morman

Besides for physical health reasons or being comfortable financially, when do you know it is time to retire from nursing?

Yet another respondent who appears to have trouble with reading comprehension... Last update that I shall post here. It was reported to the manager, who only took my report and that of the assailant. None from the other witness ultimately, no consultation with the organization's practice consultant. The male nurse said that the patient was drunk, swearing and attempting to strike out, and he responded by putting his hand on the old man's chest to restrain him. The manager had a brief discussion with him on the best way to handle an intoxicated patient. No further action was directed, including future monitoring or restriction. When I found that out (upon my own initiative because I was not given any official feedback), I did lodge a complaint with the college. At least they started a proper investigation. However, the other nurse witness downplayed her initial statement, and testified that she knew the male nurse had put his hands on the patient but she didn't see exactly what happened. With that, the whole complaint basically became "he said, she said". My introductory dilemma, remember? As nothing then could be proven, nothing more could be done other than to write a letter of direction, admonishing the male nurse against swearing in the workplace - the only thing to which he admitted that he did regularly, as a means to "establish rapport" with the client population. At least my original letter of complaint will remain in his file for the next 7 years, so if there is a replay of this incident - as I am sure there will be - at least there will be an established history.

I understand where you're coming from, NursehoneyBeBe. It seems like any attempt to exchange ideas through a round table dialogue in any sort of forum is becoming a remarkably rare commodity indeed.

No, I have NEVER stalked anyone on social media. The idea of that or of posting anything less innocuous than funny pet videos is absurd. And yes, it would be so easy to say "not my problem". Too easy. It's ironic that, in my first post, I was accused (unjustly) of being unethical and here, most responders are basically advising me to pass the buck or ignore my instincts. I respectfully disagree that our duty of care is discharged when the patient dies. That includes the decedents continued right to privacy and dignity...

No, it was an adult who has young children. And no, I doubt anyone sought the family's permission to post the picture. I guess my question is that, if we wouldn't allow media to take such pictures for reasons of patient confidentiality, why would we not extend that ban to members of the general public as well? It would be completely unenforceable though...

A young parent of young children recently coded in our emergency room. Unhappily, resuscitation was unsuccessful. Once the body was cleaned up, family and friends were allowed in to say their goodbyes. Someone posted pictures of the deceased on Facebook which were widely circulated and commented upon, not always favourably. This patient was well known by us as a very private and dignified individual. In your facility, how do you help to protect a person's dignity when they can no longer give consent? When do you consider your duty to care to be ended in a case like this?

Ah, but OP said that they were given 9 months of Directly Observed Therapy so it must have been deemed either latent or active TB, not just a positive Mantoux. And does not the States have a central Public Health Department or CDC which oversees the policies and guidelines?

Ouch. A lot of misinformation here. A BCG in infancy, or even when given to an adult, does not guarantee a positive Mantoux test. Skin reactivity is variable and wanes with time. The only time that a person is not tested is when there has been a documented positive reaction. In our region, that is considered to be > 5 - 10 mm induration, depending on the age. A positive skin test or IGRA serum assay only indicates the development of antibodies after exposure to TB without classification as either latent or active. A CXR can certainly strongly indicate primary pulmonary TB but has no relevance in extrapulmonary TB. Either way, it is non-diagnostic. The only way to confirm TB is by a positive AFB culture sample from sputum or other bodily fluid or tissue. You say that you had nine months treatment as a child in the US without regularly scheduled followup. I would guess therefore that you had received LTBI prophylaxis. Since you have already completed the medication regime, there is absolutely no need to repeat it. Unless... Is there a possibility that you now have developed active TB? I don't know how you would have any doubts if that is true though.

