I wrote up a surgeon and looking for advice

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Hello,

As a circulator tonight I'm feeling defeated. I've been a circulator for 3,5 years. Today a surgeon became really upset because I informed her it was policy to use an Legal interpreter before entering the operating room. The surgeon informed the charge nurse that she never wanted me in her room again. She stated I compromise patient care because the doctors are tired. She stated this happens all the time. I work with her about three times and on another occasion it was a paperwork issue because another doctor completed a H&P for a patient. I informed her she should update her H&P stating, "There were no changes to current H&P. "

When speaking to other co-workers they stated they just document in the record doctor refused. The hospital policy state otherwise. It states staff must utilize an interpreter. Questions:

1. Can I enter a note stating doctor refused, and still protect my license and job?

2, I completed a behavioral occurance report and email reporting the details to management. Should I do more?

3. . I strive for accuracy and perfection in an un-managed environment and unmotivated co-workers. Should I look for a new job?

4. Would it be unethical to adapt to the environment and unit culture? Im known as a hard worker, however I feel everyone view me as, "Over the top." I always get push back for doing my job, in attempt to provide positive outcomes.

Any advice would be appreciated. Thank you so much.

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Specializes in OR, Nursing Professional Development.

If there are many people not following policy, then management has created the culture that allows it to continue. I am unsure if you are in the US or not, but it is actually law that patients must be provided with a qualified interpreter (whether in person or via a communication device such as video conferencing or telephone) in the US.

"Three federal laws (Title VI of the Civil Rights Act of 1964, the Americans with Disabilities Act and the Affordable Care Act) require that providers who receive federal funds provide oral interpreters and written translated materials to LEP and Deaf and HOH patients." https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=2ahUKEwjRmtjG6KPmAhVqh-AKHYHpDScQFjABegQIDBAE&url=https%3A%2F%2Fwww.indemandinterpreting.com%2Fwp-content%2Fuploads%2F2017%2F03%2FInDemand-Interpreting-Trends-risk-1.pdf&usg=AOvVaw1gN84XkV1DSuIrtO_UgOVW

Failing to provide a qualified translator can land a facility in serious hot water, and I bet your risk and legal departments would be horrified to hear that doctors are refusing and it isn't being addressed.

If your facility policy requires an H&P/updated H&P/progress note by the actual surgeon prior to surgery, then the facility can again find itself in regulatory hot water for not following their policies (and likely those of the accrediting bodies as well).

Most likely, entering a note will not prevent you from potential issues- you are expected to uphold the policies. It's not like I can write a note stating I refuse to follow the speed limit and not get a speeding ticket.

Who gets the behavioral occurrence form? If it's your manager, yes I'd take it higher- to whoever that surgeon reports to, the medical staff office, or whatever the next level in the chain of the command is. If your facility has a compliance officer, they're going to want to hear about the policy violations- and there may be an anonymous hotline that you can call instead of having to put it in writing.

Yes, it would be unethical to adapt to the current culture. They are playing with fire, both regulatory and patient safety. Without a certified interpreter, how can patients be assured that they are actually giving informed consent? And if management doesn't address these situations, it is definitely time to move on.

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?Thank you so much for this educated, experienced, and timely response. You really educated me and allowed me to see the big picture. I am very humbled. I will take ALL your advice ❤️♥️❣️❣️

Words can't express how you helped me as a nurse. I am located in Califorina

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You should really watch how your management reacts and acts to the safety issues you have experienced and reported. If they do nothing or do not back you up, maybe you should look for a new job. The culture most likely will not be changed without management's help. Furthermore, they may not be doing their job to begin with if they do nothing for the safety issues. It should not be circulator's responsibility to discipline doctors.

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I can't find out if compliance officers are mandatory. But our free standing surgical center in California has a Compliance Officer. We are in-serviced every year about this important service. There is a number you can call and anonymously (if you want to be anonymous) report any serious issue. From sexual harassment to medical mistakes.

If you don't have something like this, look for a new job and when you get one quit.

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On 12/9/2019 at 6:06 PM, Green Tea, RN said:

You should really watch how your management reacts and acts to the safety issues you have experienced and reported. If they do nothing or do not back you up, maybe you should look for a new job. The culture most likely will not be changed without management's help. Furthermore, they may not be doing their job to begin with if they do nothing for the safety issues. It should not be circulator's responsibility to discipline doctors.

Yes, I agree. I will watch the situation. The only reason why I wrote her up was because she filed a complaint against me. I plan to look for a new job at this time. Thank you for the comment.

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1 hour ago, brownbook said:

I can't find out if compliance officers are mandatory. But our free standing surgical center in California has a Compliance Officer. We are in-serviced every year about this important service. There is a number you can call and anonymously (if you want to be anonymous) report any serious issue. From sexual harassment to medical mistakes.

If you don't have something like this, look for a new job and when you get one quit.

I have not come into contact with a compliance officer. If we have one it would be a big help. With it being a trauma center you would think they had one. I will check. We do have a risk management department that I reached out to. I will suggest yearly in services to my manager. It would be a big help if the surgeons understood our roles. I don't think they do. Thank you for your advice. Will research.

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Just wanted to say, as a current RN and a former hospital language interpreter.... THANK YOU for protecting your patients by insisting on their right to language access. It is not a doctor's right to dismiss legally (not to mention ethically) mandatory interpreter services. Not even if they're impatient and cranky and they "know" that communication is clear.

You would not believe the situations in which I encountered patients, with doctors insisting everything was fine and I could leave. Patients who had no idea what procedure they were having, patients who were told the wrong diagnosis in some medical resident's half-remembered college Spanish, patients being asked to interpret BMT consent forms for their sister in law. Nope. Good for you for making a fuss!

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Specializes in perioperative.

There was a well-known case about 10-12 years ago in the state of MN whereby a hospital was sued (successfully) by a patient for not providing an interpreter prior to a surgical procedure. One of the most common malpractice suits is in the area of informed consent. You did the right thing for sure. I would work at another facility due to this culture. There are so many outstanding hospitals that adhere closely to regulatory requirements. Your nursing career will grow when you only work in top flight healthcare systems with risk management depts that are well-supported by management.

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