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?
I'm sorry you both had to deal with nastiness from your supposed "coworkers"! It is infuriating, the insensitivity of people who are working in what is supposed to be a caring roll.
Angie, I am going to guess you won't have alot of flack from your attacker again anytime soon.
Just a few questions if I may.....Were you on 7pm - 7am? And, are you saying the physician never spoke with the patient or that you did not know if he/she did explain the surgery? Because many a time has the physician came in and explained the procedure, then walked out and on the way past the desk reminded the nurse that they have explained the procedure to them, and to obtain the consent.Perhaps this nurse felt that all the paperwork up to the vitals, checklist should have been done. But anyways, I do hate it when this stuff happens, such a shame.
Specializes in LTC, HOSPICE, HOME, PAIN MANAGEMENT, ETC.
I got so steamed reading this, I couldn't even finish reading the other posts!!!
I think you showed remarkable restraint! I have been in this position so many times! I have even added that I was a witness to sig only, attaching a note that Md informed that pt needed more explanation re: procedure. What slays me is when I think of all the other work that needs to be done on a pre-op chart and patient, to fuss over a "little" thing like a consent you had no control over...hhhmmmpphh! I totally understand your frustration! Later if you're uncomfortable you can always make amends, but she was in the wrong! Oh also, I usually remind people who say "That's ___shift's job" that we're a 24 hour facility and ANY SHIFT can do it. That irks me as much as "THAT'S NOT MY PATIENT"!!! Not a good thing to say to me!
If pt has not been instructed at all and I'm uncomfortable I WILL NOT get it signed and pass it on. Working nights I certainly AM NOT calling md for this. Pts also refuse to sign until they've rec'd better instruction. (Upon my notifying them of thier rights!) :uhoh21:
Be all that as it may...the question was asked AND ANSWERED! HELLO! After 12 hours it's time to go and if she was having trouble hearing, maybe you needed to raise your voice a little! :deadhorse :smackingf
Just a few questions if I may.....Were you on 7pm - 7am? And, are you saying the physician never spoke with the patient or that you did not know if he/she did explain the surgery? Because many a time has the physician came in and explained the procedure, then walked out and on the way past the desk reminded the nurse that they have explained the procedure to them, and to obtain the consent.Perhaps this nurse felt that all the paperwork up to the vitals, checklist should have been done. But anyways, I do hate it when this stuff happens, such a shame.
Yes, I was on night shift. Yes, the patient was medicated and sleeping for nearly all of it. Yes, I could see by the progress notes that the doc had seen the patient the night before but he did not specifically ask for consent nor did he mention in the notes whether or not he explained options, risks and benefits to the surgery. He also did not write the exact name of the procedure that he wanted to perform.
I did not see the doc. This was on the shift before mine. I gave the information that I got in Report.
So I did not feel comfortable that this was a fully informed consent and had only a guess as to the specific name of the surgery he was to perform.
And yes, the nurse following me felt that all that should've been done--except for the fact that 3/4 of the necessary information was to be done immediately before the patient was brought down for the surgery--which was scheduled for at least six hours or more after I clocked out.
So no, it was not appropriate for me to do the paperwork. Night shift only completes the paperwork if it's an a.m. surgery.
As I said, the hardest part of all that was making sure that the patient's labs were supportive of a surgery, and making sure that the evidence was on the chart. I did that part and even placed the blank forms on the top of the chart so if the surgeon saw the patient or chart during morning rounds, he could easily see that the consent had not been signed yet.
I think you were appropriate. I personally can't stand it when day shift relief holds me up in report with stupid things like that and I'll let them know when they try it. Nursing is a 24 hour job. I have to pick up where they left off, they have to pick up where I left off. Get over it or get another job.
ok....thanks for the answers....In that case, i agree with you. Just was not sure of those few questions. If you would have gone in there and had the person wake up in the middle of the night to sign a form that he/she did not have documentation that all info was given to them by the Dr, and god forbid something would have happened, you would have been in huge trouble. Thank you for explaining this, this nurse was out of line, and she is the one who needs to apologize, but Im sure that probably won't happen unless she is forced to...
Ugggg, this kind of thing bugs me so much. I am a new nurse and, yes, sometimes I miss things. I work as hard as I can and do everything that I know of that's expected of me. I hate giving report to a certain nurse because she ALWAYS can find one little thing that I didn't do then she makes a big deal about it and tells me that I need to go do it before I leave. Last time it was that a new admit that I got at 5am needed a new IV because the two that she came to the floor with were both bad. I was so behind in charting on my other pts who were very difficult (2 confused and getting OOB), then I also needed to finish the admit charting so I asked the charge nurse if she could try it and she said she would but she forgot and it didn't get done.
