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?
Specializes in Complex pedi to LTC/SA & now a manager.
I'm just curious how you would obtain contact information for a coworker you never met or see ? I would NOT be happy if my office gave out my private personal contact information. I am curious how you go about that as clearly your work environment differs from my two agencies. I am honestly curious. I would not respond to a note requesting my contact information in the communication log.
That said if there was no actual harm and the family is satisfied with care what would be the advantage of "reporting" the scenario? Since the OP successfully charted and secured the physician assessment and treatment needed, is there any more to be done? If it were a pattern by the other nurse surely the parent or clinical manager would notice?
Specializes in Complex pedi to LTC/SA & now a manager.
Last try. I am not the OP and I would not report it. The OP was distressed over reporting it or not. To contact a nurse I would leave a personal note. If she's not interested that's fine. Then the OP is back to her original 2 choices.
I know you are not the OP, that's obvious. I'm just curious how you would contact the other nurse that's all.
Clearly the OP cares for her patient and was frustrated with the scenario and sounding out her options rather than make a rash decision that may be fruitless.
The problem with bringing this up to the nursing supervisor (and yes, it falls in the realm of "discussing practice, so we all know what to do next time ((not necessarily to be seen as ratting out the other nurse out of spite)), is that invariably, you will be targeted as "causing trouble and/or extra work" and absolutely nothing will be done to rectify the situation. At least that would be the outcome 99% of the time with all of the agency personnel that I have dealt with over the years.
I worked as a pdn for a while and what I might have done in this scenario is work to update the care plan and 485 to reflect the patients normal VS and what should be reported to parents and then physician. Also, a friendly note in the communication book might be helpful: "I noticed a trend of pulse ox readings in mid/low 90s and crackles on one side. Lets all be careful about monitoring for these signs in the future so that we can get treatment started ASAP." Also, make sure to keep parents in the loop - not calling out a specific nurse but if the parents start asking "what were baby's sats like overnight" or "are baby's lungs clear?" then the off going nurse will HAVE to address those things in their report to the parents.
I think the important thing is to make sure this kiddo gets treated ASAP in the future and that requires better communication between nurses and family.
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.
This post bothered me quite a bit. I have been on this forum for awhile and have always enjoyed the positive and safe atmosphere it provided for those seeking advice/support/etc..online. I believe the OP was asking for just that...advice or some sort of other rationale. This just sounds like a straight up starting of an argument rather than a useable answer for the OP. Maybe next time, try and be a little less accusing. Honesty and opinions are good to see in the forum as you can see other people's perspectives, but you can still do it in a respectful and professional way.
As for the OP, my advice would be, choose your battles wisely. Is investigating further into this incident or reporting it going to have a productive outcome?
Specializes in Peds/outpatient FP,derm,allergy/private duty.
Gahh..thorny situations in pdn! First, I don't think you are a tattle-tale which as I understand it, is done for the sole purpose of getting someone in trouble, is petty, and doesn't have the child's optimum nursing care as the only motive. I know that picture is not you.
Are you obligated to report it? My opinion, no. The likely outcome of doing that will not result in anything good from a nursing care point of view. But that doesn't mean there is nothig you can do about it.
It appears that for some reason a nurse who has been there for years charted a (from what you describe because a sat of 93 isn't that wonky viewed as a stand alone number)) significant downward trend with no intervention of any kind. The question is why. Has she worked with the child for so long that she's seen that before and conditioned to perceive it as no big deal? Did she fall asleep or zone out and fill out the flow sheet in a hurry? Is she aware of verbal parameters not part of the current medical record? Any one of those things is not good for different reasons.
If you are not able to talk to her without putting her on the defensive you could first get parameters and interventions written as orders so if it happens again you will not be seen as having a personal issue. When that is done maybe she'll connect the dots...
You could suggest a case conference or inservice on the topic of trending vital signs and include the parents, who sound like great people! There is always more to learn there! It would be a way to raise your concerns without it seeming personal anyway.
You can report the nurse, but expect that to cause you trouble due to politics. I agree that if the parents want a call before calling the Dr, that's what you do. Some parents want to make that decision. Its best if its documented that the parents want to be called first, but if you call the Dr without permission you may not have a case to go back to. If you talk to the nurse, s/he will feel targeted and could create problems for you. Unfortunately, its best to let it go. And trust me, I'm like you and think that someone needs to talk to the nurse. Plus nobody wants to see harm caused to a child because of a nurse making a mistake. And maybe the nurse doesn't document well, but gives good care. Tough one for sure. But be careful because it sounds like you will have trouble if you react. Good luck!
