Several months ago, I had two patients in the ICU. Pt A was recently intubated, on a paralytic, pressors, sedatives, and pain meds, Pt B a new admit, found down, unresponsive, intubated, no sedation, no pressors, no pain meds, DNR (brain activity testing planned for a.m.). I assessed Pt B, went in to check on Pt A and found that a clean up and linen change was needed. I told my supervisor what I was doing, which room I would be in, and asked that the supervisor listen for Pt B (monitor right next to supervisor desk). Supervisor said yes. Perhaps the bath took longer than it should have (about 30 minutes including linen change, with no assistance).
While I was with Pt A, PT B expired. I was not informed that my pt was bradycardic or even that the pt had died. When I came out of Pt A's room, the supervisor told me "yeah just bradyed down and stopped". The death pronouncement had already been signed by the supervisor and another nurse, the patient was extubated and cleaned up. The supervisor had contacted the house sup to call the M.E., house sup was busy and had not called. I told supervisor I would call, I was told "no, house sup will do it". Okay. I contacted the family, greeted them when they came in. After the family left, I went to assess Pt A again. The supervisor heard from the house sup that it was an M.E. case, so went in and prepped Pt B for transport to the morgue.
Although I felt that I should have been allowed to take care of my patient, I was very new to the department and did not feel it was appropriate to question the supervisor.
Now:
Several months later, the supervisor makes a statement to my manager in a meeting (with other people) about my inefficiency and lack of critical thinking. Telling my manager (not all the info above) that I chose to bathe a patient while my other was circling the drain.
While it would have been great to delegate Pt A's clean up to someone else, there was no one to delegate to. Did I believe that Pt B would expire while I was in the next room? No, of course not, but it happened. I feel that the supervisor is being malicious. When my manager asked me about the incident, at first I did not recall it. When I did remember, I contacted the manager and said yes, it did happen, but that my perception was quite different than the supervisor's.
I do not want to malign the supervisor. I do not want my manager to think I am an inept and/or incapable nurse.
She did all of that in less than 30 minutes? How long into patient A's bath did patient B expire? 10 minutes? Leaving her to do the whole shebang in 20 minutes? That had to be a lot of rushing around. How far apart were these two rooms? Or from the desk?
The rooms were one room apart, the nurse's station is right in the middle of all the rooms (small unit). The pt was extubated by the RT (they are dedicated to the unit). The supervisor washed the pts face, put on a fresh gown and turned off the monitor. The supervisor did not take out the IVs or foley. Can't imagine that it took that long.
I did tell her that I believed it would be an ME case, she disagreed with me until the House Sup called.
For the record, my manager has been very supportive. I am just amazed at the whole situation.
Specializes in Medical-Surgical/Float Pool/Stepdown.
I was not in the meeting. It was a management meeting. This was the first time my manager heard about the situation, it was then relayed to me.
I just wanted to clarify whether or not this meeting was like a three month eval that you were side-swiped at or what. It sounds like your supervisor really screwed up and is either taking heat for the situation that you're not privy to or is proactively trying to reflect any expected heat from themselves.
Either way, a nurse without a concept of accountability is one damn scary nurse, IMHO!
I just wanted to clarify whether or not this meeting was like a three month eval that you were side-swiped at or what. It sounds like your supervisor really screwed up and is either taking heat for the situation that you're not privy to or is proactively trying to reflect any expected heat from themselves.
Either way, a nurse without a concept of accountability is one damn scary nurse, IMHO!
The meeting was a monthly management meeting. I had actually gotten a great review several weeks earlier (supervisor did not have input).
I really feel that if I did the wrong thing, I should have heard about it at the time. Apparently, the reason it came up in the meeting was because the manager had recommended me to be on a quality improvement team. The supervisor then made the statement questioning my critical thinking and skills.
I really feel that if I did the wrong thing, I should have heard about it at the time. Apparently, the reason it came up in the meeting was because the manager had recommended me to be on a quality improvement team. The supervisor then made the statement questioning my critical thinking and skills.
I don't like to say "It's because she's jealous of me" at any time, but this does apply to you. She's heavily jelly, super jelly.
Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.
I agree with the PP about jealousy. That supervisor is trying to cover her ass for lousy decision making and is feeling a little pea green about you being recommended for something. I can't find much wrong with what you did. You delegated the tasks of watching Patient B to the supervisor, which is proper. I'm assuming Patient B was a DNR even if they were an ME case?
I agree with the many of the other previous posters - it sounds like the supervisor is covering something up / trying to prevent some kind of backlash and/or jealous of something.
I don't really see what you did wrong - you needed to clean a patient up and asked a coworker to cover another patient for you. The only thing that might have been able to do differently is that perhaps if you all have assistants they could have cleaned your patient up. If that wasn't an option (one of the units I worked on had no techs / assistants) then you did all you could do. I'm not certain why you weren't notified of the developing situation.
When I worked the floor and we had DNR/DNIs autopsy status / potential for ME case was something we handed off. Generally I've worked at large hospitals where we get cases covered on the news - car crashes, shootings, etc - and a fair amount go to the ME so the results can be given to the county prosecutor (or other entity) for review when considering potential charges. We confirmed with the attending who was on call at the time of death/expiration before we removed tubes/lines/etc (and if I recall correctly the house sup was generally involved in those conversations - it's been almost 4 years since I was a floor nurse). It really didn't take long for confirmation and if there were unresolved questions we cleaned the patient up, left lines/drains/tubes intact and sent them to the morgue (we did have a protocol for release to the funeral homes too).
