What would your first priority have been?

[DA314]

I am a nursing assistant at a hospital. Yesterday was my first day off orientation. I was working on a Telemetry unit, and it was insanely busy (I had 11 rooms by myself). P.T. got one of my clients up to walk, and as they did, she urinated in the bed. Since she was already up, I decided to change the bed right then. As I was walking back to the room, linens in hand, a nurse stopped me to tell me that another pt. had been discharged and needed to be wheeled downstairs. I explained to her what I was doing, that I needed 2 minutes to change the bed, then I would wheel the pt. down. In the middle of the hallway, with nursing students whom I have to see at school everyday, Physical Therapist, and the patient who urinated watching, she screamed at me that I needed to learn to prioritize and that there are patients waiting to come onto the floor, and the discharge was more important than cleaning up urine. I stood there, mouth agape, and just walked away and did what she said. Another person who saw what happened changed the bed while I was wheeling the pt. out.

Was I wrong in this situation? I have only been a nursing assistant for 6 weeks, so maybe someone can explain to me why the discharge pt. would be more important?

Thanks for any input!

[Daytonite, BSN, RN]

The discharge patient was in a W/C and ready to go. That was a priority. Your other patient was with PT and engaged with being ambulated. The bed change could wait. PT could have put your patient in a chair on a Chux to wait while you returned to change the bed.

[CampinRN]

The pt with dirty bed had higher priority since you would be holding up PT to wheel another pt who is d/c'ed. She should have delegated the d/c to another staff member since the room is now available for the next pt. Sounds like a high-stress floor. BTW, her treatment of you was both inappropriate and highly unprofessional.

[truern]

First, she shouldn't have yelled at you!!

Second, I would have placed the clean linens in the room and then wheeled the discharged patient out. For all you know housekeeping was already in the other room cleaning it for a new admission and the nurse was under the gun to receive the new patient.

[Whispera, MSN, RN]

The nurse was inappropriate, no question about it. You deserve respect.

That being said, I can see two sides to the situation. First it would be nice for the patient who was up walking to be able to get back in a clean bed when she's done walking.

Second, the nurse was probably getting pressure from somewhere else and needed to accept a new patient into the room the leaving-patient would be out of. I think she overreacted.

I'm sure there was more going on in her head than what was on the surface.

And, I'm sorry you had to go through this! Obviously another person was too, since the bed was clean when you got back--that was very thoughtful, wasn't it?

[Michifura]

Yes, throughput is important...discharging and admitting patients in a timely manner but I agree with you it would have taken you a few minutes to change the bed while the patient was up with physical therapy, then you could have taken the other patient out.

I don't see anything wrong in your logic, in fact you were attempting to meet both patients' needs. Keep up the good work!

Unfortunatley, sometimes as nurses we get so focused and overwhelmed with our patient load that we forget the unit has other patients that also require care and services.

I am glad to hear that you at least work with other people that are team players (which stepped in to make the bed) and realize the concept of team work.

Best of luck!

[Luv2BAnurse]

I personally think it was more important to the nurse that the patient be discharged. I think that it would have been more appropriate to change linen first, so that when the first patient was finished with PT he/she could get back to bed (or even a chair) without seeing evidence of an accident.

[KyPinkRN]

I would have changed the bed first... my thinking is that a patient being discharged is always lower priority than say, cleaning someone up, or getting pain meds, or keeping the patients who are staying comfortable. It probably takes about a minute for you to change a bed... so I would have just gotten that done then taken the patient downstairs. After all if they are well enough to be discharged they can certainly wait 5 minutes for you to put clean sheets on someone's bed.

[Flare, ASN, BSN]

The linen change would have been my priority. It only takes about 2 minutes, as you noted and there is a high liklihood that the patient would need to be returned to the bed quickly either to finish PT or due to a change in condition such as dizziness or exhaustion.

[chevyv, BSN, RN]

what a suckish day for you! I'm sorry that you had to go through that. I wonder if the nurse could have seen that you were busy and checked to see if there was another person who could wheel the discharge down. If not, it sounds like you had already stripped the bed, so I would have had that pt sit up in the chair until I got back and then would have finished with the bed. The important thing is to not beat yourself up over it. Another important thing is to take that nurse aside and gently thank her for pointing out that you need to learn how to prioritize and that it being your first day on your own, you will learn as you go. Next time, could she please take you aside and talk with you.

Try not to hold onto her rudeness. There is no excuse, especially because she didn't even apologize to you. Sometimes when we're stressed, we react this way. It is still unacceptable! You don't raise your voice to a coworker who is with a patient (even if you were to have been alone, still unacceptable).

Blow her off and don't worry. You will learn as you go, how to prioritize. You were holding a person's dignity in your hands. I applaud you for thinking that through and telling the nurse it would be a few minutes. Many newbies try to do everything at the same time (myself included) and just end up forgetting things. You were thinking things through and that's huge! Good luck!

[Whispera, MSN, RN]

Reminds me of when I was a nursing assistant...one of my first days on my own. The nurse told me I should take a patient down to the lobby since she'd been discharged. I did. Then when I got back the nurse asked, "where's Mrs. __?" I said I'd gotten her into the car with her husband and she was off for home. The nurse was quite upset because she hadn't meant that I should take the patient down THAT VERY MINUTE, but rather that I should expect it. The paperwork hadn't been reviewed yet! I felt very duhhhhh-ish!

[RochesterRN-BSN, BSN, RN]

I would ask to have meeting with this nurse and the manager. She treated you disrespectfully and will most likey do it again, to you or someone else.

Here is a novel idea.......the nurse could have said---"Listen...why don't you take the DC'd patient out and I will take care of the bed for you. Which room is it?"

Nurses are busy and yes this is not truly a responsibility of the nurses--but in reality everyone there is a team and everyone is there for the patients. So yes nurses do sometimes need to stop and do tech work. Any good nurse knows that. A good tech realizes that the nurses are busy and is respectful in not taking atvantage of the nurses will will help if they really need to. It goes both ways.....Hell I have had PTs even chip in when they can......I have seen them help a patient to the BR, help boost a patient and even throw on a set of sheets. And even better I love it when I see a DOCTOR offer to help with something like that........I once walked into a room with the doc and the patient told us she had just soiled herself.....the doc was wanting to look at a sacral wound....I said to the doc, "let me just grab a tech to assist me to get her changed real quick then you can look at her wound." Shockingly the doc said in return..."Oh heavens, let me get some gloves and I would be happy to help you." I just about fell on the floor!!! LOL

But I wouldn't let the nurse continue to think it's okay to talk to you this way.