Yesterday it was a pt who was transfered to my floor at about 2am and she had an order from two days ago to dc the foley. I did my chart check even though it had been done on the other floor, but I only checked the last 24 hrs of orders. It was on the Kardex, but I didn't print it since I was only having her for a couple hours so I missed it. This nurse acted like I was so dumb to have missed this order, but what about the 4 other nurses who also missed it? She told me to go take it out, so I stayed and did it. Would you guys have stayed for something like that or just let the oncoming shift do it? It took a whole 2 minutes to get the supplies and do it, but still....
I was also a little irked by the tech that we have overnight. We only have 1 so we do all of our midnight vitals, but she is there to do our 0400 vitals since only some pts get them and she does daily wts and accu checks. She also helps with turns, but most of the time the nurses do them. When I gave her my 3 pts who needed things she made some comment on what would happen if we didn't have a tech, and how we expect her to do so much. Well if she didn't do the 0400 vitals what would she be doing? Reading a magazine or going on the internet probably. She always has an "I don't want to do anything" attitude. Whenever I need help from her she's either on break or no where to be found. A lot of the nurses have the same complaint.
What an ADORABLE baby in your avatar!! She's a real cutie!
Next, I do the same thing. I try to get as much done as possible, but you know, I have to finish up things that weren't done on evenings and days has to pick up on things that I don't get to finish.
That's the job.
Don't let her bully you into staying to do things that are missed unless you really want to do them for her.
I'm sure she misses things too, if that's any consolation.
But more than that, you must insist on being treated with respect.
Sometimes I think that's the hardest part of my job, especially at the end of a hard night.
Did this ever happen to you? Wanna tell me about it?
Why would you be in trouble? You did nothing wrong and you were right in what you said. I get the consents as soon as I see the written order and if the surgery will be in less than 24 hours but if I go in and ask the patient if the doctor has explained the surgery, the risks and benefits and the answer is "no" then forget it. I call the doctor. The answer I always get in reply is "don't worry we'll get it signed down here in OR". Fine, I'm not doing the doctors job for him, it's his respobsibility not mine. I've blown up a time or two in report but hey as long as you keep it civil there's nothing wrong with that. I mean if you had cussed her out, yeah, I could see you getting written up but you did not say anything wrong even if it was loud, so what! You Go Girl !
You know...on my earlier post when I was talking about SOME nurses on the day shift, I really did not mean to infer anything about day doing more than nights or vice versa. What I meant is exactly what another poster has clarified...Nursing is a 24 hour job...YOU PICK UP WHERE THE OTHER SHIFT LEAVES OFF!!! But some nurses do not believe this. I, OTOH, wholeheartedly believe in this motto.
For example, one morning I got there and the night shift nurse had several things going on.. one of them being units of blood being hung on a patient going for a colonoscopy for GI bleed. She had not even gotten the first unit hung, even though the lab called to say it was ready at 0300. NO PROBLEM!! I, of all people, completely understand that THINGS COME UP. Stuff happens and you either forget (I am the first to admit to being scatterbrained sometimes...) or you just have to prioritze. I had no problem that morning going straight into that patient's room, starting the blood and missing report and getting behind on other patient's meds. The nurse that I took over for, though, was hesitant to just hand it over since she is one of the main ones that through a fit when one little thing is not done, or you are not absolutly sure of off the top of your head. I, however, believe in killing 'em with kindness and hope that if I do this type of thing and have this attitude enough, she will kinda lighten up also:nurse: :innerconf
Every shift, every nurse even, has to pass off something to the next shift. It's a 24 hour job. Half the trick is in trying to pass off what you really can't get done, and get the important stuff done. The other half of the trick is in being the oncoming shift, asking good questions and not pissing off the shift you're relieving. "Why didn't you do this" isn't a good question necessarily. "How far did you get with this" is a better question.
Because, if you tick 'em off as you're coming in, you have to go home sometime, and payback can be interesting. On my unit we have a couple or three people who work 7am-3pm instead of the 7-7 that almost everyone else works. And wouldn't ya know it, they're the ones who come in at 7am with an attitude. We tape report. I've been in the situation of getting ready to go home after a horrific night, and having relayed in report what did not get done, and being questioned not once, but 3 times "Why not?" - so yes, that morning I did raise my voice the third time and say "BECAUSE I DID NOT HAVE TIME." The next time I saw that nurse she had no questions for me.
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camay1221_RN
324 Posts
Angie and Triage,
I'm sorry you both had to deal with nastiness from your supposed "coworkers"! It is infuriating, the insensitivity of people who are working in what is supposed to be a caring roll.
Angie, I am going to guess you won't have alot of flack from your attacker again anytime soon.