Patient safety in nursing

[rvzohfeld, BSN, MSN, RN]

I would like to get your opinion on the following scenario. Please be respectful and professional.

Nurse A takes patient B to the restroom after surgery (patient B is a female and had GYN procedure). Nurse A is with pt in restroom when she clearly needs a change of pad, mesh panty, gown etc. Nurse leaves pt sitting on toilet while she goes next door to grab supplies. The bathroom is not stocked with any supplies. Nurse A comes back in less than a minute, the pt is still sitting on toilet, but suddenly begins to decline and blacks out. The nurse velds patient head, tries to calm her down and keep her present, while she pulls the "emergency red cord".... a minute goes by and no one comes to help. Pt is back up, and fainting again. Nurse can't leave the pt or else she will fall. The nurse needs someone to come in and help this patient out, an extra minute goes by and no one comes... A tech opens the door, the nurse says get a nurse.... the tech closes the door quickly and leaves the nurse in the same situation. The nurse takes the mesh panties and opens the faucet on sink and tries to apply a wet compress to the patients head while she keeps waiting. A charge nurse appears on minute 2 and offers to bring nausea medicine and leaves again. At this point Nurse A is getting overwhelmed, all she wants is to get out there... another minute goes by, now we are getting closer to 4 minutes or more.... Nurse A, gets claustrophobic as the patient is now sweating profusely and she is afraid the patient will black out/faint again. The call light is still going. Nurse A decides to yell "Somebody HELP'.... that brings the attention from a nurse near by who brings a wheelchair and helps the nurse to get the patient out to her bed. While nurse A struggles to put the patients legs on wheelchair, there is a male nurse on the hallway, who sees the struggle, but dodges and let the two female nurses figure it out.

The patient is back safe on her bed, BP is about 90/50, and nurse A continues to care for her.

Nurse A writes an email to the nurse manager stating that she wasn't pleased with the response of the tech etc.

The charge nurse complaints to nurse manager, and nurse manager brings nurse A to unit director to talk about the incident the following day.

Nurse A is reprimanded because she was not supposed to use her voice to ask for help.

Nurse A is glad the patient was safe. She cites some safety concerns, but management thinks nurse's A is making a big deal about it, that it 's nurse A problem and who she handles the situation. Nurse A feels like there is no real support on the unit so she gives her resignation letter as she believes that protecting her license is worth more than staying and trying to convince then that there is a serious problem in that unit.

What do you think is wrong with this scenario?

What would you do if you were nurse A?

[JKL33]

I would have:

1. Asked the tech to help me get the patient back to bed (or get me a cool cloth or a b/p cuff or whatever I wanted them to do without sending them out of the room). At the very least I would have begun with not sending the tech away.

2. Asked the nurse to help me get the patient back to bed when she appeared if I had unfortunately already sent the tech away.

3. Asked the "male nurse" to help me if I wanted his help when I saw him standing there.

[JKL33]

PS - don't you all have phones?

[rvzohfeld, BSN, MSN, RN]

No. working phones given to nurses there.

That was my thinking, to not send out the tech away. I think that nurse was not very confident that the tech could have help.

[JKL33]

Altogether it sounds to me like a slight bit of hysteria and either poor knowledge base or just lack of experience was involved. Unfortunately you have mentioned 4 people and none of them acted in the most prudent way. So you have a good-sized problem on your hands maybe.

I cannot imagine coming to help a coworker and, upon seeing a diaphoretic, syncopal patient trying to recover on the toilet, proclaimed "I'll be right back with Zofran!"

And then Nurse A not protesting that ^ plan....

[RNperdiem, RN]

I would tell the tech or charge nurse to help me get the patient back to bed.

After the patient is back in bed, I would assess, take vital signs and plan my next move.

If I am alone with a patient and need help STAT,I would tell for help.

[Crash_Cart]

Experienced a similar situation myself before.

My only primary objective at the time was to make the patient safe.

In my mind this means things like asking myself "Is this person having a code?" If yes, then press the code button and lower them into a supine position onto the floor. If no, then pull the call bell cord and get them out of the bathroom and back into the bed.

Now I admit, being a male I do have a huge advantage because I actually have the physical strength (human hoyer lift) to actually pick up the patient and do this transfer myself unless they are obese or really heavy.

Once they are back in bed, then I can check their O2 sats, BP and otherwise attempt to logically reason the cause for any problem. If nothing serious is going on then I can briefly leave the room to summons other assistance.

Whenever I have to assist a patient to the bathroom by myself, I always made it a rule to always involve a wheelchair in the process because of the possibility of this very thing happening unexpectedly. One thing you might find helpful is to always keep the wheelchair in close proximity to the patient within arms reach "in case" something should happen. This way, I know I can always get the patient back into the wheelchair using a stand and pivot turn, even if I had to do it myself.

Of course, I don't agree Nurse A should be reprimanded for calling for help and think that seems a little over the top to me. If anything, management should have been supportive and tried working with her and the rest of the staff for that matter, to find better ways to prevent a repeat of these kind of incidents from occurring again in the future. I see this as a general safety issue and clearly management wasn't addressing that, when they really should have.

[mmc51264, BSN, MSN, RN]

At my facililty, we have a button to push for a rapid response. Once it was known that I was having an issue (as a nurse) no one would have left me alone. There would have been half the staff in there and a provider on the way.

In no way should you be reprimanded. This is a faulty set-up. If I can't reach an alarm button, or my phone, I would have done exacctly the same-called out for help.

And then called Integrity hotline. This was patient and nurse endangerment and I am sorry you had to go through this.

[MSO4foru, ADN]

Maybe I am just feeling snarky, is this a homework question? Is there no emergency cord in bathroom??

[JKL33]

7 hours ago, MSO4foru said:

Is there no emergency cord in bathroom??

The cord was pulled and that's why the tech came to the room. The RN told the tech to go get someone else.

[Mavnurse17, BSN, RN]

At the very least I would've gotten the patient back to bed (with whomever was available at the time) provided that it was safe enough to do so.

One night I was helping my post-op CABG pt to the bathroom. He'd been steady on his feet throughout his entire stay so I thought I could trust him to walk to the bathroom (4 feet from his bed) while I walked right behind him with both of his chest tubes in my hands. Big mistake on my part, but hindsight is always 20/20.

Out of nowhere he felt faint and had an assisted fall to the floor. I wasn't near a pull cord and couldn't reach for my phone in my pocket so I had to yell for help. Why is Nurse A being reprimanded for yelling for help?

At any rate, it sounds like a huge mess. Why was the charge nurse running to get zofran instead of helping? Why did it take 3 extra people coming in and out before the patient was stabilized?

[rvzohfeld, BSN, MSN, RN]

The tech wasn’t a tech; the nurse didn’t feel confident enough with the help of that person so (she said), so she asked for a nurse. I asked that nurse: what did you want to accomplish? Why did you send the tech/helper away?

The nurse said: “all I wanted at first was to have a second nurse to help me to get the patient out of there” the patient was now alert. When the charge nurse left to go get “nausea medicine”... the patient became diaphoretic and had symptoms of having a second black out. So the nurse now saw the real need to get out of there and shout: “somebody help”...