Should this have been an incident report?

[emoening]

I wanted to get everyone's take on this.

Yesterday at work I got out of report at 7:30am and began to make my rounds on my 6 patients. At 8:15 one of my patient's physicians called me and said he was taking my patient to the OR in 45 minutes for a urinary stent and to have him ready. This entailed printing out his OR packet, getting the consent signed, pre-op checklist, and giving him the CHG bath. He said the procedure would take about an hour and he would have him back by about 10:30. I was just finished wiping him down with the CHG wipes when the transporter arrived to come get the patient. About 2 hours later my patient had not returned, and I was told by the house supervisor that something had happened in the OR and the patient would be going to ICU after the procedure.

Later that afternoon when the patient had arrived on the ICU, the nurse taking him over called me, I was assuming to get report. Instead, she chewed me out over the phone, and told me she was filing an incident report against me, because she received the patient and chart from the OR and my charting had not been done for the day. I told her that the patient was taken from me at 9am, and I assumed he would be back to me by 10:30, when I would catch up on my charting. She told me, that is not an excuse, and it is an incident report if you do any charting after the fact, that you have to chart as something is happening. I told her I would be more than happy to come down to the ICU and do my charting for the 2 hours I had the patient, but there is no way I could have known he would end up in the ICU and wouldn't be able to finish my charting when he came back. She said fine, but that she would still be filing the report.

I told my charge nurse about what happened and asked if I was in the wrong, or what I should have done differently. She said no I was not in the wrong, and that I couldn't have done anything different. She also said we are not expected to chart everything immediately, that is literally impossible. On my floor, it is the norm rather than the exception to start your charting around noon or so, once you've assessed all your patients, done all your AM meds, taken off MD orders, etc.

So my questions are: do you think this was a ligitimate incedent report? And how many of you do your charting immediately? Or do you actually "do" everything first, and then sit down and chart later?

[caliotter3]

I chart when I choose to chart, based upon what I am doing and am able to do. I do not let another person dictate to me when or how or what I should chart. They can complain all they want. I don't tell them how to do their job, and I don't expect them to tell me how to do mine. Since your supervisor is backing you up in this, a rare thing, I would not worry about it.

[caroladybelle, BSN, RN]

The ICU nurse has no clue as to what floor nurses have to deal with to get those pts on time. If you had to hold up surgery, so that you could chart, the surgeon and the OR would have been fit to be tied.

Which reminds me, why were you getting the consent signed? That is the surgeon's job.....yeah, yeah, I know, they come up and talk to the pt, but cannot bother to consent the pt or tell the staff ahead of time so that the prior shift could have had stuff ready...so that you would have less to do....so that you could have charted.

There are issues where you work. It has to do with people not respecting the difficulty of another's job. Floor nurses at 0800 in the morning have 5-10 pts to get meds, insulin to, get report, round with MDs, can't get access to a computer or a chart, and have surgeons suddenly and immediately want someone prepped, consented, educated and red lined to the OR in the middle of it all. The ICU nurse has 2 patients to do this with. Yes, they are more intense pts, but still. And griping at you does little good.

[scoochy]

Here's my : I have been an PACU nurse, as well as an ICU nurse. An incident report was not justified; this ICU nurse was either on a witch hunt, or is just a real CRANK. ICU nurses are expected to chart as warranted, which is usually quite frequently. An ICU patient's status often changes minute to minute; not keeping up with charting is a recipe for disaster. From a PACU nurse standpoint, for the surgeon to say the patient would return to the floor by 10:30 was unrealistic. In most cases, stent insertions are brief cases. However, the patient had to be induced (anesthesia), procedure done, and then a stay in the PACU.

To get to the heart of your issue, this is my advice/suggestions to you:

1. You can always chart as "late entry." Does your hospital have a policy on this? If not, check with your state

nurses association and ask where you can find your state's Nurse Practice Act. There may be a web site for

it.

2. How about discussing this with your hospital's risk management dept? This would be an excellent resource.

You might consider asking your NM if an inservice could be given by said dept. re: documentation.

