Lost It at Work!

soliant12 · Feb 23, 2006

You did the right thing. It is the Physicians responsibility to talk with the patient and obtain consent.

OK, I don't do this very often, but there we were, in Report, and day shift nurse started harping on me and browbeating me over having a patient sign consent for surgery.
"We don't do that," I corrected her. "The doc has to do that."
"Night shift does that, now why wasn't it done?"
"Because the doc hasn't spoken to the patient about the risks and benefits of the surgery. The DOC has to get consent, not us."
"No he doesn't. WE do it. You were supposed to do that. Why didn't you do that?"
"Because the patient's procedure isn't scheduled until this afternoon. The doc has plenty of time to come in and see her about it."
"But NIGHT SHIFT is supposed to do that!"
...she would not get off it.....
I didn't even want to get into what the Nurse Practice Act says about the surgeon getting the informed consent with the nurse only witnessing the patient's signature, but I wasn't giving a lesson on Nursing Law; I was trying to give Report.
"But you were supposed to get the consent signed!"
Finally my temper blew. I stood up and said, "You need to stop arguing with me and just TAKE REPORT. I am trying to give you REPORT so that I can GET OUT OF HERE and go home. I am giving you THE INFORMATION THAT I WAS GIVEN. I DO NOT KNOW if the doctor has spoken to this patient about this procedure. Therefore, CONSENT WAS NOT OBTAINED. Do you understand."
Very loudly. Heads turned.
On the one hand, I've NEVER stood up for myself like that before. OTOH, if she'd just have shut up, I would've stayed and helped her. OTOH, I feel terrible for losing my cool.
I'm probably in a whole lot of trouble.
Did this ever happen to you? Wanna tell me about it?

DusktilDawn · Feb 23, 2006

In regards to consent, what nurses are allowed to do is sign as a witness. It is the physicians responsibility to explain the procedure, the risks, the benefits, and obtain consent for the procedure. I don't understand why your co-worker was adamant that it was your responsibilty since you work nights and why she made such an issue out of it. This person obviously wasn't comprehending what you were trying to tell them.

BTW, I doubt you'll be in trouble. If I feel I was out of line in how I responded to a co-worker, I will apologize.

Mississippi_RN · Feb 23, 2006

:yeah: You did absolutely the right thing! (Maybe you could have done it with your voice a little less raised but I know how it is in the heat of the moment) You could NOT get the consent signed if the doctor had NOT talked to the doctor about the procedure. Just like if the doctor HAD come, went down there talked to her for 2 hours even, and then come up to the desk and told you to get the consent signed...only for you to go down there and the patient say "I have some more questions" or "I dont think I understood him/her" --- YOU CAN NOT GET IT SIGNED THEN EITHER!!

Some of the people on our night shift are exactly like this...you do and do and do trying to make their load lighter and then, even if you miss one little thing (the other night ONE dose of Reglan IVP) they spaz out. I mean, days are way more busy than nights, not that night people don't have their share of things to do.. But point is, EITHER shift can only get what they can get done and that is it.. The only time I would complain (although I'm not a big complainer) was if something (or a lot of things) were blatantly NOT done out of what I could absolutely discern was just laziness.

Otherwise, I don't blame you.. When people keep harping on the same thing and just kicking that dead horse :deadhorse it gets real frustrating.

You shouldn't get in much trouble (besides maybe the raising your voice thing--but I wouldnt get you about that) because you were RIGHT.

crb613, BSN, RN · Feb 23, 2006

I don't think you did anything wrong......I know it makes you feel like crap for losing your temper.... I would just try & forget it & carry on as usual.

carolinapooh, BSN, RN · Feb 23, 2006

Hey, there are limits....she hit yours....you're human....you lose it. The term "loud" is relative, as anything over a low voice in a quiet room sounds like screaming. I doubt you were screaming at her.

Apparently the nurse you were talking to was either (1) still asleep, (2) completely lazy, (3) a complete idiot, or (4) all of the above.

I wouldn't worry about it.

