Stabbed in the Back for the First Time..

[TopazLPN, LPN]

Nursing has a strange professional culture. We have to work together to get the job done, but ultimately I feel very alone. No one wants to be responsible when something goes wrong and people are quick to point the finger at some one else. The most experienced nurses seem to have a special talent for interpreting potentially bad situations into something more benign. As a new nurse I look up to my co-workers, but I am learning to keep my distance. Recently, I was horrified when another nurse blamed me for a mistake she had made. I was involved in the situation, but I did what I was supposed to do. I have heard the saying, "Nurses eat their young," but never encountered that kind of attitude. I have been welcomed and supported. Now I feel betrayed by this other nurse.

This is the situation -

Evening shift, toward the end of the night. I was working, in the room of a resident passing meds, when a CNA called out for me in the hall. One of the other residents had fallen. I rushed to the scene, but I was calm because I knew what to do. Falls are a fairly common occurrence in nursing homes. Tho potentially very very bad because of the possibility of breaking a hip, people normally get back up with minimal damage - a bruise or a sore bottom. I assessed the resident, took vitals, (all normal, no c/o pain, ROM WNL, no bruising, able to bear weight) and had the CNA take the resident back to her room to lay down. So my next action would have been to call the Dr. and alert the family, and then fill out an incident report.

However, the resident that fell was actually assigned to the other nurse that was working with me (we have two nurses per floor in my facility). When the resident fell, the other nurse was on break so of course I stepped in to assess. But the nurse came back from break just after the resident was put in bed, so I told her the situation and gave her report of my assessment. She then told me that she had given the resident a sleeping pill earlier, so that was probably why she was woosy. I went back and finished the med pass on my hall. Later that night, I noticed that the other nurse had not filled out an incident report and when she gave report she told the night nurse that the resident was kind of woosy and slumped over but didn't really fall. At the time, I was surprised, but said nothing because this other nurse has more experience than I (Tho she is a new nurse too, having worked only about a year and a half).

Guess what ... The next day, the resident had an "unexplained" bruise on her hip that her family, who just happened to visit, noticed! The CNAs explained to the family that the resident had fallen. The family was angry because they were not notified. The same nurse I had worked with that night was working when the family came to visit, so she explained the situation... but GUESS what she said..

She told the family that no one told her the resident had fallen!! Lie! I had told her, the CNAs had told her. Why would I have given her my assessment and taken vitals on the resident if the resident had just been "woosy"? I went with her to the resident's room when she did her assessment of the resident. I know she didn't witness the fall, but neither did I. I would have gladly done the incident report and notified the family, but she took over and I went back to my med pass. She was done with her med pass. I had no idea that she wasn't going to fill out an incident report ... and I felt unsure what to say when I realized she hadn't done one.

Then she comes to me with her friend the Charge RN from Day Shift - they're both looking at me like I'm the idiot who caused the problem - and I get politely chewed out. I tried to explain that it wasn't the way the other nurse said, that I had very clearly told her "_____ fell." and taken vitals and done an assessment and turned it over to her. But somehow the truth was twisted around and I got blamed. They were even very nice about it and acted like I was just a poor dumb new nurse. The Charge RN helped the other nurse to chart everything very specifically as an "unwitnessed fall" and the DON was notified... so that no one would get into trouble... officially, I am not even mentioned in the report. However, the more I think about it, the more it makes me angry.

I really believe that the other nurse was tired, didn't want to talk to the resident's demanding family, and made a bad judgment call to not report the situation as a fall by justifying it in her head with the idea that the resident was just "woosy" from the sleeping pill. This other nurse is a really nice person - great with the residents and always going above and beyond to help other nurses... but she was scared for herself and used me to cover for her mistake! I felt like it was high school~! I couldn't believe the way she behaved. The worst part is that I think she acted the way she did because of the pressure she was under as a nurse and not because she is a totally evil person. Maybe it was easier for a person like me to be blamed - but I was used.

Am I being naive or is this kind of thing truly caused by the pressure that nurses are under? It really disgusts me.

In the future, how do I respond to/prevent a situation like this?

[gentlegiver, ASN, LPN, RN]

You are not being naive, this "type of thing" is not caused by the pressure the nurse is under. When ever I am called to the scene of an incident or fall I make sure to start the paper work charting my assessment, vs, pt comments. Then hand the paper work back to the patient's nurse. This way my behind is covered, unfortunately in this profession (as in many others) the CYA rule is supreme. Sorry this happened to you, I hope the other nurse realizes what she's done to you, but, I doubt she'll mention it to you again.

