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)
Absolutely you did not overreact. Any injury that breaks the skin, reguardless of the patients history, requires an assessment by the house employee health physician (usually ER) as soon as it happens. Someone needs to review your current imunizations and consider boosters as required. If the physician feels there is a serious risk of a life threatening pathogen being transmitted other measures- gamaglobulin, Hep-B-VAC, or even HIV prophylaxis could be instituted. When in doubt I also follow up with my PCP in case my employee health staff are being a bit too "cost conscious" with my risk management interventions. We work in a dangerous enviornment with less control of our risks than would be optimal. You have to take care of yourself. If you were a nuclear power plant worker exposed to a radiation leak you wouldn't wait to see if you glowed in the dark before you sought medical assessment and prophylactic intervention. HIV, Hep, VRE, MRSA all can kill you just as dead as plutonium.
Honestly, I think you overreacted. In my facility, it's the INCIDENT REPORT that needs to be done within 24 hours. If you were to follow up in the ED or with a physician, you could have easily done so after your shift; the injury wasn't such that you were not able to work with it. If someone, say, hurts their back, a visit to the ER right away may be indicated depending on the severity.
A few people mention the documentation of it as why the ER visit right away is necessary, but the incident report IS the documentation!
I think it depends on the facility. If we get injured on our floor we are to fill out the IR and go immediately for medical attention. They don't want us waiting until the end of the shift. Of course the ER if they aren't totally swamped under get to us ASAP so we aren't down there for four hours unless medically necessary.
I adamantly APPLAUD you for standing up for yourself and taking charge of your personal health! This is exactly what is wrong with the nursing profession today!! Why can't we look out for ourselves and protect ourselves? Who knows what diseases this patient may be harboring like AIDS or Hep. C. The people who feel that you wasted time or should feel guilty for leaving the floor for 4 hours should be ashamed. We have to take care of ourselves first and foremost! You bet I would have done the same thing. If this scenario had happened outside hospital doors, would it have been assault?
Though I am still a mere student, I'd like to weigh in on this. Every job I have had, had the policy that we go to be checked on company's time since it is a work related injury(typically this is not an ER, because my jobs were never in a hospital).
But I agree with many of the other posters...it all depends on your facility's policy. If they do not require an Employee health visit or ER visit on off hours, or certain medical facilities, I would certainly see my PCP just in case.
I just wanted to emphasize that you have a very narrow window for intervention if it is determined that you need intervention with gama or HIV proph. I think it would be very unwise to wait till the next day to call the doc or make an appointment. I wouldn't want to ever hear " sure wish we could have started treatment 3 days earlier- you might have lived.."
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.
steph
Agree 100%. That's our policy as well so we do go to ED whenever something happens that might end up in WC claim.
Around here it's kind of a triage system. During 7-4 the employee health nurse acts like a triage nurse, and off hours it's the supervisor. I've done supervision on off hours. You have to make the decision "is this an emergency". If not there are several options that include self-care, a trip to a worker's comp approved md, or an urgent care center. Sometimes you can just put a bandaid on a cut and go about your business, but you always need to document. I knew of a nurse that cut himself on a suction machine in a patients room. A very minor cut, that he treated with good handwashing. But becaues he documented, he was covered when MRSA cellutitus set in. But at the time of the cut a trip to the ER was not warranted or necessary.
ER should not be the first place employees go for every bump and scratch.
Thanks for the responses everyone, at this point and in the short hind-sight, I know that I did everything correctly. I was contracted to the hospital, so the following morning, when I did go to occupational/employee health, I was told that they(occupation health) could not see me or do anything for me. I did immediately call my agency and they filed me on their worker's comp. If I hadn't gone to the ED immediately, I would have to have gone about 12 hours after the incident to the ED or find a clinic/doctor in a the area.
As far as my assignments, I gave my 5 patients to the charge who had no patients. I had assessed the patients and ensured that they were in no acute distress. As nurses we should support each other,not become ****** when another nurse is injured, however slight it might appear. Have you ever seen cellulitis and MRSA wounds that take weeks of IV antibiotic treatment, that came from a scratch? It's very serious. I know that a nurses we provide a service, but have to protect ourselves just as much.
suanna
1,549 Posts
Absolutely you did not overreact. Any injury that breaks the skin, reguardless of the patients history, requires an assessment by the house employee health physician (usually ER) as soon as it happens. Someone needs to review your current imunizations and consider boosters as required. If the physician feels there is a serious risk of a life threatening pathogen being transmitted other measures- gamaglobulin, Hep-B-VAC, or even HIV prophylaxis could be instituted. When in doubt I also follow up with my PCP in case my employee health staff are being a bit too "cost conscious" with my risk management interventions. We work in a dangerous enviornment with less control of our risks than would be optimal. You have to take care of yourself. If you were a nuclear power plant worker exposed to a radiation leak you wouldn't wait to see if you glowed in the dark before you sought medical assessment and prophylactic intervention. HIV, Hep, VRE, MRSA all can kill you just as dead as plutonium.