Just an update.... I reported as I had always planned. The manager promised to look into the whole thing but has not done anything in 6 weeks beyond take my written statement and request one from the other witness (who is well and truly scared of the potential consequences). It turns out that none of the other nurses who worked primarily with him in the past year have ever disclosed other incidents of verbal and physical abuse, only whispered about it amongst themselves. The college will take no action at the present time, relying instead on the manager's future findings - if it is disclosed at all. Apparently, it's up to employer. The union cited conflict of interest. Shades of grey for everyone... The appointment of the male nurse to a position of increased independence and greater responsibility has proceeded. There will be no on-site monitoring at his new location. I on the other hand have been asked to step aside in order to accommodate the introduction of another manager into our already fully staffed unit who unexpectedly found himself without a portfolio. Um, right. This whole episode has been painful on a number of fronts. I have been accused of lying on this forum. My coworkers are suspicious of me as a whistle-blower. I feel devalued by my managers. And ultimately, I have failed to protect other patients.

Curiosity called me back to check this thread once again. Thank you to those who had had specific, noninflammatory observations and suggestions. I appreciate the consideration. Once again, this is a true scenario. I would like to point out that there are a number of places that a nurse can work besides an American hospital or urban care setting. I can disclose little more other than to say that there are no in-house managers and few supports at this very remote site. The other nurse and myself defused the situation immediately and took steps to protect the patient until it was possible to report. The duty to report was never in question, it was how to do so safely and most effectively. For those of you who inferred that there was hesitation because I was at all worried about spoiling my chances of a promotion - sorry, you very much have the wrong end of the stick. He was being considered for a lateral position to me. It is because of the "quasi-competition" that I feared that I would not be taken seriously due to apparent conflict of interest or that I would be accused of submitting a fabricated report simply to "screw up" the other guy's chances. The latter sure proved to be a valid concern - some of you took it there already... And for those who were "shaming" the second nurse, did it never occur to you that they were afraid of the male nurse and any possible retaliation? There had just been physical and verbal intimidation and they felt unsafe. Not everyone reacts the same and, while I don't share that particular apprehensiveness, I can understand it. Shades of gray, people.

Before I disengage from all of you, let me reiterate that I have never said that I was NOT reporting - that is not an option for me nor has it ever been. Reread my comments! What I was relating was the honest trepidation that I had in disclosing the incident from a position of weakness and how it may ultimately impact other "whistle blowers" in the future if no action was taken in this case. How was the best way to handle the situation? I've looked after the patient's well-being but am I expected to be oblivious to my own? I created this account because I was looking for dialogue with my peers in a safe, anonymous setting. So the fact that the great majority of you are saying that I am fake and/or unethical, well, shame on you. That simplistic, hasty, censorious mob mentality is EXACTLY what I am concerned may happen to any reporting party - the "snitch" - whether it's myself or those who come after me. So thank you, I guess, for the foreshadowing taste of things to come. Carry on...

Nope, this is NOT a homework assignment and no, I have no concern about my career - nor my ethics. He will be reported. The patients need protection. My question has more to do with being taken dispassionately and seriously. The male nurse quickly laid groundwork for a defense after the incident, saying that the patient had swung at him. That is most certainly not the truth. But when I bring this forward to the manager, I worry that it will be a case of "he said, she said". And in the end, because it can be argued that I have an "axe to grind", I shall be totally discounted and nothing further will be done to rectify the situation. And how will that affect potential reporters of future incidences? I am glad for those of you whose world is so black and white. Mine is full of gray...

Ah, that is the rub. I truly think that any report I make will be discredited as nothing more than sour grapes, and will henceforth be labelled a trouble-maker. Perhaps the anonymous route would better, then I could just volunteer as a witness. Seems devious though...

A big male nurse grabbed a struggling, intoxicated elder by the throat in front of me and pushed him back on the bed, growling "I told you to f'ing lie down!". I would normally have absolutely have no problem reporting this, except that we are in quasi-competition for the same job. I have little trust that the management will not see my disclosure as anything but self-serving and untrustworthy. The patient himself cannot make a complaint and the co-worker who was with me doesn't want to "borrow trouble". What would you do?