I've been suspended

[Sheila2155]

I am new to this site and need to ask a purely hypothetical question about communication between nursing staff. I hope you can help.

Okay - as a staff nurse if someone approaches you on the ward and says that a patient is 'quiet' when they have been assisted to bed for a rest - how would you interpret that comment?

Thanks everyone.

[Karou]

I think we need more information... How did you respond when the student told you "John's quiet"? Did you ask for more information or clarification? Did you assess John?

Was the patient actually deteriorating and was there a delay in care? How was he deteriorating and what was done to help? When? How long after the student mentioned the patient did it take for you to become aware that he was unstable?

I can see how you would be suspended if you were not aware that your own patients status was declining (student or not) and care was delayed.

I would have asked the student for clarification, assessed the patient, and called the physician/RRT and intervened as indicated. Most important would be to ask for clarification and then assess the patient...

[TheCommuter, BSN, RN]

I can see how you would be suspended if you were not aware that your own patients status was declining (student or not) and care was delayed.

Yep...especially if this is an acute care hospital setting where hourly rounding on patients is interwoven into the minimum standard of care.

If we lay eyes on our patients at least once per hour, this is often sufficient enough to catch subtle changes in patients' conditions before the situation evolves into outright deterioration.

[Been there,done that, ASN, RN]

I have no idea how I would have responded to that statement. Many variables here. That is not a request for help with a deteriorating patient.

This is your manager hanging you out to dry.

Where was the nursing instructor, and did they also receive that vague statement?

What does your malpractice carrier say?

[Been there,done that, ASN, RN]

Yep...especially if this is an acute care hospital setting where hourly rounding on patients is interwoven into the minimum standard of care.

If we lay eyes on our patients at least once per hour, this is often sufficient enough to catch subtle changes in patients' conditions before the situation evolves into outright deterioration.

Hourly rounding would not be "sufficient" to catch cardiac arrest.

[elkpark]

Are there any other nurses out there who would have reacted to those 2 words differently?

"Quiet how? What do you mean?" (And go from there.)

[ambobam]

Thank goodness there are many of us who would have responded differently, with concern.

Always check your patients.

Don't ignore students. They may have less floor experience, but they are ear deep in text books full of signs and symptoms every day of their lives.

[elijahvegas, ASN, RN, EMT-P]

i can see where most of you are coming from with your responses, and i agree, I too would've asked "quiet how". but i think its because we got the full story..or rather...we got the end result of the story that we're making some hasty assumptions because honestly, unless the OP is trying to save face, theres no reason anyone would assume "Johns quiet" is an actual distress warning.

In my mind this is how it played out

The OP was charting or tending to some other patient, the student had just checked on "john" but being a student, probably didnt do a very thorough assessment. Probably just popped in there to check to see if he was okay or something. The student went back to the OP and said "john's quiet" which the OP probably assumed meant "john is sleeping" or "john is just relaxing". Later on, it became apparent that john had already/had been coding, and no one caught it until maybe tele saw something was up? Or perhaps another nurse? Things escalated, the patient deteriorated and when case man or the charge started to investigate what happened and asked the OP why didnt they check on the patient, the student tried to save face by saying that they alerted the OP of john's "unresponsiveness" when they said they were "quiet". Since the OP has the higher degree of burden this couldn't go unpunished and they got suspended.

Given the information and the way this played out, this is really the only logical sequence of events i can put together because i cant imagine in any world where "john's quiet" means "rapid response"

[Mavrick, BSN, RN]

TLI. Too Little Information.

People communicate with much more than words. Had the student said, "John's quiet" in a little whisper and a relieved look, that might well be interpreted as "All is well, John is finally quiet after a very harrowing day".

However, had the student said, "John's quiet" with a questioning look, furrowed brows, tight lips and shaking her head, that invites more questioning such as "What do you mean by that? Tell me more about John. Let's go have a look."

I'm now very suspicious of you. Knowing full well a lot is communicated in two words, you have purposely left all that out in your original post. Now that you've been suspended it comes out that you ignored a request for help and a patient deteriorated because of it.

I don't know what you expect from here. NO NURSE will admit to ignoring a request for help.

It's too late for malpractice insurance but consult an attorney.

[TheCommuter, BSN, RN]

Hourly rounding would not be "sufficient" to catch cardiac arrest.

But at least hourly rounding will be sufficient to catch the patient before the 3 to 4 hours it takes for full rigor mortis to set in...

I wonder if the situation arose due to quiet 'John' being found in full rigor, which would mean no rounding was done. Then again, unchecked speculation on my part is morbidly bad...

[nurseactivist]

Hind sight is always 20/20 and to those superstar nurses who would immediately assess that is with the information that the client was declining. I can imagine a demanding patient and being told "John is quiet" and thinking oh that is good.

If you are a union hospital be sure to notify your shop steward to assist you in due process.

All we can do is learn from our experiences.

[lavenderskies, BSN]

Hourly rounding would not be "sufficient" to catch cardiac arrest.

Well to be fair, you'd have to be rounding q5min to catch every cardiac arrest.

[nursel56]

Agree we don't really know enough of the story to say for sure, but if the student approached you while you were busy with something else to tell you that "John is quiet" you can immediately assume there is a cause for concern, since the non-problematic reasons for a person to be "quiet" (taking a nap, watching TV, etc) aren't things a student or anyone else would make a point of bringing to the nurse's attention.

So it really isn't the 2 words, and hopefully you will acknowledge the lapse in judgement if they are going to meet with you before making a final decision on your future there. None of us is mistake-free, so whatever happens, try to dust off and move on.

I agree 100% with the others regarding the necessity of checking in with your student/patient at regular intervals and understanding that the actual words someone speaks are just part of effective communication. Hope everything works out for you!