Last week I was working w a trached toddler who had been recovering from a severe cold w fever. I worked w her Monday night, her o2 sats were WNL (97-100). Tuesday I was somewhere else. Wednesday I returned, dad reported she was feeling a lot better and had a great day. However, her sats were not good: 92-95, mostly at 93. This was really, really abnormal for her. Her lungs were congested and I heard crackles, so I texted her mom at work (also an overnighter) who called the MD. MD told her to go in for x-rays in the morning. Turned out the girl had pneumonia (as we both suspected) and she got the treatment she needed, two nights later when I returned again, her sats were WNL again.
Here's where I'm not sure what I should do: that Tuesday night I was not there, the night before I noticed the problem, the other nurse on duty recorded low sats all night long, on the vitals record sheet: 92, 93, 93, 93.... her nurses notes said nothing about it, nor did she report to the parents in the morning that the sats were low. This is one of their regular nurses, too, she's been w them for years. THEN, her nurses notes for the night of her ER visit and x-ray, there was nothing mentioned in her notes about the visit or the diagnosis (also bronchiolitis, tracheitis, some collapsed aveoli, plus she got a positive diagnosis that her bad cold w fever the week before was influenza) so I'm outraged by the balls this nurse dropped. All her notes said was that she had a bad cold. I KNOW the parents reported everything to her.
Would I just be a tattle-tale if I told the clinical manager about this nurse's failure to report a change in status, and delayed this girl into getting the treatment she needed? Is it my business? Is it my duty? Or do I just do my work the best I can, and not be the busy body getting the other nurse in trouble? The vitals record page stays with the chart for months, nobody will ever review it seriously. The nurses notes are not detailed and generic. Nobody will ever notice this failure. The parents are aware of it but I don't think they realize how serious a mistake she made. What would you do?
Leave the nurse a note with a smiley face to call you, or go out to coffee. Be friendly, review the case and ask about the particulars. "That night of x when the sats were 93, you know we can titrate o2 from x to x" and "If you include xyz in your notes it's helpful because that way _______ " fill in the blank. Maybe she's a new grad or re-entry and it's a teachable moment. If she can't understand then speak to the case manager.
Sorry I just re-read that she's the regular nurse who's worked there for years. I'd still leave a note to ask her to coffee as a professional courtesy. I'd pick her brain about his history, how he's changed since she's been taking care of him. Then ask her about these specifics like "I see on night x his sats were 93. From what I know of him that's way below his baseline. What do you think?" and "with x breath sounds, what parameters are in place to get ahold of mom?" etc. Have the discussion and you both might benefit.
Specializes in Complex pedi to LTC/SA & now a manager.
ask yourself what it really is you want to accomplish do you want to satisfy your outrage do you want better communication for the future once you determine your true goal you'll find a way to get there[/quote']
Very well said. There would be a different scenario if the delay in treatment caused harm to the child then you would be a mandated reporter.
I totally understand it's not so easy to just leave a note for a nurse you never see or have met to "meet for coffee to discuss" in a night shift private duty pediatric scenario. That would backfire or at least be laughed off on most of the cases I've worked on. If there is a major change in status, one of the QA chart auditors reviews the charts for the few days leading up to the concern to see if something or a trend was missed for educational purposes in my one agency.
Typically in home care, the parents call the doctor. The nurse provides them with the information they need and advises them to call. It is their judgement whether to call or not.
"I totally understand it's not so easy to just leave a note for a nurse you never see or have met to "meet for coffee to discuss" in a night shift private duty pediatric scenario. That would backfire or at least be laughed off on most of the cases I've worked on."
Actually it's very easy. Our crew has had pancake get-togethers for years. All I'm suggesting is to try some form of communication first. If the effort is laughed at, that's fine. The OP can stick to plan A and report her.
Specializes in Complex pedi to LTC/SA & now a manager.
"I totally understand it's not so easy to just leave a note for a nurse you never see or have met to "meet for coffee to discuss" in a night shift private duty pediatric scenario. That would backfire or at least be laughed off on most of the cases I've worked on." Actually it's very easy. Our crew has had pancake get-togethers for years. All I'm suggesting is to try some form of communication first. If the effort is laughed at that's fine. The OP can stick to plan A and report her.[/quote']
It's wonderful that "your crew" has pancake breakfasts for years. It's not ever happened in either agency that I work for. When I worked ED get togethers were common.
I will say that this type of communication " please call me to discuss over coffee" is not appropriate for the official communication log.
Sometimes it can be facilitated via the office, and this has worked in my one agency. However most nurses don't share personal contact information with other staff that they have neither seen nor met. Unlike a hospital or other facility setting there is not much interaction in PDN with other staff nurses especially in cases that are a single 8, 10, 12 hour shift per day. If a shift isn't split between two nurses where there is interaction or overlap it is not uncommon to not meet the other nurse(s) on a case aside from on paper. There are cases where the only PDN shift is 8-10 overnight hours and no shift overlap.
Though if I accompany a patient to the doctor or am given report of a new diagnosis (example I work nights mom reports she took the child to the physician and X-rays confirmed a new diagnosis of pneumonia & initiation of antibiotics) I chart it in my notes, the communication log, and report to the clinical manager.
IMHO there is not much to be gained by "reporting" the other nurse. The clinical manager can review the notes from the other nurse to see if there was a subtle change in status that was missed.
Questioning the other nurse's (especially if you never met her) assessment and documentation skills over coffee might not go over well and create undue animosity.
More important is that you documented the changes you observed and notified the parent & clinical manager. Would you or the patient gain anything by "tattling"?
Ok just to be clear I am not the OP and I would not go to the office. The OP's core question was, report the matter or ignore it in angst? I'm suggesting a 3rd alternative that cuts through the confusion and avoids blindsiding a co-worker. Ok forget about the coffee! Geez! But get her number or email and solve this thing. All too often the only person on the unit who doesn't know about a problem is the one who is about to get nailed. Don't we owe it to each other to do better than that? Even if it's inconvenient, or it's taking a risk?
Elle23
415 Posts
This is what I was wondering. My patient has very specific parameters in the POC for when to call the doctor.