[Melina]

This other nurse certainly shouldn't of lied, but I'm surprised you didn't document anything yourself. As the nurse who assessed the patient, wouldn't you be responsible for filing the incident report? Regardless, to prevent such things in the future, document everything. I probably would have spoken to her privately, something like "I know you were feeling pressured, but I really don't appreciate the way you handled things. If you are feeling rushed or overwhelmed in the future, I hope you come to me for help before things get out of control."

~Mel'

[CHATSDALE]

good advise from gentle..always cover your but, the other nurse didn't want to call or do paperwork, i know that this is timeconsuming in a ltc but it is why you have a job, she should have done i

you have learned what this nurse is like, watch your back from now on

i hate to work with this kind of conditions but sometimes it is necessary

[Jolie, BSN]

What time of night did the fall occur? I can't help but wonder if the reason the other nurse failed to fill out paperwork and make notifications was because she was partially responsible for the fall, by giving the resident her sleeping pill too early, at the nurse's convenience, not at bedtime, when it was safe for the patient to receive it. Why was a sleeping pill given to a resident who was still up and around, and not in bed?

Better late than never. Go in to work tomorrow and write up an incident report. Use objective statements to describe the event, including the names of the CNA and other nurse, time you were notified of the fall, assessment findings, time and content of report given to the other nurse, and quote of her verbal statement that she had medicated the resident with a sleeping pill earlier. Most facilities do not allow photocopying of incident reports, so handwrite a second copy for your own records. Add a late entry in the resident's chart documenting the same.

I suspect that you were done wrong by a co-worker who had something to hide. Sorry that it happened, but it won't be the last time. I'm sure that you learned a valuable lesson to never trust any one else with documentation.

You sound like a very conscientious nurse.

[caliotter3]

Even though it is late, I second that you should do what Jolie suggested. Should this incident grow to become part of a complaint or lawsuit brought by the family, right now, there is nothing in writing showing your side of what happened. This can come back to haunt you in more ways than one. Even if the family does not bring adverse actions, you should start to prepare now for your job evaluation. I can almost bet a paycheck that you will hear something about this when it is time for your evaluations and/or your probationary period is up. Show the DON and other supervisors that you know what documentation is necessary and that you do not intend to be everybody's fall girl. Lessons learned: Never leave an incident not documented, even if it is not your resident. Do not make the mistake of trusting all of your co-workers, all of the time. Good luck to you.

[steelcityrn, RN]

Seems like the one mistake you made was you did not document what you seen and your action. Other than that, you work with a real jerk. One trait that all nurses need is honesty, or they will not make it. They may get away with it a few times, but it will catch them sooner or later.

[TopazLPN, LPN]

Thank you everyone for your valuable responses - all of you are right. Thinking about it now, I can't believe that I didn't do the documentation myself instead of turning it over to her. That was really dumb.

Her dishonesty gets worse though. When I looked back at the narcotics MAR to see when she had given the sleeping pill, I noticed she had crossed out 2000 and written in 2200 by scribbling a two over the first zero - but the resident fell at about 2130.. and since the other nurse admitted verbally to me that she had given the pill before the fall, I just wonder if she lied about giving the pill or if she changed the time to cover herself to make it look like the fall and the medication were unrelated.

I am now scared because I didn't document what happened... and I didn't explain my side of the story very well when the charge nurse confronted me with the other nurse, it was only later that I realized how serious the situation was, so I am wondering if they will even believe me at this point... but I will have to go back and document.

[pagandeva2000, LPN]

You are not naive, you are new. The next time something like that happens, I think it would be better that you, yourself be the one to complete what happened, meaning the incident report, the assessment, contacting the physician and family. This way, you are sure that it is done, that it is your word and documentation over another. I am a new LPN myself, but I worked in health care for a long time...seeing nurses do this all the time. I had a similar situation, but at my job, LPNs are not supposed to write incident reports. A patient fell, reported it to me, and I told the RN, who never came to assess the client. I took vitals, investigated about pain, (all the stuff that you did), and then, I also documented that I informed the physician of the clinic and that particular RN by first and last name. Also documented that the provider stated she was free to go home, and I also checked her out again. When the situation came up to question, it looked as though I did the RNs job. I documented in the way that my facility said that I could to cover my butt.

Sorry this happened, I do think you did the right thing. Just keep in mind that next time something happens, you complete the entire thing...if the other nurse was out to lunch, you would have been expected to do it, anyway. And, the administrator just wanted to bury her face in the sand, anyway. Not unusual, sorry to say.

[MrChicagoRN, RN]

Backstabbing can happen in any field.

This is what I'd have done.

Fill out incident report myself as I was the firtst professional responder.

Notify the Dr, Notify the assigned RN.

Document: CNA notified RN that pt on floor, blah,blah..., no apparent signs of injury, assisted to bed, SR upx2, Dr---- paged, ------RN notified & to f/u with assigned patient.

Then, you are covered, the patient is covered, the hospital is covered.