Should I report this CRNA?

[RNPamP]

Hi everyone, sorry for the length of this post. I had a situation happen to me at work on Friday that I would like to get some feedback on. I am a PACU RN with 5 yrs of experience, and I consider myself to be extremely competent at what I do. Here is the situation: a male CRNA brought a lap chole patient out to PACU still intubated with an oral airway in place. Almost immediately upon arrival, the patient began to wake up, gagging on ETT, sitting up in bed, etc. At this point, the patient wasn't even on a monitor yet, and the CRNA extubated the patient. After the extubation, he turned away from bedside to throw away the tube and the patient contined to gag and cough quite severely on the oral airway. Thinking of risk of aspiration, I quickly removed the airway (which is something nurses on our unit do all the time). Also, there were 2 other nurses at the bedside with me who were both saying we needed to take the airway out. Anyway, the CRNA became very angry, saying "Don't you ever remove MY airway!". I tried to explain that she was gagging and seemed to be at risk for vomiting and aspiration, but he was too worked up. The next thing that happened is the part that I am thinking of reporting him for--he grabbed my arm and tried to pull me away from the bedside. I pulled away from him and said, loudly, "Don't you ever put your hands on me again; that's completely inappropriate for you to touch me!" :angryfire After that I think he realized what he was doing and he apologized, and we went back to business as usual. (In case you're wondering, the patient did fine). The more I think about it , the angrier I become, and I really want him to be reprimanded for his inappropriate and intimidating behavior. If you were in my situation, what would you do? I am thinking of putting the incident in writing and giving a copy to his supervisor and my manager. I just don't think I should let this go away. After all, how many other times has he probably done this (or worse) to someone else? Thanks for any help you all can give me.

[healingtouchRN]

write this person up, totally inappropriate! Witnesses?

[pat022351]

It's certainly within the scope of your practice to remove an oral airway if in your assessment you believe your patient no longer needs it and/or is gagging on it.

[CRNI-ICU20]

you should document this incident, if not for yourself, any subsequent incidents he will undoubtedly have. He doesn't have the right to put a fingernail on you, period. I suppose I can understand his concern regarding "his airway" issues...however, he handled it totally inappropriately. You were looking out for your patient; he was looking out for his territory and ego....if he had been paying attention, which he wasn't, he should have provided that step of comfort for the patient himself....and since you stepped in and did so, he doesn't have the right to grab your arm....

write him up....defend your position as "looking out for my patient"....he doesn't have a crooked leg to stand on.....idiot!

[sharann, BSN, RN]

It is the patients airway, not HIS or your airway to protect. If the patient was gagging and sitting up then they should have been extubated and had the airway out. Once they cross into the PACU the patient is both your patients. I would not htink twice about writing this person up either both for the verbal comments and of course the physical aggression.

Stick to your guns and keep good documentation.

[Ortho_RN]

So is it not normal for you to remove airways from your patients??? Our CRNAs leave patients with us intubated all the time... We remove airways.. and have even replaced oral and nasal airways when needed?

[bossfrog]

When he apologized, did you forgive him? If so, you should let it rest and be watchful.

[Larry in Florida]

Thanks to everyone for the advice. I have written up the incident and reported it to my acting nurse manager, her supervisor, and the CRNA's supervisor (figured I'd cover all my bases). I'm glad to hear that others would also report the incident; I was trying to convince myself that it wasn't a big deal but of course it was. BTW, I think if he decides to write me up he doesn't have a leg to stand on, the patient met all criteria for the removal of the airway. Also, there is nowhere that it says "only CRNA's can remove airways" and he's only going to make himself look bad by saying he was going to leave in an airway on an awake patient. I stand by my decisions, and I managed to keep my cool!

Why didn't you just solve the problem while he was there? All the write ups believe it or not sometimes backfires. I'm sure he got the message or would have if you had just said I want to talk to you. Then explain yourself and then if he didn't act right use the pen.

[RNPamP]

Thanks to all who responded; I appreciate the interest. I did end up writing this guy up. I was going back and forth on the issue, and while I do see the viewpoint of those who said to just accept his apology, I draw the line at physical contact. I felt that if he just had a bad attitude and was nasty, that was one thing, but grabbing my arm took it to a different level. As far as I know, he was probably reprimanded and still occasionally see him, but he's not working here that much. Anyway, I really just wanted him to know how serious I felt this was and that to do so again would probably cost him his job. Hopefully, he will learn to control his anger/impulses in the future! Thanks again for the support.

[SeaTracer75]

good for you!!!! :)