Report or not when administrators have favorites

Nurses Relations

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  1. Report or not?

    • 5
      Report it to my admin
    • 4
      Report it to BON
    • 22
      Don’t report it

31 members have participated

Just looking for some advice on a situation and whether to report or not or even how high to escalate it.

I work in a neuro ICU as a charge nurse and return to work one day to find that the day shift charge (L) had left early due to an emergency; apparently there was a death in the family. Another nurse took over charge and gave me report, but clearly didn't know very much about any of the patients except his own. I had questions about the final patient that the previous charge, L, had been assigned to that day. This was a fairly stable patient, hence why the patient was assigned to a charge nurse for the day, but nonetheless, this is a neuro ICU and the patient had had brain surgery, was wheezing, and retaining urine. Relief charge had no idea what was going on with the patient and all other day nurses stated they did not assume care of this patient. Relief charge then told me, "I guess the patient didn't have a nurse for the past hour."

I texted the previous charge, L, and apologized for bugging her during her family emergency but just wanted to know who she gave report to since charge report is vague without the fine details. No response. I was left with no other option than to give report on this patient to my night shift nurse based on my limited charge report for this patient.

My director showed up not long after and I explained the situation to him. He tells me, "Yeah, she's (L) not going to text you back. Under the circumstances, just have your night nurse read the patient notes." He leaves. I suddenly get a call from my clinical coordinator, my director's #2, and she tells me that she "heard" I had questions about a patient. I told her I spoke to my director already, to which she had no idea. This leaves me to conclude that L had completely disregarded my text and went straight to our bosses to let them know I was texting her.

This situation frustrates me in several ways. First off, to me, this nurse essentially abandoned her patient because she did not properly transfer care of her patient. Secondly, this patient had no nurse for an entire hour and considering her current state, a number of things could have happened and there would have been no nurse to take accountability for the patient. Patient safety was severely jeopardized here. It also put me in a position where I had to give report on a patient that I was not assigned to, did not care for, and had limited information on. Lastly, this nurse should have been a professional and responded when I texted considering she was the last known nurse for the patient, but for her to go over my head and straight to the coordinator was uncalled for. In the time it took for her to contact the coordinator, she could have replied back to me with a quick text.

I'm stuck with the decision now whether to report this or not because I truly think that it was wrong what this nurse did and that the patient's safety was jeopardized. I completely understand that emergencies happen, but proper handoff of this patient should have taken place. My reservations in reporting it though, are that for one, my administration is incredibly corrupt and they will throw anyone under the bus to get what they want, and will retaliate like they have with several of my colleagues. My admins are also very friendly with the day shift staff, as is how it usually is when night shifters are treated like the orphan children. So I know for a fact that if I reported this day nurse, that they would do everything in their power to protect her. Even my CNO and my director are very tight with each other, so that puts me in the line of fire with my entire chain of command.

What do I do? What are everyone's thoughts?

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You got a bad report. That happens once in a while for various reasons, although it's not right.

You're sort of making it sound like there was no source of information beyond the nurse who left, though. Typically there would be assessments, notes, labs, etc. in the patient's chart that you could refer to.

I don't think you're going to get anywhere with this.

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I've gotten bad report before numerous times, so I'm no stranger to having to read through labs/notes to find out what's going on.

In this case, no one ever took over care of the patient and report was never given.

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What accommodations were made for your unit when a CN needed to leave to attend to a family emergency? Who came to help? Who bridged that gap? Whose responsibility is it to make sure that gap is bridged?

Report to the BON is one of your poll choices. If you're even willing to think that thought over an issue that may happen on any given day due to your employer's business practices rather than a nurse's bona fide emergency then my opinion is that your judgment is out of whack.

What you do in a situation like the one you walked into, is take care of the patient the best you can. Immediately assign an RN, assist with assessing the patient's current condition if required, intervene as necessary to get things back on track.

In addition, use your facility's incident reporting system to explain the situation neutrally. "At 1900 while functioning in the role of oncoming CN, I assumed care of patient [account number] who was not presently assigned to any nurse. Report not able to be received. Pt care was immediately assigned to ______, RN, night shift staff nurse."

If there are habitual problems like this or if problems involve repeat offenders, then you'll have something to talk about. As it is, you're becoming delusional about something that happens very rarely and when it does it might be for any number of reasons. Guess what - people have actually gotten crazy busy and flat out forgotten about a certain patient. This is not "okay" and it's certainly not good. But what it is, is LIFE.

