am I that "b" nurse? or am I being an advocate?

[guestnurse]

Ok I am not perfect and I don't expect every one else to be either. I wrote myself up just the other day for missing an order for Solumedrol. Last night I had a hellacious night. Followed behind a new nurse/orientee and his charge nurse preceptor. I am flex pool nurse so I work all units at all 4 of our hospitals in this area. (love it) I usually don't work this unit as it is a med/surg and I usually work ICU/stepdown. When I was getting report from this orientee I could already tell he was lost with no direction or "precepting" being done. I soon quickly realized how lost he was when I came upon numerous missed orders, meds not signed off, iv infiltrated. So I spent the first part of the night sweeping mines. Finally began to chart at 130am. Had to do 2 incident reports due to iv which was infiltrated and pre-op orders for patient going to surgery which were not taken off and were written at 1400. I don't like to write incident reports. Was told by night shift charge nurse I had to for the iv infiltration and missed orders. My biggest problem with all of this was that this was a NEW nurse. Fresh out of nursing school who was receiving no guidance and teaching from his charge nurse preceptor who had no patients of her own, except to follow and oversee this orientee. So by the morning I am thoroughly p.o. I have already emailed my suprevisor about my hellacious night. When day shift came on and I was about to give report I told the new orientee that I had to do 2 incident reports last night and there were numerous missed orders and meds but that in no way was he to blame. I told him that as a new nurse and orientee it was the responsibility of his preceptor to oversee and go behind him to make sure all was done. I told him it was clear to me that she did not check behind him or oversee him. This charge nurse quickly piped up that "Oh yes I did check behind him!" to which I replied "well if you checked behind him how were there medications on every patient's mar left unsigned off and orders missed?" I told him that the incident was in no way to place blame on him only to ensure that procedures and policies can be improved and carried out in a way to ensure patient safety. I then talked to the nurse manager of that unit when she got there to which the first thing she said was I was "unprofessional" by bringing that up at the nurses station and confronting the charge nuse about her precepting of the orientee. If this had been a nurse I followed behind I would have cleaned up the mess and not said anything. The ONLY reason I was irate and made a big deal was because this poor orientee is being thrown to the wolves with no direction or teaching. I felt bad for him and I could see he was totally overloaded and overwhelmed. He had to stay until after 8pm to finish charting because he had been so busy. His "preceptor" charge nurse clocked out at 708pm. I was darn glad I confronted her face to face. It's about time someone stood up to her and let her know that she isn't doing her job.I"m a flex pool nurse, I work all over and I"m not tip toeing around any charge nurse or anyone else for that matter. If I make a mistake and have screw ups I gladly would like for any nurse to confront me face to face and let me know so I can apologize or make ammends as best I can. I don't expect everyone to be perfect cuz lord knows I"m not, but to throw a new nurse 6 weeks out of school to a busy med/surg unit taking 5 patients with admits and crazziness is just not right. I guess I will get the Bioatch label at that hospital because a few weeks ago I called the nursing supervisor because a patient from the other end of unit kept calling out for pain medicine and no one was answering her call bell or giving her pain medicine. When the nursing supervisor got up there he found out the charge nurse had left to go get food the other RN left to go on smoke break and left only an LPN on that hall with a nurses aid. She just didn't answer the call bell or do anything because she couldn't give the ivp pain med ordered. When nursing supervisor got there and I found out what was going on I told the LPN all she had to do was come get me and ask me to give the pain med, I would have gladly given it despite being busting butt busy with my 6 patients. Then when the charge nurse got back he was furious that I had called the nursing supervisor. OK so am I a bioatch nurse or am I being an advocate??

