Tattletale nurse

makingitright · Sep 9, 2010

The world is full of mean people and one has to learn to defend oneself from such people. The most important thing here is the wellbeing of your patient. Secondly, you cannot leave yourself open to be accused of negligence and such. You did the right thing by reporting these people, and if they try to get heavy, stand your ground respectfully. Trust that management will handle it and if they do not, check to see what the grievence protocol is. This is not about being a snitch, you are not going tit for tat by the looks of things, stop being so hard on yourself. You have worked hard to get where you are, you cannot allow anyone to mess that up for you. This is just my two cents. Please take care!

allnurses Guide · Sep 9, 2010

I'm a little unclear about what you reported the day nurse for. She didn't tell you the child had been to the doctor? I'm not sure exactly what happened, but I do know from experience in home health that "report" and the accuracy of the chart are inconsistent, and some nurses breeze out the door 2 seconds after you arrive saying,"he's-fine-bye" and some want to review the medical history of the last 5 years!

Usually what we do- and this is because in between nursing shifts are caregiver shifts who don't chart at all- is to put a note on the outside of the chart alerting people of out-of-ordinary things like MD, visits, new orders, etc. You are right though, you should have been made aware of those things. Vaccines can cause adverse reactions and the care plan should be updated reflecting the new diagnosis of hip dislocation.

In our agency, the first nurse on duty after a new order is given should write in her notes pertinent information like that but in the real world of home health there are many breakdowns in the smooth flow of up-to-date information. I guess the take-home lesson is that you have to be proactive.

Usually I ask the patient or parents when their last well check was and when they are to return for recheck. That way you know in advance when to ask if they kept their appointment and what transpired there. It's amazing the amount of info people don't feel any particular need to share with the nurses.

I'd say the odds are good the nurse you reported will be royally p.o ed. What form that takes time will tell. We have some nurses who play "gotcha tag" back and forth. I'd suggest paying particular attention to detail for a while!

IndiKast · Sep 9, 2010

Thanks y'all. I reported the fact that she wasn't including important things like the hip dislocation in her report. All I'd get was "No BMs" or some such. I also told them I'd tried to speak to her about this several times and she kept blowing me off. I appreciate your support. It's so hard to know what is appropriate when your only professional exposure is a few bad experiences at some downhill LTCs.

pagandeva2000, LPN · Sep 13, 2010

I think that the next time something occurs that leaves you in doubt, YOU be the one to report it to your agency-act like it is the first time you were aware of it...this way, it doesn't appear that you were the neglectful one. If the agency already received report on a situation, then, good, if not, then, at least YOU told them. And, whatever happens afterwards regarding those other nurses, let them be the ones to deal with it.

I had a similar situation with pediatric home health. I only worked this case on Saturdays, because I already have a regular fulltime job in a clinic. I came in and the mother told me that her daughter reported to her that while she was in daycare a few days ago, another little girl caressed her lady parts. This client has a nurse around her 20 hours a day-including school hours. I am not saying that the nurse had to see it directly (this is pre-kindergarden, where children sit in a circle, drawing, doing other activities). The client did not report it to the mother until the night shift nurse gave her a bath (I guess the bath reminded her of the incident). In any event, the mother went to the school, reported it, got the parent of the other mother involved, etc... Meanwhile, the nurse that reported it and the dayshift nurse did not report it to the agency, nor write a note about it.

I, on the other hand felt this way...if the little girl remembered at the time she received a bath, and she is only 4 years old, what if she then, associated that nurse bathing her as the one that touched her inappropriately? I mean, all nurses have to bathe intimate areas on our clients. And, what if more happened to this little girl that no one decided to report because they weren't really supervising her at the school? So, I called the agency that same day, left a message, and made sure I called back Monday morning again and reported the situation. Now, it was up to those nurses to explain what happened, but I reported as I heard it. Whether those nurses were going to report it or not was one thing, but I was going to make sure that I said it.

I did eventually leave that case, however, it was for other reasons.

caliotter3 · Sep 13, 2010

When I find out pertinent information, I put it in a communication note and send that to the agency. I have done my job. I do not waste more of my time or effort worrying about what the other nurses may or may not have reported to the agency, to the next nurse on report, wrote in their shift report, or placed in the communication book. Nine and a half times out of ten, when I report something it is the first and only time it has been reported.

pagandeva2000, LPN · Sep 13, 2010

When I find out pertinent information, I put it in a communication note and send that to the agency. I have done my job. I do not waste more of my time or effort worrying about what the other nurses may or may not have reported to the agency, to the next nurse on report, wrote in their shift report, or placed in the communication book. Nine and a half times out of ten, when I report something it is the first and only time it has been reported.

You're right. I have found that chasing other nurses to make them do what they were supposed to do can be fruitless. I report it because I found it. If I don't report it, somehow, it can fall on me, so, I have no choice. After that, this is the agency's issue.

What this can do, however, is teach all of us that we have to increase our observations, have as much of a rapport with the patient and families as possible in order to be more current on the status of our patients.

caliotter3 · Sep 13, 2010

I have learned to directly question family members to find out things. Some have stated they don't think it is important to keep all nurses informed (we are seen as "the household help" rather than as professionals), and others will actually go out of their way to keep information from the nurses. It helps them to manipulate nurses, particularly those nurses who care about what is going on and not just showing up to put in "hours" to be paid.

allnurses Guide · Sep 14, 2010

Wonder how my fellow home care nurses would treat this issue in terms of mandatory reporting laws (in California they have increased the liability of nurses who know about something bad going on even if they have no firsthand knowledge of it).

So technically we're not legally required to inform the agency "about" something, but we are legally required to report to CPS or APS, and if we don't we are in the doo-doo. So for example if we know the mother reported it to the school is that where our legal responsibilities end? We don't know in a case like that for sure if it's been reported to law enforcement. Just wondering how you interpret that in a practical situation.

caliotter3 · Sep 14, 2010

I keep my agency supervisors informed about things because it is part of my job, whether or not they take any kind of action. If I had to inform CPS or another agency, I would still involve the agency. And in the case of the mother informing the school, I would again bring this to the attention of the agency supervisors in a communication note because I don't want to be caught up in some untruth. Unfortunately, it is quite possible that the family member will tell the nurse what they know the nurse wants to hear or it is possible that information will somehow be "lost" in the ozone. When I provide a written statement to the agency, I am covered.

IndiKast · Sep 14, 2010

So much to think about! Well, since my original post, the offending nurse has continued to treat me like the enemy. Mind you, before this incident I was her "bff" to which she brought starbucks in the morning, etc. I never asked. I never responded in kind. But I knew it would stop one day. So now I get catty remarks, insults and very long reports. I'm assuming since the report to the office said she was neglectful in her reporting she's now sarcastically including everything and coming back to see if I have questions. Pity really but I just play dumb and thank her. Thank you all for your kind words and support. My RN is around the corner and Im applying to a local hospital for an internship in med-surg since the odds are better for that than most other depts I figure. Good luck to you all out there!

caliotter3 · Sep 14, 2010

Sorry Indie, but the behavior she is exhibiting is quite common in home health. The best you can hope for in extended care cases are those where you do not relieve or are relieved by another nurse and/or where the family is intelligent enough not to get caught up in manipulation originating from any of the nurses on a case.