This is exactly what you're doing with the other nurse.
OP then clarified that this baby was in fact on an ATB for 7 days post 'cold with fever'. So, a trach baby was put on an ATB for a 'cold', and a week later same baby was diagnosed with pneumonia, even though OP claimed the baby 'was recovering'. Obviously the baby wasn't recovering at all- and OP is attempting to pin the blame for 'delayed treatment' on a single nurse, on a single day for that entire week- even though OP further delayed treatment by 'texting Mom'.
I have another guess that OP might in fact be looking to replace the nurse OP claims is negligent, since none of this scenario makes sense- and if in fact OP decided to pursue a claim of negligence against the 'long time nurse', that an investigation would reveal facts that none of those nurses would want to have to explain.
OP then clarified that this baby was in fact on an ATB for 7 days post 'cold with fever'. So, a trach baby was put on an ATB for a 'cold', and a week later same baby was diagnosed with pneumonia, even though OP claimed the baby 'was recovering'. Obviously the baby wasn't recovering at all- and OP is attempting to pin the blame for 'delayed treatment' on a single nurse, on a single day for that entire week- even though OP further delayed treatment by 'texting Mom'.
I have another guess that OP might in fact be looking to replace the nurse OP claims is negligent, since none of this scenario makes sense- and if in fact OP decided to pursue a claim of negligence against the 'long time nurse', that an investigation would reveal facts that none of those nurses would want to have to explain.
Best bet? Sweep your own porch first.
You must not do PDN. Many parents won't allow the nurse to call the PCP until the parent has been contacted. Some parents don't want to nurse to contact the Dr for anything. Maybe at the point that it was obvious that the kid had more than a cold, it was on the other nurses shift. And maybe you are right about a few things. But one thing I agree with the OP about is that if the parent wants a call/text first unless 911 is needed, then you contact the parent first. Its ultimately up to the parent to take the child for treatment, so if the nurse contacted the parent, the nurse placed the responsibility back to the parent.
Gahh..thorny situations in pdn! First, I don't think you are a tattle-tale which as I understand it, is done for the sole purpose of getting someone in trouble, is petty, and doesn't have the child's optimum nursing care as the only motive. I know that picture is not you.
Are you obligated to report it? My opinion, no. The likely outcome of doing that will not result in anything good from a nursing care point of view. But that doesn't mean there is nothig you can do about it. It appears that for some reason a nurse who has been there for years charted a (from what you describe because a sat of 93 isn't that wonky viewed as a stand alone number)) significant downward trend with no intervention of any kind. The question is why. Has she worked with the child for so long that she's seen that before and conditioned to perceive it as no big deal? Did she fall asleep or zone out and fill out the flow sheet in a hurry? Is she aware of verbal parameters not part of the current medical record? Any one of those things is not good for different reasons. If you are not able to talk to her without putting her on the defensive you could first get parameters and interventions written as orders so if it happens again you will not be seen as having a personal issue. When that is done maybe she'll connect the dots...
You could suggest a case conference or inservice on the topic of trending vital signs and include the parents, who sound like great people! There is always more to learn there! It would be a way to raise your concerns without it seeming personal anyway.
Sent via my Samsung Replenish from Boost Mobile
This...situations like these can bring up great chances for inservices; it also prevents the thorny politics that can occur.
Eliciting a communication book or a board for reminders or updates can help as well; it had also helped on several trach/vent cases to have one for continuity in my experience, as well as it was a requirement in some cases with potential high acuity.
JustBeachyNurse, LPN
13,957 Posts
I'm just curious how you would obtain contact information for a coworker you never met or see ? I would NOT be happy if my office gave out my private personal contact information. I am curious how you go about that as clearly your work environment differs from my two agencies. I am honestly curious. I would not respond to a note requesting my contact information in the communication log.
That said if there was no actual harm and the family is satisfied with care what would be the advantage of "reporting" the scenario? Since the OP successfully charted and secured the physician assessment and treatment needed, is there any more to be done? If it were a pattern by the other nurse surely the parent or clinical manager would notice?