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Joint Commission had me for lunch.

Posted

This is a vent. I got cornered by a surveyor yesterday. Patient was 98, post op ortho, lost a liter of blood in the OR, got transfused but needed a dose of a pressor after he dumped his pressure upon arrival to the PACU. White as the sheet. Anesthesia encourages me to start small with any pain meds I give. Did I mention the history of kidney disease?

Here comes the JC to question me about my care. ALL they cared about was if I was following the 1-10 pain scale, and if the pain meds were ordered according to that pain scale. (They were) They didn't like my mention of nursing judgement regarding the low BP upon arrival and my choice to start at the lower dose (which was within ordered parameters.) they demanded to see the orders for the parameters for the low BP r/t the pain meds. A co-worker jumped in to intervene at that point; she was quicker at pulling up the info they wanted.

I transferred the patient to the ICU then went to lunch. I was then told that the JC had demanded to see my file to assess my competencies. Director sent them to HR, as I am on orientation, and she didn't have anything to show them. I was pretty upset at that, even though everyone told me not to worry. Anesthesia MD said to me that if we are ONLY going to medicate according to the 1-10 pain scale without looking at the whole picture of what's going on with the patient we would kill a lot of patients. A robot could medicate that way. Do you think the JC will be there to have our backs after that kind of fallout? I doubt it. For the record, I did medicate the patient for pain twice, and he was comfortable and safe when he left my care.

Pat_Pat RN

Specializes in ER, Med/Surg. Has 8 years experience.

Not everything is black and white. There are multiple shades of grey. We didn't go to school to just follow orders and not use our brains.

SierraBravo

Has 3 years experience.

You make a great point. We're not just robots following orders. We're trained professionals who are licensed to practice nursing. As a trained professional, I always apply critical thinking and my assessment skills to practice safely within the parameters of what the provider orders. It sounds as if you did the same. Like you said, the patient was comfortable and safe.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

((HUGS)) the JC is the hospitals problem..you did fine.

meanmaryjean, DNP, RN

Specializes in NICU, ICU, PICU, Academia. Has 40 years experience.

You are fine. That's just how they are.

On a related note: How badly would it SUCK to be a Joint Commission inspector? Absolutely NO ONE is ever happy to see you.

duskyjewel

Specializes in hospice.

Must be like being an IRS agent....

Morainey, BSN, RN

Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.

I got cornered for a practice one of these... and ALL they asked about was the pain scale, 0-10. It was so frustrating to explain to two play-acting administrators that no, the patient hadn't received any PRN pain medications, because she WASN'T HAVING PAIN. I guess we should just load everyone up on pain meds according to their stupid 0-10, even if the patient states that their 4/10 is tolerable to them, because otherwise it looks like "it wasn't addressed". :sniff:

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

You are fine. That's just how they are.

On a related note: How badly would it SUCK to be a Joint Commission inspector? Absolutely NO ONE is ever happy to see you.

It's probably as sucky as being a state surveyor. I always felt bad for the facility staff because I'd been on the receiving end of surveys for years and knew how stressful they are. Unfortunately, being empathetic did not make me a very good surveyor, and I didn't last long.

westieluv

Specializes in Med/Surg, Tele, Dialysis, Hospice. Has 26 years experience.

And if you had medicated for pain strictly based on the pain scale without taking into account the pt's BP, would the JC have commended you when the pt. coded? Nope, of course not. They would have thrown you under the bus and given you a lecture about how you should have done a thorough assessment before medicating the patient and USED YOUR NURSING JUDGMENT.

It must be awful having to be the nazis of the healthcare system. :rolleyes:

Just one more reason I love working nights.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

Just one more reason I love working nights.
Amen sister...LOL

Pat_Pat RN

Specializes in ER, Med/Surg. Has 8 years experience.

On a related note: How badly would it SUCK to be a Joint Commission inspector? Absolutely NO ONE is ever happy to see you.

It's probably as sucky as being a state surveyor.

No one makes them take those jobs. :dunno:

Nurseboy1

Specializes in MICU, SICU, CICU. Has 12 years experience.

I can empathize, the JC was at my facility once and wanted to observe a rapid response call if it happened. Of course one was called and I was the charge nurse that responded and got to deal with a decompensating liver patient and coordinate moving her to the ICU, while the survey team, my manager, the floor manager, the CSU director and the VP of nursing all stood in the doorway watching. Then after getting her to the ICU they all wanted to sit down and discuss the rapid response, even though by that point the unit was busy and I was still trying to relieve as many nurses for lunch as I could.

NurseCard, ADN

Specializes in Med/Surge, Psych, LTC, Home Health. Has 13 years experience.

I would HATE to be a state surveyor. Could not do that job, nope.

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

I would HATE to be a state surveyor. Could not do that job, nope.

I couldn't either, which is why we came to a mutual parting of the ways four months into the job. Part of the problem was I was too friendly toward the staff---I lacked the poker face and the killer instinct. I just didn't want to be the kind of surveyor who goes around intimidating people.....I know all too well what that felt like. Oh well, it was worth trying.

martymoose, BSN, RN

Specializes in PCCN. Has 18 years experience.

This is another reason why I want to leave nursing.You get punished for having critical thinking.

Whats up with this damn pain scale anyhow???I get the pain scale.I understand that.What I don't understand is the push for the pain scale 1-10, yet MD's are being told they are over prescibing pain meds.

No win situation. Or is that what the JC really wants?????

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

Well, they have to have something to justify their phony-baloney jobs, don't they?

meanmaryjean, DNP, RN

Specializes in NICU, ICU, PICU, Academia. Has 40 years experience.

JC is surveying our hospital next week. I get off work at 0730 Monday morning, and don't come back until 1900 on Friday.

I am one VERY happy nurse right now!