Taking ownership of pts

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Need to vent. I work in recovery in a teaching hospital. Every few months a new round of fellows and crnas come through. The most recent batch seems to be a little sloppy. For example one transferred a pt w/ESRD, right arm fistula. Had the bp cuff on the right arm. I pointed it out to him and he said "oh oops. owell its okay". I then pointed out the bright pink arm precaution band on her arm that states "NO IV/NO BP". He then raised his voiced and said "so what do you want me to do??" and stomped off. I wanted him to keep in mind and be more careful next time. If it was his family member I'm sure he would raise a big stink about compromising this pts life line. Another colleague dropped off a pt that was dry heaving, retching and remarked "I had no time to give zofran" . Really? Takes under 2 min. And another dropped off pt w/gown soaked thru in stool. "We had no time to clean her, Ineed to start the next case". Really? Pts are not just a paycheck/number. We are a team but take ownership of your pts. Am I over reacting?

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Specializes in critical care, ER,ICU, CVSURG, CCU.

most frustrating

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Specializes in Pediatric Hematology/Oncology.

That's terrible! I don't think you're overreacting at all. It's interesting how some groups just seem to have a bunch of entitled "special ones" that seems to spread throughout. I hope you get through this bunch without any further (serious) pt care issues. Poor pts!!

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Specializes in Med Surg.

I've had times where I changed and cleaned up a patient 10 times in a couple hours, but when he was soiled again at shift change the next nurse huffed, stomped her size 5 and accused me of "Neglecting the patient."

Don't be that nurse.

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Oh I did not accuse anyone of anything. She admitted the pt had not been cleaned even once throughout the procedure. The room had MD, CRNA, RN, and techs w/new gown and sheets in the cabinet but she just wanted the single pacu nurse to take care of it "since you have time".

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Specializes in NICU, PICU, Transport, L&D, Hospice.

In some areas the patient/case is just one in a long line of procedures to be accomplished during the shift. The staff perceive that their role is limited to getting the patient through the procedure and out of the OR/procedure room alive. A great deal of this attitude is directly related to the management of the area(s).

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Yea I guess the nausea and stool is not life threatening and they can pass off the pt like that. I was mostly bothered by the colleague that got upset at me pointing out the arm precaution. this all happened on the same day so I was thinking do these ppl even care about their pts? Some of them dump the pts before they are hooked up to the monitor confident in the inherent stability of their pts while other ones Ive worked with before will stand and check the first vitals while giving a good history/report. Hopefully they will get better with time.

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Specializes in None yet..

The students may have been defensive and afraid. Perhaps that explains their rudeness and denial. That said, I don't think you're overreacting at all. I'm inexperienced so I can't speak to how some behaviors fit into the corporate rules and procedure, but the BP error was a BIG no and the attitudes you encountered with everything else were also a problem. I hope you had a way to let the instructors know about them.

Really, there are too many of us out there who care about delivering excellent patient care and respectful teamwork to let personnel like this fill space. What kind of feedback happens in your teaching facility? How can you be part of it? There must be something in place!

I share your hope that with these folks will get better with time. However, I'm not holding my breath. I've been in institutions that tolerate misconduct and incompetence. All that happens is a kind of negative osmosis: the talent flees the scene, leaving the bad apples behind. (Excuse the mixed and scrambled metaphors.)

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Well, we report to different managers/attendings. Theoretically feedback can be given by a staff nurse regarding a different discipline but the only time I've seen quick action is when a doctor/pt/family member complains - not the other way around. I've talked to my coworkers who've been here longer.. they mentioned "food chain/hierarchy" and "ego" are big driving factors. But you are right, no one likes to be caught in the wrong. My own reaction is to apologize (sometimes profusely, especially when I was a new grad lol) and make amends but that is my personality.

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I can see leaving the stool because they don't have the time. How many times do we get the patient completely clean, only to have them soil the brand new bed as you do the last turn? Do they start over and clean again? This can definitely start to take time away from other patients waiting in line. However, a patient that is about to/is vomiting? Please, they can give zofran. They have given tons of other meds already, the zofran would make the patient much more comfortable (and would help their recovery). Unless they had no zofran on hand I don't see how it can inconvenience them giving one more medication.

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It is very frustrating. And while the CRNA was reporting the patient off to me, I would have just moved the BP cuff to the other arm. And made some sort of "light" comment about "arm bands are not for nightclub admittance. look at em or your attending will not be pleased."

Bottom line is patient safety, you should not accept a patient that has an error in care right in front of you (meaning you should not just leave the BP cuff on and wait until CRNA leaves to fix). This is such a catch-22 and the only thing you can do is fix it in front of the reporting nurse.

Additionally, this needs to have an incident report done on it. Mainly because now, unfortunetely, you know that a BP was repeatedly taken in an arm containing a fistula (which could result in patient harm) and any outfall of this is now your issue. Which stinks. Your plan of care going forward is to include something regarding fistula patency, skin integrity around the fistula site, pain around the site...you know the drill. And make sure you make the MD aware---cause the last thing you want is this patient to go to dialysis and have a fistula that is not working.

And you can site the "hard stop time out" that seems to be the newest Joint Commission standard, that should include any identifiers and precautions.....

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lol I like that nightclub comment! Will save it for future reference. I changed the cuff as soon as I noticed and did indeed do the aforementioned plan of care & highlight it on my off going report. You are right, patient safety is the bottom line. They are counting on us!

There was a time my coworker received a pt with equipment we were not familiar with. When coworker asked about how to maintain/assess it they made the nurse feel stupid for not knowing - even though we only see it once in a blue. In the ideal world, there would have been a stop - demonstration/teaching and opportunity for question during hand off. In reality there was a bit of eye rolling and a little shaming. Luckily we have online access to resources and were able to learn more about it on our own.

I told my coworker its better to "look stupid" then to start messing with something you're not sure of and compromise pt safety. Such is the world we live/work in.

On a lighter note... a cartoon I saw online..(does not apply to just docs)...

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