Tattle tale? Or my duty to report?

58jeli · Feb 5, 2014

I'd talk to the nurse first.

Sam J. · Feb 5, 2014

I'd suggest that you ought to have called the physician yourself, rather than 'texting' Mom, if you expected your patient had pneumonia, before you tattle-tale on another nurse that you claim was negligent. More so when the assessment and treatment was then delayed, on a toddler with a trach, until the next DAY.

Elle23 · Feb 5, 2014

I have been with a heart baby too long because sats of 93 sound great to me!

Honestly, I would probably take my concerns to the nurse before I considered taking them to the agency.

Elle23 · Feb 5, 2014

Was the nurse in question the one who went with the child to the ER? If not, I'm not sure why she would mention it in her notes?

CloudySue · Feb 5, 2014

I have no way to contact this nurse. I don't know her personally or have her cell phone.

The mom always wants to be contacted first and make the calls to the MD herself. She wants to be texted because she's at work and cannot always take a phone call. Dad sleeps and works early. I'm working within the specific parameters established within the case.

I alway report exactly what any caretaker reports to me. If you are working with a trached toddler and started the shift with a child dx earlier that day w pneumonia, don't you think that's relevant information to document the condition in which you receive your client? If the parent says "he's fine" that's what I put in quotes.

Elle23 · Feb 5, 2014

The mom always wants to be contacted first and make the calls to the MD herself. She wants to be texted because she's at work and cannot always take a phone call. Dad sleeps and works early. I'm working within the specific parameters established within the case.

That is understandable. I would always go through the parents first. I mean, they are the parents! (Unless it is an emergency of course...)

I alway report exactly what any caretaker reports to me. If you are working with a trached toddler and started the shift with a child dx earlier that day w pneumonia, don't you think that's relevant information to document the condition in which you receive your client? If the parent says "he's fine" that's what I put in quotes.

I don't really document details about report...just my assessment and findings. If I wasn't the one who was with the child at the ER, I don't see the point in charting about it. It should have been documented by the day nurse who was with the child.

That's just me. I am admittedly still pretty new to pdn (coming up on a year), and have only had one patient, so I may not do things the way some more experienced pdn may.

Sam J. · Feb 5, 2014

A symptomatic trach baby is 'recovering from a cold and fever', and showing signs of decline, and the nurse 'texts' Mom, and Mom (who is at work) makes arrangements for follow up for the next day, yet the OP is attempting to cast blame on another nurse, from a prior day, for 'causing a delay in treatment'?

Good luck if that baby had died. I'm sure Mom would have stood behind you, as well as the BON- after all, you acted prudently by 'texting Mom', even though you also admit that you suspected that baby had pneumonia.

Stunning.

CloudySue · Feb 5, 2014

You're making judgements on a situation you were not even there for. The MD assessed the situation from the facts I had presented, and determined the child was in no immediate danger, and it could wait until morning. I had instructions to call 911 if (set of parameters given). If the baby was blue or coding right from the start please don't assume I'd be stupid. The point is, I kept the parents in the loop to make the final decision, and contacted the clinical manager in the morning who also followed up. She was happy w the way it was all handled. So were the parents.

I guess people are being hostile here because nobody likes a tattle tale. My concern is a nurse out there who sits next to a sick child all night who thinks nothing of pox below WNL and doesn't tell the parents AT ALL. If you're fired up about my actions, you must be livid about that... right?

Elle23 · Feb 5, 2014

Well, I don't think I was being hostile. I didn't think you did anything wrong in the first place. I always assume there is more to the story than is being relayed on a message board.

Honestly, if you are truly concerned about the nurse's competance, then contact the manager.

I'm curious...is there no list of parameters in the patient's care plan for when to call the doctor?

CloudySue · Feb 5, 2014

The 485 doesn't encompass everything, of course. I think we all agree that a change in status requires a call to the MD. In this particular case, mom wants to be informed of everything before anything happens, even a dose of pain med has to be approved first.

What I didn't explain properly is that this child had already been to the doctor when she took ill the previous week and was already about 6-7 days into ABX. Her o2 never was a problem, always stayed where it should be. The child was actually getting better. Playing happily and afebrile for two days. The only red flag was the uncharacteristic dip in o2 and crackles on one side. If the nurse had just mentioned it in report to parents the previous morning, she would have gotten to the doctor a day earlier. And all I'm asking is, am I obligated to inform my clinical manager or do I let it go?

ventmommy · Feb 5, 2014

What are the parameters for this girl's vitals in regards to notifying the parents/doctor? Did the Tuesday night nurse note whether her lungs were clear or not?

Me personally? I read the notes every day and would have caught this. But we also had very clear parameters posted in several places about when my husband or I should be notified about a vital sign or assessment finding.

As to the people that are annoyed by the fact that you called the parent before the doctor, that's how it was in my house too. Had you called the doctor before talking to me, I can guarantee that you wouldn't have been working for our family again.