[cjcsoon2bnp, MSN, RN, NP]

This seems like a rather complicated story and a bit hard to follow but after rereading it I think I get the gist. I don't think that you were being the "B" nurse as you call it, I think you were being an advocate for both the patient and the new grad. nurse but I'm not sure you handled it in the best possible way. I think you were correct for writing the incident reports and sending an e-mail to your supervisor about the situation. I think that speaking to the nurse about this at the nurses station probably wasn't the best way to go about it. I think you should have gone directly to the manager of the unit and spoken with him/her about what had happened and then let them take it from there. Reprimanding the preceptor is not your place and if you are concerned with the job she is doing as a preceptor then that is something to address with the manager along with facts to back up your opinion. Again, I don't think you were being a "B" nurse but I think there was a more professional way of handling the situation. Keep the spirit of an advocate (for both patients and new nurses) but use the proper channels when dealing with this kind of situation in the future. IMHO

!Chris

[classicdame, MSN, EdD]

I did not read all of your long post, but your priority is to take care of patients. If co-workers get in the way of that, let them know

[love-d-OR]

I don't think you are a B-nurse, but as the previous poster stated you could have handled it more delicately. Here is what I would suggest next time:

1. Do not confront the preceptor, as it is not your place to reprimand her.

2. Next time a patient is screaming, instead of calling the house supervisor (you are skipping chain of command here), go to the patient and find out what the patient needs first. You said you told the LVN to get you, but you should have done this BEFORE involving the supervisor. What if the charge RN was in the middle of a code somewhere, and the second RN had legit reasons to not make herself available? You calling the supervisor whithout knowing whats going on sounds pretty drastic. I'm actually suprised she/he came up to see what was going on. I and am pretty sure my supervisor would have asked me why the patient was screaming, what I wanted her to do about it and why I had not called the charge nurse first.

[guestnurse]

Yes I think I could have handled it better. Mark that up to my learning experience. The reason I called the supervisor was because I kept calling the nurses station with no answer and was too busy to leave my 6 patients. If there had been a code I would have heard it called overhead. Our supervisors like us to call them and as a matter of fact he asked why I didn't call him last night when I was finding all the missed orders and missed meds and having a hellacious night.

[mesa1979, BSN, RN]

I think you handled it quite well! Kudos to you!

[guestnurse]

Also there were 2 RN's an LPN and 2 nurses aids on that end. On my end it was me and 1 other LPN with phones ringing, call bells going off and trying to take care of our patients. It wasn't safe for me to leave 12 patients with 1 LPN on our unit.

[tyvin, BSN, RN]

You are not a "B" and I think calling her out like that solidified the moment and perhaps she'll be able to get her priorities straight after this. It will definitely remain with her and be a decisive prompt for further action for some time to come but unfortunately people like that have short memories. Yes, yes; I know it was unprofessional and all that but sometimes we need to break the rules a little bit to tighten the ship (selectively of course ).

[tikilpn2]

It sounds like your heart was in the right place...:redpinkhe you were trying to advocate for the new nurse and ensure patient safety...

[SkiMama]

I am a student - but a question. If OP should not have confronted the preceptor, what could she have done differently/better when the issue of the incident reports came up and the preceptor stated "I did check up on him".

I assume that during report or other times - it's not uncommon for a nurse to come across another nurse's oversights. Is it not prudent to first go to that nurse before heading to the mgr?

[07302003, ASN, RN]

I think the best policy is to confront the person you have an issue with. Period.

What's unprofessional is going behind the person's back to the manager - deal with the person first, if you can, in most situations.

And you need to be a "B" at times to be an advocate. Men do it all the time, they call it what it is, and women have to be a "B" to call it what it is. That's why I like working with male nurses.

[nursemike, ASN, RN]

I am a student - but a question. If OP should not have confronted the preceptor, what could she have done differently/better when the issue of the incident reports came up and the preceptor stated "I did check up on him".

I assume that during report or other times - it's not uncommon for a nurse to come across another nurse's oversights. Is it not prudent to first go to that nurse before heading to the mgr?

I think confronting the issue during report was correct, but the OP's account seems to undermine the preceptor with the new nurse. I think it would have been more important just to note objectively what was left undone and what incident reports had to be written. If the OP felt it was necessary to critique the preceptor's performance, it would have been courteous to do it privately, away from the orientee.

On the other hand, I think calling the nursing supervisor on the other occasion was entirely proper. Leaving the floor with insufficient staffing not only prolonged the patient's pain, it may have put other patients' safety at risk.