sloydrn

I agree with the other comments. Don't take this kind of gruff for one more minute. I would document in an objective and factual way in writing and go over the asst manager (who has failed to respond) and give it to your manager and copy it to your Director of Nusing. Sometimes you have to put a fire under people to get them to act. Your managers owe you a duty as their employee and as a professional and fellow nurse (I might add) to assist you in resolving this conflict. You can probably be sure of these things too: You're not the only person this tech treats disrespectfully. She could be treating patients this poorly as well, so you are advocating for the patient by pursuing a resolution. Don't worry about 'getting her fired' etc. It is not your job to decide if she gets fired, punished, etc. That is up to managment. Maybe she has issues/personal problems/medical or chemical dependency problems, just an unhappy person, etc. Who knows, but none of these are an excuse to behave the way you described. Management is getting paid to worry about these problems/issues and you deserve a supportive work environment. Dont' accept anything less! As for the parking lot suggestion....You're on your own on that one!! Good Luck.

What happens 7-10 years later when the nurse is called to testify in court? Here's what happens: The plantiff atty will use your notes, in whatever format, to attempt to discredit you and support his theory that the care you gave was below the standard of care. I don't think it matters if you use 'exception' charting but what does matter is consistency, accuracy and completeness. If the patient is really ill, you should have additional entries detailing what is being done and when the doctor/supervisor are notified of changing condition/acuity. In other words, it isn't the method (or format) that is the problem. Failing to advocate for the patient and initiating the chain of command are the most frequent arguments for nurse (and therefore, hospital) liability. As we have often heard, 'if its not charted, it wasn't done' is not altogether true. But the more detail the better, especially if you have a patient who takes alot of time and/or deteriorates on you. Patients go sour sometimes and how you react and document can make a big difference in your liability. You might also collect chart samples from other hospitals similar in size and location and tailor your forms to your insititution. I might also run a literature search and see what the currently available research has to say. Good Luck.

Bravo for having the courage to make a difficult change! I'm a mother of 2 daughters who both graduated high school last week. When they were young (both in diapers) I gave up my FT Head nurse job which I loved, to work part time evenings as a supervisor and concurrently attend graduate school. My husband and I both made monetary and time sacrifices so my children were only at day care 3xw. ONe of us was always with them otherwise. It was VERY difficult, but looking back, I can tell you for sure...what my children remember is the TIME I spent with them, not how much MONEY I spent ON them! For me it was the right choice and I'm not saying it would have been the right choice for everyone, but you can never get those precious days back when your children are young, and that time really shapes their future. You might check out nursing scholarships too. The Govt has MANY scholarships that are just sitting there for nurses that noone takes. Some institutions also will pay your nursing school tuition if you agree to work for them for a period of time (like 2 years) after graduation. I know Baylor in Texas has an offer such as this. I would recommend looking into that. Start with a GOOGLE search and go from there. Who knows, maybe you can combine your nursing skills with the IT field one day and have the best of both! If it feels right to you, go for it! Best of Luck! Nursing is not an easy profession, but it can be rewarding and flexible for sure.

Compartment syndrome is a (fortunately rare) complication of IV infusions that are placed in the extremities that contain the compartments. You cannot control how the person's compartment will react to an IV infusion. Even if it appears "patent" if the arm becomes engorged, etc, the proper action is to dc the IV, notify the physician, administer antidote if applicable, etc. The IV does not have to be caustic, it can happen with just plain run-of-the-mill common fluids. From your description, it sounds like you took proper action and kept following up and documenting what you did. Sometimes people just get complications, you can't prevent them all, just be prudent in your follow up and keep the physician and /or your nursing supervisors apprised on an ongoing basis. It sounds like you did just that. It can be intimidating to 'appear' before the 'judges' of risk management, administration, attorneys, etc. They are going to be concerned with possible litigation and mitigating their exposure and ultimate damages ($) they may have to pay out. As they say, hindsight is 20/20. Don't feel like you are to "blame" for the compartment syndrome. As long as you did what a reasonable and prudent nurse would have done in that set of circumstances, you met the standard of care. Even if you met the standard, the patient can still sue the hospital, but if your actions were within the standard of care, the hospital will have a much stronger argument to lessen the damages. Just keep doing what you know is right, and initiate the chain of command anytime you feel uncomfortable/unsure in a situation. Live by the motto: Bring 'em down with ya!"

Hi, I thought I would chime on this one. I have a background in administration and legal nursing. When a tragic event such as what you described happens, the hospital is going to be worried about a negligence/wrongful death action. ie Administration has to assess whether the LPN who was responsible for the care and safety of the patient during that shift was negligent in her duties, ie did something a reasonable and prudent LPN would not have done, or failed to do something a reasonable and prudent LPN would have done. Sometimes people just up and die unexpectedly, but some of the factors the hospital will look at include: was staffing adequate for the acuity/caseload that night? If the unit was short-staffed, was the supervisor notified, when, by whom? Did the nurse(s) keep speaking up until they were heard? How long since the patient was checked? 3-4 hours may seem like a long time. Was he allowed to get OOB? What was his state of mind? confused or orientated? Was he high risk for falls? if so, what precautions were taken? Did anyone hear him fall? How often would a reasonable nurse have checked on him? Was proper action taken once the patient was found? You also may not know if this particular LPN had any other personnel issues that may have prompted her firing. The hospital may have elected to terminate her in an attempt to mitigate the possible exposure to damages that might be claimed by the surviving family of the decedent. ie they can say they took action to prevent future events of this nature, a defensive tactic which gives them the argument (at least) that they took action after the event. Although this may seem unfair, unless the RN had direct knowledge that something was happening with that patient and chose to ignore it, the responsibility rests with the direct care provider, even though the RN "supervises" her. It would be unusual to expect the RN to check on every patient the LPN had, in addition to her assignment. Unless that is the customary practice in your facility, there was probably no breach of standard of care for the RN, as she wasn't assigned directly to that patient, even if she was 'charge' nurse. The responsibility would fall more directly to the LPN. It is the administration's responsibility to make the hiring/firing decisions, and in Texas, there is at-will employment, so a person can be fired at any time without explanation. I would be disappointed to hear that this event causes a rift between the LPNs and RNs, as they say, the next time, it could be you that ends up smack in the middle. I would hope you can find a way to each learn from this unfortunate event, and if your staffing is inadequate, keep speaking up. That is what a reasonable practitioner would do. Initiate the chain of command when you sense something is uncomfortable for you. I hope you and your peers will find a way to continue working together and support each other, as it is not easy in the nursing front lines! Thanks for the chance to respond!