making enemies

[loridoo]

I worked third shift last night and received complaints about the nurses who cared for my patients on day shift. I passed these complaints on to the supervisor on day shift this morning. She told the RN from days that she wanted to speak to her about some patient complaints at some point today and the RN pressed her to talk immediately. The supervisor went on to tell her the complaints (while I was sitting next to her). As I was walking down the hall to clock out both the RN and her tech approached me and told me from now on to come to them first before going to the supervisor.

The complaints were from a pt who stated that a dose of her phenergan IVP was slammed into her IV site and from a pt (and her family members) who complained she had been left in the chair for entire first shift - she is "bed bound" at home.

I thought I handled the issue properly - these patients would have talked to the head nurse today themselves I am sure - I was just giving her a heads up. I like to think I take the patient advocate part of my job very seriously.

Any thoughts?????

[sissyboo]

Lori, I'm just a student but thats probably exactly what I would have done! I hear all the time about the nurses role as pt advocate. If you informed the staff ahead of time they'd likely go quickly into comming up with excuses or explaining to you that thats not how it really was. I feel like going to the supervisor was the right decision...

[Dixielee, BSN, RN]

Unless it is a life and death situation, I would always go back to the nurse where the complaint originated. You never know both sides of the story, and families frequently misunderstand or misconstru events. I have taken care of patients who tell wild tales of treatment that I know are not true.

Unless you want to cause trouble for yourself and your co-workers, I would go back to the original nurse or tech and if you feel that your concerns are ignored or not addressed, then you may have to go to your supervisor, but not until.

Being a patient advocate is one thing, working as a team is another.

[ILWannabeRN]

I'm just a student, but I"ve been a CNA for a while now...try not to make enemies...the nursing world is rather small. Instead, spoil those patients rotten on your shift...make them forget any negative experience they had during the other shift, and just nicely mention to the other nurses whose the complaints were about that the pt confided in you that he/she prefers to be in bed, that's the way it is at home, and wasn't comfortable after sitting up all day.

Also, sometimes patients don't ASK nurses for anything...they just complain. Did the family or pt ask to be moved back to the bed? Is there a medical reason that the nurse thought perhaps it would be good for that pt to sit up? That's really info you should find out from treating nurse, not from family members who are obviously very emotional about their loved one.

I hope that didn't sound rude...I just know from experience, you have to deal with these people (co-workers) sometimes more hours a week than your own family. Definitely go to them first, I would only say something to a supervisor if it's a reoccuring problem or your suggestion didn't change the situation. .

[Dixielee, BSN, RN]

Also, sometimes patients don't ASK nurses for anything...they just complain. Did the family or pt ask to be moved back to the bed? Is there a medical reason that the nurse thought perhaps it would be good for that pt to sit up? That's really info you should find out from treating nurse, not from family members who are obviously very emotional about their loved one.

You may be "just a student nurse", but you give very wise advice and already have a good understanding of things. You will make a good nurse!

[canoehead, BSN, RN]

Go to the nurse yourself, and approach it as an FYI thing for her.

Treat the complaining patients like kings/queens, especially if you think they were actually treated poorly. Provide them with the name of your nurse manager if they choose to speak to someone up the chain of command. If they want to take it further they can. Sometimes they just need to vent in the moment, but I always like to give them information on the next step if they choose to go there.

In general I don't write up incident reports if the patient wasn't harmed, and if they can speak for themselves. (In general) If there is a history of neglect with that nurse, or the problem is repeated in spite of giving the FYI that the patient was unhappy I would think about going further with the complaint. Think about how you would like to be treated if you made the same mistake.

[ParrotHeadRN]

Sometimes pt's do try to pit nurses against nurses. And honestly, we don't really know what happens on someone else's shift. As a previous poster noted, there may have been a reason the pt was in a chair all day long. Regarding the phenergan, what constitutes "slamming it in?" Phenergan can hurt like hell, some patients tolerate that better than others. I always mix it with tons of saline and push it VERY slowly, but that doesn't guarantee that it won't hurt. I have no way of knowing how the other nurse administered it, but it may have seemed to the pt that it was "slammed in" if it burned.

