"And it's all going to be your fault"

[AngelfireRN]

You know, I've been thinking....

Dangerous pastime, apparently, because the more I think about this, the madder I get. I am not doing my blood pressure any favors here.

I have been a member for a while now, read these threads even before I became a member, and I have noticed a disturbing trend. I am wondering if anyone else has as well.

It all our fault.

I don't care what happens, who does it, who causes it, the nurse gets blamed. Management backs up the customer-cum-patient, admin backs up the managers, HR backs up the admin.

So, I dreamed this little warning label of sorts up for all those wide-eyed, fresh-faced nurses-to-be out there. I wish someone had told me what I was getting myself into.

Dear Soon-to-Be Nurse:

A Friendly Warning. It's all going to be your fault.

After school, you'll get a job. You'll be ready to take on the world. Get ready. It's coming.

You'll get asked for medical advice by every family member, friend, relation, acqaintance, and person you don't even know that gets wind that you are a nurse. One of 4 things will happen:

1) You will advise them, they will not follow the advice. They will not get well. And it's all going to be your fault.

2)You will tell them that you would rather not advise them, that they need to consult their regular doc. They won't do it amd that won't get well. And it's all going to be your fault.

3) You will advise them and the advice will not help and the y will not get well. And it's all going to be your fault.

4) You will advise them, they will get well, pass along the advice to a friend, who had a DIFFERENT problem, and he will not get well. And it's all going to be your fault.

You will go to work. You'll go in to meet your patients for the day (or night). You'll smile and be perky. They will complain because they just found out that they have a dreaded disease and they don't want to be smiled at. And it's all going to be your fault.

You'll go in to see your next patient, still upset by the reaction of your first, and are a little less upbeat. They will complain because they have had a bad day and they think that their nurse should be happy just to serve them. And it's all going to be your fault.

The doctor did not order the pain medicine that Patient Number 3 ordered because the patient is a known drug abuser who is only in for his fix. The doctor explicitly states in his orders that he is not to be called for orders for pain. That patient refuses to accept this. And it's all going to be your fault.

Patient Number 4 is NPO, and Aunt Katie can not understand why he can not have something to eat. After all, he's hungry, and you are starving him to death. All the other nurses fed him. You're just mean. And it's all going to be your fault.

The doctor comes in to see Patient 4 and finds him wolfing down pizza that Aunt Katie brought him because she knows what he needs better that you do. They snuck the pizza in as you were coding Patient 5. Patient 4 now has to reschedule his surgery since he ate. And it's all going to be your fault.

The doctor will call the supervisor to tell her how incompetently run this floor is and how no one ever does what they are supposed to do. The supervisor will pacify the doctor and the patients and family. She will tell you to be more careful in how you present yourself, because the patients perception of you, while not measurable, is important. Never mind that you have done everything by the book, to the letter, and that, Oh yes, nuber 5 is alive, thank you. No, no, we have to work on our image and smile, smile, smile, (except around patient 1) even though you may have just herniated your umbilicus doing compressions, because our patients have a perception. And if it goes to heck, it's all going to be YOUR fault.

No, the above did not happen. Maybe I am just jaded. That's why I got away from the bedside, and why I am getting my NP. I want to be a manager that has my nurse's back. That will say, "No, Mr. Loudmouth, you may NOT have 4 cheeseburgers. You may NOT call my nurses foul names. You may NOT help yourself to any and everything on this floor like it was your own personal mini-mart." If I ever acted the way I have seen some sups act, "Well just watch how you present yourself.", I would hope someone smacked me!

Flame me if you want to. I really do think newbies should be warned about things. I think they should be trained how to handle it, not sold up the river. Maybe this would also help with the shortage. Just maybe. Thanks.

[aeauooo]

But I did not apologize again after that. What would I be apologizing for -- medically appropriate decision-making? Isn't that what it is that we do in health care?

I know opinions vary, but as a GN at a county hosptial I was taught never to apologize for something that isn't my fault.

You can honestly say, "I'm sorry you feel that way."

My wife hates I when I say that to her because she knows it's not an apology!

[aeauooo]

Now the patient is saying that he never refused it. Must be my fault!

I tell people "It's your right to refuse whatever you don't want. It's no skin off my back, as long as I document that you refused."

The patient usually consents after I tell her/him that.

[suzy253, RN]

I tell people "It's your right to refuse whatever you don't want. It's no skin off my back, as long as I document that you refused."

The patient usually consents after I tell her/him that.

Did that....told him that and documented that he refused....still refused. I did what I had to.

[AngelfireRN, MSN, RN, APRN]

Sometimes that's all you can do. And sometimes it's STILL all your fault.

I have documented refusal before, countless times, for surgery prep, for medications, for procedures, etc.

Each and every time something was said, it was along the lines of not doing enough to wheedle, encourage, plead with, educate, demand, cajole, threaten, implore, whatever it took to get them to do whatever it was they refused, short of holding them down and forcing them down.