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What I did was when I showed up, I attempted to find out if anyone had assumed care of the patient. Nobody had. So I gave report on the patient to the best of my ability to the oncoming nurse based off what I had, and helped her ensure the patient was stable. We inserted a foley, got the patient respiratory treatments, and then continued on with the shift. I feel that I did my job and improvised the best I could.

From what I understand, the director and coordinator were the ones that approved her to go home, so they were well aware of the situation. As far as the gap being filled, that's where the lapse in care was since the gap never got filled. Accommodations for this nurse were made as accommodations have been made for other nurses on day shift with similar emergencies. On the contrary, we've had a couple of night shift nurses go through the same issue and were forced to stay the duration of the shift or were written up.

I understand where you're coming from when you say that it's life and all because I've had to leave due to emergencies before and I've also been in such a rush that yes, I've forgotten to give report on a patient before leaving as well. But when that happened, I immediately went back to give report or I even called when I was driving to give report and answer questions. I didn't just disregard the correspondence and go directly to someone else to call the unit for me.

I didn't report or write an email to my director because yes, I know, things happen. Let me clarify that I'm not upset at the fact that she had to leave or the fact that she didn't transfer care properly. Things happen, yes, it's life. But if she knew she didn't do it properly, at least try to fix it or reply when I try to reach out.

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I say do not report anything. Anyhow....the nurse that L assigned the unit to should have had some clue, a light bulb go off over their head, that no one was taking care of a patient...or that nurse L had been assigned a patient and now nurse L was gone.

Anyway..just let it go. I'm sorry it happened, I appreciate your being concerned. The only death was was in nurse L's family, the patient survived the hour unattended.

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Yes, I agree. No one got hurt and the nurse did suffer a loss, so I didn't escalate it and make matters worse. There definitely should have been more accountability, but it is what it is. Thank you for understanding

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From what I understand, the director and coordinator were the ones that approved her to go home, so they were well aware of the situation. As far as the gap being filled, that's where the lapse in care was since the gap never got filled. Accommodations for this nurse were made as accommodations have been made for other nurses on day shift with similar emergencies. On the contrary, we've had a couple of night shift nurses go through the same issue and were forced to stay the duration of the shift or were written up.

The larger situation/background is irksome, but I would submit that all of these ^ problems are management-related. If they approve someone to leave during a shift, they can come and evaluate whether their help is needed or at the very least touch base with the CN to see if the CN has or knows of any needs, and to confirm that everything is covered and that the nurse's assignments and responsibilities have been accounted for and absorbed.

Night shift makes do with "whatever" a lot more than people give them credit for. It's not acceptable to not have any back-up plan for what would happen if a night shift nurse had a legitimate emergency/family death. I would say that (assuming there aren't other details/nurse-specific difficulties you aren't aware of) I probably wouldn't stay at a position where I was treated poorly in a situation like that. But you have to decide how much you're going to let OPPs bother you. [Other people's problems]. I would suggest "not much."

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Specializes in Critical Care.

Report her to the BON??!!

I am sorry if I am wrong, but I get the impression there is more to it in your motivation to get this person in trouble. I get your frustration about getting a bad report, but I think you might be overreacting.

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Specializes in Critical Care; Cardiac; Professional Development.

If you were that nurse in that same situation, how would you hope someone would handle this?

Personally I would be extending them quite a bit of grace. I hope you will consider doing so as well.

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Specializes in PICU.

OP:

First it sounds as thought the Charge RN L had to leave very quickly. It is likely in her grief that she may have inadvertently not given report on her patient, or she felt that her Charge hand-off was okay. It is possible that the person who relieved her for the hour may not have realized that the patient also needed a nurse.

As for not texting you back, it is possible that she may have called the directors and told them that she would not be able to take any calls prior to your text and maybe nobody notified you personally about it.

It sounds like it was just a crazy hand-off and everyone tried to do the best the could. It could be a good point as to why Charge RN should not have an assignment as well as Charge.

It is hard to interpret tone in an on-line forum, but it sounds like there is great animosity on your end towards Charge RN L. Especially considering reporting her to the BON. Most people would agree safe hand-off is very important. Maybe she thought that the relief Charge understood that they would have her patient as well.

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Specializes in Urgent Care, Oncology.

If your unit is so corrupt, have you thought of looking for employment elsewhere?

Anytime favoritism has impacted my duties or schedule, I've just gotten out of dodge. I have found it is hard to prove favoritism and hard to get in favor of the favorites. Sometimes it is just best to move on.

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