Maybe this is an area to improve communication? Suggest this information is shared more freely to prevent this from happening again? If I recall correctly, at the last hospital I worked as a floor/stepdown nurse at, our patients had several symbols on our assignment board. I think it was something like a red asterisk for a DNR/DNI/comfort care only. I believe we used a blue triangle with it when the family had requested autopsy or it was an ME case. We also used a yellow circle for isolation patients, I think we used a purple circle for flight risk patients or sitter cases (either or both). Our board had room numbers, no patient names, applicable symbols, and the primary assigned RN plus the RN phone assignments. At the bottom of both boards (each side of our unit) the charge nurse plus phone and assigned tech/PCA/CNA and their phone number was also there. The boards were not in an enclosed or protected area so we didn't used names just room numbers. The only other people who knew the symbols were staff members (it was uniform throughout our hospital system). The board gave us a snapshot of patient status but we would still open the chart to check code status if patients were found unresponsive as we had no bracelet system. We also had a sticky note system in the chart - not part of the official medical record but things the other members of the nursing staff needed to know quickly if they were opening a chart on a patient other than their own - family contact info, code status, ME/autopsy status was generally there too. One of the more useful features of that stupid charting system (otherwise it sucked).
I'm saying this because nothing will change what happened - and you didn't do what happened. OP stated that RT removed the ET tube and the supervisor handled what was done of morgue/post-mortem care? Those things need documented (we documented what we did for morgue/post-mortem care and who did what) and that's not an action you completed OP.
I don't know what advice to give you about the coworker so willing to throw you under the bus. I worked with people like that. I tried my best, and left before I could get thrown under the bus. I watched it happen to another new grad and I got the heck out of there as soon as I could. Yes I had two jobs in 12 months. Three if you count that I started at my current employer at the end of those 12 months. I explained the situation in my interview for my first job at my current employer, focused on the things *I* learned (clinical/patient care *and* the things I don't want to become as a nurse). They hired me anyways. I've been promoted three times since I started there, and have been there almost 4 years. It balances out, after some time. If you *do* decide to leave your current job in the near future make sure in your interview for a new job you highlight the things you learned - don't talk badly about coworkers or the organization you are trying to leave. Healthcare can be a very small world.
Don't feel inadequate or inferior to your supervisor. As a new nurse (about 7-8 months in) I wrote my supervisor up for a similar situation (didn't end in death but was a stupid decision that could have). When you stand up for yourself, it shows your confidence. Clearly, if what you say is the truth, she was responsible for the patient. When a nurse watches your patients during lunch and they fail to act, is that on you? I don't think so. Sounds like your supe didn't do her job.
Agree that extubating an ME case is a no no. Maybe the supervisor was getting heat for that and is deflecting to you?
Or maybe she just resented having to do work on "your" pt. As a new icu RN I got needle stick. Since it was after hours I had to go to the ED for blood work. That is protocol. My pt was a neuro pt who was extremely agitated, restrained but able to pull out of them because he was strong and neurosurg wouldn't order any sedatives so we could monitor his neuro status. The charge- who had no pts since part of her role is to help with other people's pts-had to watch that pt while I was downstairs. It took a few hours- it was a busy ED. There was nothing I could do about it. She called down there every 20 min or so all upset that "I've been holding your pt down for xx minutes! When can you come back? " well,sweetheart, I was holding him down the whole shift which is how I got stuck and I cannot make the ED any less busy. She continued to call and was so nasty she almost convinced me to leave without getting the labs done so she wouldn't have to take care of my pt anymore. Lucky the MD talked some sense into me and righted my perspective and I stayed.
The point is, the situation was an accident, her job was to watch my pt while I got checked. She didn't like it because my pt was tough and she took it out on me. It was bullying.
It sounds very much like your situation was similar. And as someone else said I highly doubt she would have reacted well if you asked her to do the full bed bath and change while you watched a pt who appeared to be stable. It's unfortunate the pt chose that time to brady out but that's what happens when someone is (likely) brain dead- they can die very suddenly. You had two pts who needed something- one a bed change and the other to be watched. You are one person and can't be two places at once. Since you didn't have an aid I'm guessing part of the supervisors role is to assist when a nurse has more tasks than hands. She could have pulled you out to deal with the death and finished the bath herself. She chose not to.
Plus- the pt was dnr-all she had to do was pronounce and clean him up. It's not like she was exhausted from compressions and had to set up 5 drips and get more access etc during a code. She really didn't have to do that much which makes me think she may have been talked to for breaking protocol re ME cases and is now blaming you and trying to turn the attention to you instead of her mistake.
Either way from what you've said it doesn't sound like you did anything wrong. If a lot of your coworkers are like this or you have to work with this person a lot you may want to find a position with more team players.
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qaqueen
308 Posts
The rooms were one room apart, the nurse's station is right in the middle of all the rooms (small unit). The pt was extubated by the RT (they are dedicated to the unit). The supervisor washed the pts face, put on a fresh gown and turned off the monitor. The supervisor did not take out the IVs or foley. Can't imagine that it took that long.
I did tell her that I believed it would be an ME case, she disagreed with me until the House Sup called.
For the record, my manager has been very supportive. I am just amazed at the whole situation.