Dorito, ASN, RN · Feb 23, 2006

I agree with the above posters. The patient needs to make a decision about the surgery based on information the Dr has informed him of. I know I've had to get consents signed as well but for any major procedure it's the Dr's job. As far as losing your temper...I've worked plenty of nights and by the end of the shift it's all you can do to drive home. I wouldn't worry. You can always apologize to her and tell her your reason's for not getting the consent signed when she's willing to listen.

SmilingBluEyes · Feb 23, 2006

I can't see why you would be in trouble. You conveyed the appropriate info and the person was not willing to listen. I am sorry it took your losing your temper to be heard----sometimes, this does happen. If you feel badly about it, you can take this person aside and say you are sorry you "lost it" and request you not be interrupted while giving report again.

Don't be too hard on yourself, however. Your frustation is clearly understandable.

beautifulb · Feb 23, 2006

I think you did the right thing. The day nurse just wasn't comprehending what you were saying. As long as you weren't screaming and yelling at her (which you weren't) you should be all set.

psalm, RN · Feb 23, 2006

You did absolutely the right thing! (Maybe you could have done it with your voice a little less raised but I know how it is in the heat of the moment) You could NOT get the consent signed if the doctor had NOT talked to the doctor about the procedure. Just like if the doctor HAD come, went down there talked to her for 2 hours even, and then come up to the desk and told you to get the consent signed...only for you to go down there and the patient say "I have some more questions" or "I dont think I understood him/her" --- YOU CAN NOT GET IT SIGNED THEN EITHER!!
Some of the people on our night shift are exactly like this...you do and do and do trying to make their load lighter and then, even if you miss one little thing (the other night ONE dose of Reglan IVP) they spaz out. I mean, days are way more busy than nights, not that night people don't have their share of things to do.. But point is, EITHER shift can only get what they can get done and that is it.. The only time I would complain (although I'm not a big complainer) was if something (or a lot of things) were blatantly NOT done out of what I could absolutely discern was just laziness.
Otherwise, I don't blame you.. When people keep harping on the same thing and just kicking that dead horse :deadhorse it gets real frustrating.
You shouldn't get in much trouble (besides maybe the raising your voice thing--but I wouldnt get you about that) because you were RIGHT.

...okay, I don't want this to become a nights vs. day shift thing, but I work nights and average 6-9 pts. Days average 4-6 pts. Both shifts have their own stresses...Yes, days deals with lots of distractions but they usually have more help with CNA's, pts. are gone for dialysis & other treatments. There have been times I was told at report that so-and-so was scheduled for surgery in the a.m., but chart has no orders for preps or pre-op meds, no consent form, pt. who is a&oX3 isn't aware of said surgery. So I don't get a consent signed!!

...once I was giving report to day nurse and she asked why I didn't have this done, that done, this other thing done, etc. I held up my cheat sheet and said : because I had 9 pts. and an admit at 0600, called docs all night and did the best I could with what I had (that was the night the computers were down as well as the pneumatic tube system) had 2 pts getting blood and we were short a CNA. Then I laughed :chuckle

...most of us try to get things ready for the next shift, esp. for the first hour to run smoothly, as hang new bag of IVF, get supplies ready for enema or go-lytely ordered for 0800, etc...

Hang in there...

Town & Country · Feb 23, 2006

Some of the people on our night shift are exactly like this...you do and do and do trying to make their load lighter and then, even if you miss one little thing (the other night ONE dose of Reglan IVP) they spaz out.

I can so relate to that statement.

If anything, I think the day shift nurse should be in trouble for trying to browbeat YOU into stepping outside the bounds of your license.

Even if you had gone and gotten the consent, it wouldn't have been legal unless the doc had talked to him.

If I were you I would discuss this incident with your NM because you can bet there will be a repeat performance unless this is straightened out.l

No way would I apologize. She would not shut up, you did what you had to do, don't back down now! What you are doing is also advocating for your patient by insisting he gets INFORMED consent.

Sounds like that unit has some problems. I would talk to the NM, pronto.

SouthernLPN2RN, MSN, RN, APRN, NP · Feb 23, 2006

I think you did the right thing. This person didn't want to listen and you were patient with them. Anyone would have lost their cool with that kind of junk!