Terrible Charge Nurse, I have to do his job!!

Mrsexylegs · May 22

Everyone has their own aptitudes of skills, but I can see a few problems here that is lack of communication of the team as a whole. None of these are personal attacks I noticed some things from the story.

The first thing I noticed you said you didn't take VS wanted to send out a resident for painful breathing. With no mention about going back to retake vitals. Every NP/MD I known/met one of the first things they will ask is: what are the vitals? And if you can't provide them they will say don't waste their time and call them back when you get the vitals.

Second while trying to make the transition smoother by making copies of the transfer paperwork informing the charge/supervisor might be best to do first and while they are getting the paperwork ready you could take the vitals"Hey resident So and so is having some respiratory distress. We might need to send her out. I didn't get a chance to take a full set of vitals but they are complaining of painful breathing (hopefully you were able to get her RR and got atleast a painscale for the pain). I'm going to do that now or would you like me to start to do the transfer paperwork?) Saying something like this makes it so they are aware and not just yep, unhuh, paperwork fog, making sure they heard you, and let's they know there is a problem.

Third you must document document document and CYA. At XX00 noticed resident so and so was in their room with respiratory distress. Charge Nurse X was informed of resident's change of condition @ XX08. At the end of the day if something happens it's your lisence and your job with potential other stuff happening. Most companies will throw the lowest level employee they can under the bus then admit fault. And if something did have to go to a court and jury. The lawyer will would pick apart your statement that isn't document (amd even documented) and twist it making you seem like your the bad person "example: Oh you saw resident So and so having a active medical emergency. Instead of going back to them after informing the charge why didn't you go back to make sure their condition didn't get worse?). never assume but rather be under the impression. The former sounds like guessing or you weren't certain, as the later gives way to more logically accepted sounding response. (I assumed after I informed him, he would take care of it because he was the charge Nurse vs I was under the impression after informing him he would go monitor the resident due to him being a nurse in a higher position in, being the charge nurse).

forth while for thomas it sounds like he might have poor time management from how it is retolled it doesn't feel complete. But it was very good that you did go to inform the family

DallasRN · May 22

Mrsexylegs covered many points. But I have to ask, what exactly are you referring to as "painful breathing"? What made you think it was "painful"? Did the patient have pneumonia? Some sort of lung injury?

I'm assuming you are working in a nursing home environment and I know some things are not different than acute care but in all environments, I would hope if someone is having "painful" or "difficulty" breathing, the nurse would immediately summon help, remain with the patient to assess vital signs, lung sounds, oxygen saturation. Was O2 previously prescribed for this person? If yes, did you ensure she was getting adequate O2? Was the physician notified of the events? If this patient was bad enough for you to believe she needed to be sent to ER, I think you or someone else should have stayed with her while others completed paperwork, notified family, etc. Also, why didn't you check on her or check with Thomas before a 2-hour time period? Thomas may have dropped some balls but you definitely did as well. I've been a charge nurse and I've worked under fantastic and not-so-great charge nurses but in the end, you are the assigned nurse in charge of the patient. You can't pass the buck. One more thing I'll say...med passes are important and none of us want to be late giving meds. That said, I doubt anyone has ever died in a nursing home because their routine meds were an hour late. But someone having difficulty breathing? Minutes can count.

I would recommend you talk to your supervisor and/or DON and request some guidance for these types of situations, perhaps some updated training. Have you read your facilities policy and procedure manual on sending patients to ER?

FolksBtrippin, BSN, RN · May 27

For a patient reporting painful breathing, vital signs are the first thing to do, at least RR and SPO2; heartrate and temp should be quick and easy, a blood pressure may not be feasible. Do what you can for the patient right then and there, PRN O2, neb, (or morphine if applicable) whatever you have, give it. Then call 911 and tell your charge at the same time to get support with paperwork and the non-emergent stuff.

Thomas isn't really the problem here. This is mainly a communication and prioritization problem. Very common for assisted living, but still needs to be addressed so that situations like this are handled better in the future. There should be some expectation as to who does what when someone needs to be sent to the ED. You should know your role and Thomas should know his.