3. Remember, nothing documented = nothing done. If this patient's record was ever examined by an attorney,

it would be noted that there were no entries in the record for the time you cared for him. This is why "late

entry" works. You could have done your charting on your unit, then brought it to the ICU and placed in it the

patient's chart yourself. This was acceptable practice in the 4 hospitals in which I worked.

4. Lesson learned: NEVER, NEVER assume anything in nursing. It was the first thing I learned in nursing school.

All the best for better days. Experience is the best teacher!

[apocatastasis]

I'm an ICU nurse. I'd never have done to you what that other ICU nurse did. She sounds like she was looking for trouble, and you were her victim. Don't sweat it.

[apocatastasis]

The ICU nurse has no clue as to what floor nurses have to deal with to get those pts on time.

That may or may not be a false assumption. Lots of ICU nurses work or have worked the floor, and we deal with time constraints as well. The issue is simply that the ICU RN is a you-know-what. I'm a new grad and some of my coworkers have this attitude, and it's extremely unpleasant to have to deal with them whether you're an ICU, ER, or floor nurse.

[Jules A, MSN]

She just sounds nasty to me. I don't think its my duty to write up fellow nurses. If it was that big of an issue your manager should have been the one to follow up on it, imo.

[shoegalRN, RN]

Oh my God give me a break!

When I worked in the ICU, it seemed like most of the nurses were looking for something to either complain about or write someone up over something as trival as linens not fully stocked.

Forget you had a code that night, by God, that linen cabinet should have been stocked.

Forget you had a code that night, your other patient should have gotten a bath.

I swear, majority of my old coworkers thought their ish didnt stink. They gave everybody grief, the floor nurses, the ER nurses, the PACU nurses, the cops that were sitting on pts, the transporters, the unit clerks, the residents, EVERYBODY!

I'm so glad to be out of that miserable environment.

[HeatwaveRN]

It sounds like they need to blame somebody. Patient unexpectedly going to ICU? They must have messed up somewhere and are already anticipating a lawsuit. But the patient was at the care of someone else at the time. You're patient was okay before going to the OR.

Really? An incident report? For charting a couple hours late? She must be crazy!

Late entries are better than NO entries. (I mean if your facility allows late entries, which I think they would).

There are times that I get so busy that I end up charting at the end of my shift.

If I were one of those who has to review this incident report, I would be angry at that ICU nurse and write her up for wasting my time.

You'll be just fine. Just do what you can do.

[StayLost, BSN, RN]

... why were you getting the consent signed? That is the surgeon's job...

I have always understood that the MD is supposed to obtain informed consent. Can the RN run into trouble with his/her license if the nurse obtained the signature?

Sorry for sidetracking.

[apocatastasis]

I have always understood that the MD is supposed to obtain informed consent. Can the RN run into trouble with his/her license if the nurse obtained the signature?

Sorry for sidetracking.

In Texas, at least, doctors can write orders for an RNs to get a consent signed. The doc is still supposed to discuss the procedure... why they can't also get a patient to sign on the line is beyond me. Just one more thing that the average doc is not capable of doing, in Texas at least.

[caroladybelle, BSN, RN]

In Texas, at least, doctors can write orders for an RNs to get a consent signed. The doc is still supposed to discuss the procedure... why they can't also get a patient to sign on the line is beyond me. Just one more thing that the average doc is not capable of doing, in Texas at least.

An MD can write orders for a lot of things - that does not mean that we as nurses should be following some of this orders because they breach scope of practice or the law;

Examples:

- Restrain pt PRN

- Resume previous orders (postop).

- Continue home meds (on admission when the MD has not reviewed them).

- Resume home meds on DC - without specifying those meds and the doses.

- Consent pt (the MD has not spoken to pt, met pt, or discussed jack with the pt, but wants them consented, on form that specifies that MD has discussed procedure with pt - GIs doing endoscopy are major offenders).

- TPA/Talc chest tube - outside nursing scope of practice in all states in which I am licensed. Yet in virtually every one I have had MDs that fully expected me to do so.

Etc.

JCAHO - has been on a tear about restraints and med reconciliation. Yet MDs persist in being passive aggressive about not doing med recs, and continuing the very dangerous "Resume/Continue home med orders", no matter how much damage. And they persist in the "Consent pt" order, though it is THEIR JOB to do so.