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?
:yelclap: You did what you had to do. You gave report. The nurse was obviously not "getting" it. (Like another poster said, I think she was still asleep). BTW, I commend you for sticking up for yourself. Nurses get run over many times; it's time we start to speak up. I really doubt you will get in trouble. If anyone tries to write you up, make sure you don't sign anything and make sure you tell them your side of the story. It is the MD's responsibility to get consent. You can't go above your scope of practice. What did that nurse want you to do? Endanger your license? I wonder if she even knows about nursing laws. Don't worry, though. You did what you had to do and you also did your job. So, GOOD JOB!!! YOU WERE RIGHT!!!!
I work nights and this is a frustrating thing. One time I had a nurse just look at me with this "you imcompetent fool" look because I didn't get the patient to sign a cath consent that was just a possible stent. Furthermore, like you I had no proof that the doctor had explained the procedures, risks, benefits, and alternatives.
All of this would be avoided if 1: nurses respected the shift before them and 2: if Dr's would write in the MD order section if a cath (or any procedure) is planned and 3 VERY IMPORTANT: If physicians stated in the progress notes that blah blah blah was explained to the patient and patient agrees to have procedure. Then I would much better about witnessing a patient's consent.
It seems like it has become more of a day shift vs. night shift menatality!
I can understand some of it to a certain degree, but really it is ridiculous. I have worked every shift out there in the hospitals and every shift is guilty of a "little left over". There are a lot of times you just can't help it. Pt's illnesses and needs do not go by our time clock. Needs don't wait at shift change.
I am glad that you stuck up for yourself and now maybe she will realize how she was acting.
Let's not forget: often these nurses who "don't understand" why you didn't get X,Y, or Z done are so "upset" about it because they don't want to actually DO ANYTHING THEMSELVES.
That's why they bully the last shift - whatever you leave, they have to do.
I work nights and this is a frustrating thing. One time I had a nurse just look at me with this "you imcompetent fool" look because I didn't get the patient to sign a cath consent that was just a possible stent. Furthermore, like you I had no proof that the doctor had explained the procedures, risks, benefits, and alternatives.
All of this would be avoided if 1: nurses respected the shift before them and 2: if Dr's would write in the MD order section if a cath (or any procedure) is planned and 3 VERY IMPORTANT: If physicians stated in the progress notes that blah blah blah was explained to the patient and patient agrees to have procedure. Then I would much better about witnessing a patient's consent.
Actually I don't understand why physicians don't witness and obtain their own consents. Why are we put in the middle as "witnesses." In fact I worked at a facility (in Canada) where this was done, the physician obtained and witnessed his/her own consent. The CNO (College of Nurses of Ontario) strongly believed that whomever requires the informed consent should also obtain the signature. In fact, a number of Ontario hospitals requires the physician to obtain their own consent.
The fact is, are we usually even present when a procedure is explained. If a witness was acting in a "clerical capacity" only, than any support staff, such as a ward clerk/office clerk could carry out this function. Despite being told we as nurses are only to "witness" a consent, our SBONs despite what any agency policy says about a nurse only "witnessing" a consent, hold us responsible in our capacity as patient advocates to ensure that when we witness a consent that the patient has been informed. This is a problem for nurses when it comes to "witnessing" a consent, we are now accountable for ensuring the physician has done his job by informing the patient. Why are we "babysitting" physicians in this area?
I just don't see why it is even necessary to involve nurses in what is clearly a physicians responsiblity. Why is it so much bother for them to fill out and obtain their own consents at the time they discuss the procedure with the patient? Why are we, as nurses, under the guise of a "witness" thrown in the middle basically to ensure the physician has provided informed consent? It's not necessary.
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?
Good for you! so often in an effort to be nice, we allow other staff to browbeat, intimidate and irritate. You answered her question correctly and considerately the first time. I bet she has often displayed that behiavior with others, I bet now she will pause before she acts that way with you again.
In the case of what happened to me, now that I've had a couple of hours of sleep and a little time to think about it, I think this poor girl was simply overwhelmed.
I think I snapped out because the most important stuff WAS done--
Steady girl. Stick with your guns and don't make excuses for her. I find it hard to believe that she was overwhelmed before her day even started. Also, she just would not accept your answer that it was the Doc's job. She wanted you to do whether it was right or wrong. I don't think that she wasn't understanding or hearing you, she was trying to bully you into admitting that you should have done something that is clearly NOT your responsibility.
I'm very fortunate where I work where the nurse's only responsibility is to make sure the doc's sig and a witnesses sig is there for the pre-op checklist.
You did nothing wrong. You just established boundaries. Don't erase them now!
I work night shift and we get blamed for everything that is missing, dirty, done wrong, whatever! It's all OUR faults. We had a new grad that had been orienting on days and then had to orient with us on nights - she stated to her preceptor and in front of all the other night nurses that the "night shift had it made". I swear they think all we do is sleep at the desk :angryfire
To answer your question, yes I have lost it sometimes - and no you were not wrong in my opinion. Some people just don't know when to shut-up!
Good for you! 
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MMARN, BSN, RN
914 Posts