would have had to go to ER in case something did happen to prove that it wasn't there before we went to the ER on that day so work comp would cover.
Same here. We had an orderly get hurt in a similar scenario, and she had to do a report and they sent her to the ER. If we get hurt, even in a minor way on the job we're supposed to have it looked at. Either by Employee Health, or the ER on off shifts. We're union though, so they can't bag you for this.
The reasoning behind this is if the injury turns out to be more serious than first thought, you're covered from the workmans comp angle.
A Few Years Ago I Saw An Episode On Oprah. It Was About Security,the Dues And Don'ts Of What We Should Or Should Not Do In Order To Protect Ourselves.
He Gave An Example As To Why Women Are More Likely To Be Assaulted Or Raped(stay With Me,i Have A Point)
Here's The Example He Gave: A Woman Is In An Elevator Going Up To Her Apartment Holding 2 Grocery Bags. There Was 1 Man In The Elevator. He Was Kind Enough To Help Her With Her Bags. When She Got To Her Door She Thanked Him For His Help And Asked Him To Just Put The Bag Down At Her Door . He Insisted On Carrying Them If For Her. Her Gut Right Away Said No But Women Don't Like To Hurt Peoples Feelings And Ignore Their Internal Warning System And You Can Guess What Happended. That Topic Had A Large Impact On Me And I Have Followed It Ever Since.
Tell Me The Truth,"do You Think You Overacted?"
Did You Follow Through And Listen To Your What Your Mind Was Telling You? Yes,you Were Doing What You Needed To Do For You. Who Cares What Other People Think.
Never Doubt Yourself. I'm Sorry For Rambling But Stuff Like This Annoys Me.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i do think that an incident report was the correct action. not sure that i would have gone to the er for a scratch or two.... but again i was not in your position.
regardless, your charge nurses should have assisted you in dealing with the patient.
in many institutions, if you're going to fill out an incident report, you need to be seen by employee health, urgent care or the er. she's afraid she might get mrsa or vre from the patient, and reading between the lines, perhaps hiv or hepatitis. the hospital is going to want to document that she doesn't already have those things. and they're going to want to check the patient.
your charge nurse should have assisted you. but i can't believe they made an employee wait for four hours for a work injury! when i went to the ed (after sticking a fistula and, when i flushed with 10cc of ns the whole amount plus some blood comes spouting out of an old needle stick in the fistula right into my face!) it was really busy. there were codes, traumas and patients on guerneys in the hallway. i was seen right away by a nurse pracitioner -- on a chair in the hallway. but right away. (of course maybe that had something to do with the fact that they really wanted an icu bed!)
Dolce, RN
861 Posts
Do you work in LTC or a hospital?
If it were me I would have washed my arm very well with soap and water. I would have also filled out an incident report. I probably wouldn't have gone to the ED, but it sounds like your manager prompted you to do that. I'm sorry you were so unsupported in this situation. You should have had leadership telling you what to do, especially because you are a new nurse. I hope everything turns out for the best.