When I am in that situation, I always speak to the nurse first, and I never make judgements. "Just to let you know, pt x is complaining that his/her phenergan was slammed in and that it hurt." This gives my coworker a heads up about possible complaints to higher ups and well as a chance to address it with the pt/family directly.

I can't tell you the number of times I've heard from other shifts about things that were supposedly said and done. Being on the other side of the bed so to speak, either as pt or family, is very stressful and misperceptions can easily occur. Being a pt advocate is absolutely your job, but as nurses it's also our job to be supportive of each other because sometimes that's the only support we get! I would have a hard time working with someone that I knew was going to go directly to my supervisor without at least speaking to me first, and hearing my side of the story. That makes for a very threatening and hostile working environment, IMHO.

[Roy Fokker, BSN, RN]

Also, sometimes patients don't ASK nurses for anything...they just complain.

Curious incident:

A few weeks ago, management got complaints about 3rd shift (I work 3rd shift) from three different patients about the "lack of quality care" over night. They complained to their physicians, who "indignantly" took it up to the "highest authority" that 'their patients were being ignored'.

Strange - since we were in THEIR rooms MOST of the TIME! We spent more time with the patients who "complained" than with the others on the floor!

Results? Night shift got "chewed out" for being "lax". I'm in the process of making/typing out my notes on what happened that night - because I think it's very unfair that night shift got dumped on - given our absurd staffing.

I'm not afraid of working hard - my undershirt was SOAKED that night from sweat - not because it was hot, but because I was running around so much (Irony: a couple of the "complainers" commented about it too!)

But I resent being manipulated and I really resent being treated unfair!

Point being: Just because a patient (or a family member) makes a complaint, it might not always be "legit". I'm not saying "defend a nurse, any nurse, to the death; no matter what".... nurses are human after all and even the best of us make mistakes. I'm saying "before you pass judgement, try to get both sides of the story".

cheers,

[clemmm78, RN]

I feel that you jumped the gun. If a patient complains about me or my care, I would rather hear from it from my peer first, so that I can either explain what happened or get a heads up if, indeed, I did do something worthy of a complaint.

Think of it from their point of view. If there is a complaint about care on your shift, woudln't you rather the opportunity to clear the air before it gets to an upper level? What if their complaints were not valid?

I compare this to a child complaining about a teacher being "mean" and the parent going straight to the principal before speaking with the teacher about the child's interpretation.

Edited to add: by going to the source first, you are not changing whether you are a patient's advocate or not. Advocating for your patients means doing what is best, and, in cases like this, it is best to find out both sides of the story first.

[burn out]

Loridoo,

Alot of times in nursing we have to make out patients do things that they may not want to do, but it is in their own best interest if they do. If we let patients just lay in bed after surgery and did not make them get up post op day 1 to ambulate they will have a longer and harder post op process. In your case I wonder why the patient was not up out of the bed and sitting in a chair, did they just leave her in bed?..pain is no excuse. The most important that needs to happen is that the family and patient need to understand why the patient was gotten oob instead of looking for wrongdoer or someone to balme because that just gives credence to the patients complaint and makes them think they are right. the poor day shift nurse probably just got reported for doing her job, and we wonder why nurses burn out.

[judyblueeyes]

Do you have a pt advocate?

We make a referral to the advocate so that the follow up comes from her.

She always takes the side of the pt (as it should be, that is her job), makes the pt feel heard and understood, relays constructive criticism to the staff and generally helps alot in these kinds of problems. Sometimes pts are not reasonable in their requests or complaints, but they should still be heard.

[StrwbryblndRN]

With all the advise given, maybe you could talk to the RN (the one who alleged slammed the phenergan) and let her know that next time will approach her first. That way any tension that may have arised from the current issue could be cleared. So if in the future another similiar situation comes up and you are the "bad" nurse you will find it relieving to know the RN will come to you first.

I am a student also and I am glad I got to read this thread. I initially would have thought to go to management first too. But after all the responses, I will know what to do when this comes up. I know at some point in my career I will encounter a similar situation.