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?
Honestly, yes, you could pay a HHA 1/3 of what the RN/LPN is getting and the family would still get what they really want which is mostly help with ADLs and a bit of time-off to work or do other things. Like SDALPN, I have one case that stood out where the kiddo had a g-tube and was MR and a total assist. Family did the feedings, there was no meds. I got paid $17/hr to watch her bang on toys. It was frustrating that there was funding for THAT but not for what the family really needed -- their wheelchair van fixed, and a lift to get the kid from her bed to the wheelchair.
Qualifying criteria is a matrix with a heavy emphasis on "technology." G-tube, trach, vent. It's based on what a nurse should be doing in theory - which for a simple case should be a few meds and feeding through the g-tube, trach care, and monitoring for anything from seizure activity to the trach suddenly coming out to skin issues - but you'll often find families that aren't comfortable with the nurse doing many of those things. (Not necessarily the family's fault, either. High nurse turnover rightfully leads to issues of whether the next new nurse is competent.)
But now I'm just rambling. :)
Took care of a baby once from 6 weeks to 16 months, 10 hours a day, was paid $15/HR which then was great money, more so since he slept so much. Still, there's only so much Sesame Street and 'baby genius' tapes a person can tolerate without ending up in a padded cell.
Honestly, yes, you could pay a HHA 1/3 of what the RN/LPN is getting and the family would still get what they really want which is mostly help with ADLs and a bit of time-off to work or do other things. Like SDALPN, I have one case that stood out where the kiddo had a g-tube and was MR and a total assist. Family did the feedings, there was no meds. I got paid $17/hr to watch her bang on toys. It was frustrating that there was funding for THAT but not for what the family really needed -- their wheelchair van fixed, and a lift to get the kid from her bed to the wheelchair.
Qualifying criteria is a matrix with a heavy emphasis on "technology." G-tube, trach, vent. It's based on what a nurse should be doing in theory - which for a simple case should be a few meds and feeding through the g-tube, trach care, and monitoring for anything from seizure activity to the trach suddenly coming out to skin issues - but you'll often find families that aren't comfortable with the nurse doing many of those things. (Not necessarily the family's fault, either. High nurse turnover rightfully leads to issues of whether the next new nurse is competent.)
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.
It's highly common to contact parents first. Home care is a completely different animal. Now- contacting the parents but not updating the agency? No one is suggesting that, and that would've been a mistake. I agree w ventmommy
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.[/quote']
I'm glad many encourage u to talk to the nurse first. Agencies don't care.
Personally, I would just drop it. The parents were notified, the child received care at the ER.
Reporting to the agency, talking to the nurse/parents will just stir the pot. Agencies don't want to hear it.
Sam J.
407 Posts
Took care of a baby once from 6 weeks to 16 months, 10 hours a day, was paid $15/HR which then was great money, more so since he slept so much. Still, there's only so much Sesame Street and 'baby genius' tapes a person can tolerate without ending up in a padded cell.