And nine times outta ten, they'd agree to it in the presence of the doc, making you look like an idiot, then, as soon as the doc left, right back to refusing.

[traveljen]

i think that no matter where you work in the hospital you'll feel this way. i work in the lab and trust me it always all faults. one night i had a bad ob patient who had a low hgb. dr. didn't want blood until moring finshed up all the work called the ob unit before i left in am told them blood was reay. howeveer for some reason never got told to the day shift nurses or nothing was done. dr calls down to lab in afternoon and yelled at the staff about the blood which mind you had been ready since around 7 or 730. now sometime later i'm pulled into my managers office and asked about the situatiton and its all my fault even though no one called until the dr in the afternoon. i know nurses get blamed also trust me as i was in a situation where it happened. i was drawing a pt for a pre-op PT/INR when drawing blood back i noticed it looked thin so i asked the nurse should pt have a hgb done before surgery plus it looks low. so i drew for it even though it wasn't ordered took back to lab and ran it. hgb was very low called the nurses who called surgeron and ansilogsit of course they didn't believe it because pt had an hbg on admit 3 days ago and it was fine. so i said fine i'll have the other tech come and redraw it. the level was the same and so when surgeron came it was yelling at nurses why wasn't hgb ordered eariler. dr did ordering but somehow it was the nurses fault and of course some what labs because why are you drawing and running things that aren't ordered. the only anwser i have for that one is because i don't want pt. to bleed out in surgery and i knew hgb was low oh and you probably would have added it on stat before surgery and than been ****** because we didn't do it earlier.

[AngelfireRN, MSN, RN, APRN]

I can not believe the response here. Thanks!

[suzy253, RN]

Yesterday, starting my 3-11 shift there was a pt who was an ER holdover--apparently wasn't supposed to be 'admitted'...never got to the bottom of that story but he was being discharged. NP comes in to start the DC paperwork; in the meantime I was involved in cleaning up a major code brown and the poor fellow had to wait about 35 minutes. Mind you, the NP didn't finish with the paperwork and when I finally got a hold of it and took it to the patient, it was MY FAULT he had to wait for sooooooo long. Why is it always our fault? I can't discharge him without the paperwork which the NP was still working on. Pt was all kinds of angry with me because NP said she will do the paperwork right away but I get to hear the nasties being spewed out of the mouth at the nurse. I literally have to bite my tongue sometimes.

[Curious1alwys, BSN, RN]

Great post OP. :yeah:

Depressing, yes. But realistic? Yes. And funny? Hell yes!:lol2: I thoroughly enjoyed that! You should be a writer! That one needs to circulate on the internet or at the very least be made a sticky!

[nurturing_angel]

Once, on Super Bowl Sunday, I had a patient and his entire "entourage" onto me because they could not pick up the appropriate channel for their super bowl party. YIKES! Whats the world coming to when a hospitalized pancreatitis patient cannot have a decent super bowl party! Called maintenance, they came, couldn't get the right channel, left and I was again the scapegoat! Longest afternoon of my nursing life!!!!

[AngelfireRN, MSN, RN, APRN]

What, you mean you didn't offer to stand on the roof, wrapped in aluminum foil and holding a coat hanger in each hand? SHAME!!!! I can just see some entitled patient sticking his head out the window, "Go to the left. No, your OTHER left. A little more. Now, back a little. Pick your foot up. Lean back. THERE! RIGHT THERE!. Now, hold that."

[nurturing_angel]

LOL! I am not climbing out on the roof for ANYBODY! Even when they started threatening to leave AMA. So long, adios, BYEEEEEEE! Enjoy your pizza mister pancreatitis. When you come back doubled over in pain and retching in a basin, don't forget to stop in ER to be readmitted.

Here's your AMA form to sign and leave your saline lock on the way out!

:argue:

[southlandshari]

It is also all your fault when patients make it through another night to see another day.

And all your fault when they get the meds they need to thrive and, in many cases, simply to live.

And all your fault when they escape infection due to the care you take in cleaning and re-dressing wounds and incisions.

And all your fault when they receive a potentially life-saving transfusion because you noticed their H&H results were significantly low and took the time and energy to call the doctor, type and cross the patient, get the consent signed, order the blood and spend hours in the room monitoring their response when you had a million other things to do.

And all your fault when they keep breathing because a respiratory therapist is called in to give a breathing treatment when you noticed that their O2 sats were down. Because you bothered to put them on a continuous monitor... just in case.

And all your fault when their legs aren't amputated because you checked their blood sugar on the hour instead of the regular Q6 or Q8 schedule after their 7:00 accucheck read 321..........

For every bitter anecdote any of you have, I can reply with ten stories of ways in which nurses improve and save lives every single day.

Nurses are my heroes.