What would you have done?

[wbdtrt]

In the dining room last evening and resident begins to cough, could still speak and had good air exchange. Told her, "cough it up MC." She continued to cough and since it was dinner time, all staff was in the dining room and we monitored her.

Dietary aide comes along and begins to hit resident's upper back. I asked her to not hit resident on the back, explained if something was in there she (dietary aide) may lodge it even further. Dietary aide shot back at me, argumentatively mind you stating,"there's nothing in her mouth, she's not choking and I'm not going to lodge anything!" The dietary aide continued to argue with me, dining room full of residents and all staff. I firmly stated, "don't ever hit another resident on the back, thank you."

I was the ONLY licensed person in the building, entire staff witnessed this occurence.

What would you have done?

[Erclifton85]

I would punch her in her mouth... oh wait... definitely write her up. Scratch my first thought.

[Katie5]

Time to flee the country.

LOL. Not country...just you:)

[systoly]

LOL. Not country...just you:)

I guess today is as good as any day to get a talking to.

[CoffeeRTC, BSN, RN]

It sounds like the op tried to have the diet tech stop what she was doing. Not sure is she educated that person on why, etc. The nurse would be the one who should take over after a lay person started.

I think what got the OP was the argumentative attitude.

[Nicole74]

Are you serious??

uuuuh yes. I asked a question and received several snarky answers. Thanks for all the clarification.

[GM2RN]

just to be clear, the intervention was incorrect, not outside the dietary aides scope of practice.

my 11 year old nephew did the heimlich on a person in person who was eating dinner at a table across the room. his mother, an rn, watched as he did it.

i don't care if you serve food, mop floors for a living or just earned your boy scout first aid patch, please perform a life saving intervention if you can. that is the true message that we need to be sending to the community and our staff. you don't need a license to save a life.

but for the question "what would i do?" i would listen to the pts lungs, watch for sx of pneumonia, order a cxr if appropriate. i predict aspiration pneumonia soon.

i'm confused...i didn't know the heimlich was performed by pounding someone on the back.

[Annewr]

Okay, everyone, take a deep breath. I have been on this site for about a week. The snark, not helpful. There were, IMO, really good responses to "What would you have done?". Snark is funny/acceptable only when the recipient knows you and understands your sarcasm. Otherwise, just hurtful/nasty. As we are all anonymous here, well, you get the point. In addition, I have begun to wonder if this site isn't the respository of the opinions of all the people I left some nursing jobs to avoid...I "get" the "venting". Or, should I assume that we are training each other through "tough love"...and to think, I just recommended this site to someone just entering nursing. I can take it, I just think its an immature coping mechanism, and believe me, most of your peers do also...

[andrewRN]

and being 20 it is not about being "cool" it's about protecting a patient form a potential harmful intervention when you are the licensed person in the building and the only one to be held accountable if something goes wrong. If that kitchen aide had disloged a piece of food form the residents throst to lodge it in her trachea and the resident dies it's the nurse held responsible because she should have known better and stopped the harmful behavior.

I would have pulled the aide aside when the resident was nor longer coughing or choking (and called the supervisor if there was one) to tell her that she was not the one in charge of a medical emergency in the facility; and she will, in the future,do as she is instructed in a emergent MEDICAL situation and that I will be letting her immediate supervisor know the situation through the proper chain of command so that education can occur and this situation will not happen again.

You need to have clear conscise guidelines and rules when dealing with people especially when your liability and license is on the line. If this was a habitual behavior for this employee then documentation is the route to follow.

I'mm al for developing a rapport with those at work but when patient saftey is concerned the patient comes first.

I can see your point of view. I think when I mentioned the word cool, you got the impression that I value rapport MUCH more from my coworkers than patients. In my opinion, both are important. Nevertheless, that wasn't the main point of my post nor was my age.

My intention was that the poster to resolve the conflict between her and the dietary aide; not to pacify the aid but to develop a cohesive teamwork that looks at the common goal through education and management!

There are many style of management and one is not more right than the other. And yes, rules and guidelines must be followed and I failed to add that. IF the patient was hurt, there must be accountability just as you have stated. In her scenario, the resident is not. Therefore, I focused not on the patient safety issue, but the supervisory and managerial aspect of the problem.

I'm sorry, but it seemed you have misinterpreted the reason why I used the word "cool." In my philosophy, one can be professional and be liberal. Then again, that is MY philosophy. :)

[Annewr]

To AndrewRN, I just thought you showed amazing understanding of interpersonal relations. Regardless of your age. You will be an asset to conflict management, both micro and macro. Good for you:yeah:

[nursel56]

. . .I suggest that you look for that employee and have a small talk. Say something like this, "Hey Joe. Yesterday we had a little incident at the dining room. I want to say that I didn't handle the situation as well as I wanted. As a nurse, I always put the resident first and you do too. You are a good person. I did not intend to put you in a position where you would feel defensive, you know that right?"............."Anyways, if you see a resident and you're not sure if they are alright, ask them to speak up first is the best thing to do." "Are we cool now?" (I use the word cool since I'm 20).

Empathize!

You have some great ideas, but the only thing the OP possibly didn't handle well was that she continued the conversation after calmly explaining the rationale and getting a confrontational response from the dietary aide, and I'm assuming she continued to hit the patient in the back after she was told not to. Anyone who lays hands on a patient must be very sure there is a compelling reason behind it. In this particular case her intervention was incorrect, which also needs to be pointed out.

While a write-up may sound simply vindictive to you, it can also be accompanied by a talk about the whys and wherefores. It would be highly counterproductive to have a conversation that didn't address the aide's behavior as well.

[andrewRN]

You have some great ideas, but the only thing the OP possibly didn't handle well was that she continued the conversation after calmly explaining the rationale and getting a confrontational response from the dietary aide, and I'm assuming she continued to hit the patient in the back after she was told not to. Anyone who lays hands on a patient must be very sure there is a compelling reason behind it. In this particular case her intervention was incorrect, which also needs to be pointed out.

While a write-up may sound simply vindictive to you, it can also be accompanied by a talk about the whys and wherefores. It would be highly counterproductive to have a conversation that didn't address the aide's behavior as well.

Totally agree! What I was iffy about was just the simply-write-you-up-cuz you-were-wrong.

Everyone's thoughts are derived from personal experiences. I, for example, work with those type of nurses so I easily/spontaneously advocate for the humanistic approach, sadly.

This thread is truly educational. Gets the the critical thinking going on :):redbeathe

[nursel56]

Totally agree! What I was iffy about was just the simply-write-you-up-cuz you-were-wrong.

Everyone's thoughts are derived from personal experiences. I, for example, work with those type of nurses so I easily/spontaneously advocate for the humanistic approach, sadly.

This thread is truly educational. Gets the the critical thinking going on :):redbeathe

I know! I agree! And I am completely behind a style of team-building that is not punitive. Lots of people think "manage" is top down control, and there are situations where you have to be blunt for the sake of safety. I never wanted to supervise others because I am not confrontational - and have been surprised how many situations can be defused by taking a good listen to someone rather than a simple knuckle rap with the ruler approach. A good manager can make or break the morale of an entire unit, and it's ability to retain good employees. Your approach is a good one.