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Discussion

Was I wrong?

Just to give a little background I work in a ltc facility and my daily patient assignment is taking care of roughly 22 patient's. A few days ago I was dealing with a patient who is known to be a very brittle diabetic when I was alerted that another patient needed my attention. So I go to the other patient's room, when I entered I saw that the desk Rn was in the room as well assessing my patient that was completely alert sitting up in bed showing zero signs of distress. The other nurse stated that she entered the room and the patient was totally unresponsive "practically pulse less" so she directed someone to call 911 and staff put her in bed and all of a sudden the patient was responsive and alert. It was after 911 was called that someone brought it to her attention that said patient was a DNR, she had the families phone number and stated that she would notify them due to the fact that they may become upset that 911 was called. I notified this nurse that I had another patient that needed my attention and the decision was made that she would stay with this patient until the ambulance arrived. About 10 min went buy before they arrived and I reentered the room to speak to the medics and gave them report before they left. The nurse who stayed in the room then leaves the floor to attend her morning meeting as she usually does, I think nothing of it and a hour or so goes by and the patient's husband comes to visit the patient only to discover that she's not in her room and it was then I was left notifying him that she was sent out. I try to get ahold of the nurse that was in the room to find out why she didn't follow through with calling the family and I was told she left after morning meeting for a dentist appointment and would be back later. I had no knowledge of any of this. Now the family is upset that she was sent out in the first place and secondly they weren't called. Was I wrong for leaving a stable patient with another Rn to attend to my other patient? Was I wrong to trust that she call family besides the fact that our desk nurses almost always call family and if not they tell you that they didn't call family so that we make sure to call ourselves. I'm just so confused as to how to handle this situation if it were to ever occur again.

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    • Experts

    Welcome!

    You know the old saying: "If you want something done right, do it yourself."

    Since the resident was ultimately your responsibility, it fell upon you to notify the family. If the 'desk nurse' failed to notify the family as she said she would, it falls on you because this was your resident and no one else's.

    Your post is slightly difficult to follow, but you do not say why the other resident needed your attention. Good luck to you. LTC is difficult and thankless.

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    I hope it worked out. I would definitely have a chat with the NM about it because it sounds like she did a ton of stuff without even asking you, then left you high and dry. At the very least you should have a good sit down with her (hopefully in front of a witness!)

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    I read this three times and only sort of understand what happened ....but I think I agree with commuter. The other nurse may have stepped in temporarily, but I wouldn't have expected her to continue handling the situation after I finished what I was doing and became available.

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    Yeah - those things happen. You would not believe how many patient with a DNR/DNI do NOT hospitalize and on hospice or some kind of comfort care are brought to the hospital from a facility.... In most cases we are unable to track what exactly happened and why they ended up in the hospital. But it happens.

    Make sure that if it is your patient that you call the family.

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    • Author

    Sorry my post is a little difficult to follow it's been on my mind non stop for days now and it's exhausting me. The patient I had to attend to was having major problems with their blood sugar. I did go back in the room prior to the patient leaving and this nurse never let on that she didn't follow through. All she had to do was say something I feel like she knew 911 shouldn't be called and messed up and left me to take the fall.

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    I follow you. I don't know what a desk RN is but I'm going to assume s/he has co authority with you. They stated they would make the call and didn't. I would say you did nothing wrong. Hopefully they don't try to avoid taking responsibility although at this point there's nothing left to do but make apologies. Next time I'd maybe follow up sooner but with 22 patients.....yeah, sometimes stuff just happens.

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    She specifically said she would do it and you had no reason to believe she wouldn't. There's no question of appropriate delegating/not delegating since she's an RN as well. It's certainly a "gosh I'm sorry you weren't called" moment but you didn't do anything wrong.

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    • Experts

    Moved to the LTC forum for more responses.

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    • Experts

    Another RN told you she would do certain things, then just left them undone and left the building? That's a deplorable lack of accountability. Even if it was your patient, you should be able to trust another nurse to do what she said she would do. Instead, she set you up.

    I think the whole thing needs an incident report and a chat with the nurse manager. I would not bother talking with the other nurse. If she didn't know better than to do what she did, a talk with you isn't going to change anything. It's not your job to train her or teach her about accountability. Fix this situation with the patient and family as best you can and document.

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    I follow you. I don't know what a desk RN is but I'm going to assume s/he has co authority with you. They stated they would make the call and didn't. I would say you did nothing wrong. Hopefully they don't try to avoid taking responsibility although at this point there's nothing left to do but make apologies. Next time I'd maybe follow up sooner but with 22 patients.....yeah, sometimes stuff just happens.

    A desk nurse is a nurse who manages shift work; meaning, they take off orders, update care plans, responds to emergencies, investigates falls, skin tears, makes assignments, and puts out fires.

    As a former desk nurse, I would have taken care of the pt; notified the doc and the family; if the pt is a DNR, I would still notify the doc and family prior to sending the pt out; even if it was to get additional testing as to why they ended up pulse less and then OK, and then follow-up with the nurse to make sure they were in the loop and can assume care for the patient.

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    • Author

    This is an update from my other post, today I got the call and was terminated due to failure to remain in the patient room. I'm frustrated because I had another patient at the same time that needed help because of blood sugar. I'm only one person and directed another RN to stay with my other patient whom was a DNR and in no distress, she was alert & oriented, vitals stable. I attended to my other patient and returned to the first patient before EMS arrived. Would filing unemployment open up other problems like the BON getting involved?

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    • Experts
    This is an update from my other post, today I got the call and was terminated due to failure to remain in the patient room.
    I am so very sorry that your employment was terminated. Working the floor is becoming a lose/lose situation these days. Good luck to you.
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