When your eyes and ears are being ignored

Thunderwolf, MSN, RN · Sep 6, 2005

You all raise good questions. Remember, this is an information board for nurses. We support each other by raising issues of clinical practice and issues of concern as it impacts us as nurses. In saying this, we support and validate each other. We also get some answers to our questions. Knowing that this information can be viewed by "anyone", even non-nurses, it should provide some sense of self censor on the poster's part... how much or what type of information...is being released. Identity is a big issue. That is why Mods delete identifying poster info when found and PM the poster. Your co-worker, friend, or employer can view the same material if on-line. So, thank the Mods when we do this.

Wolfie

rn/writer, RN · Sep 6, 2005

3 days later. the same nurse calls me over very concerned. dr. is in the nurses station. nurse asks me " what happened to that pt?" of course, i said that i did not know and that she was complaining of back pain. dr seems very annoyed, along with his np. acting very concerned, and worried this time, the nurse asked well how long has she been in pain. i told the nurse, dr, and np everything that happened, when i took care of her. well dr ask me well did you chart what you told the nurse? yes i did. dr sends pt to hospital.

the kicker is, that i asked her very alert roommate what happened to pt. she said in the morning 2 to 3 days ago (i worked swing). pt fell while trying to go to bathroom. two cna help her along with a nurse. neighbor says that they go her off the floor. nurse gave her something for pain, and never charted the incident.

my gripe, is that i know that the lpn and rn are busy passing out meds. because one miscalculation could be fatal. however, please take one second to see if what the cna is telling you. it might not be important now, but could lead to being very important later. do not come to the cna acting concerned when the doctor is breathing down your neck.

call me a cynic, but one possibility here is that this was a deliberate omission. there are those who try to use the old charting maxim, "if you didn't chart it, it didn't happen," to their advantage. it isn't clear to me if the rn involved in the fall and the rn you tried to alert are the same person. if so, she may have been putting on a big performance for the doc. her aggressive interrogation could serve to make her appear unaware, and therefore innocent, at the same time as it casts aspersions on anyone she questions.

the primary concern is making certain that the poor patient gets the care she needs. the secondary, and in someways more important, concern is finding out who was involved in the incident and why all kinds of documentation is missing. there should have been charting that included the event, assessment data, contact with doc, new orders or statement that no new orders were made, repeat v/s if appropriate, an incident report and anything else the facility requires. that's what makes me think this wasn't just a simple oops. any of three people could have started the paper trail and no one did.

it shouldn't be too difficult to look up staffing for the shift in question. the biggest problem here is that it's very possible that someone is willing to sweep serious problems under the rug and two others are willing to go along for the ride. this doesn't bode well for patient safety.

if someone in authority is not investigating this further, they're ought to be.

good catch on your part. you'll be an attentive nurse to both your cnas and you patients, i'm sure.

Thunderwolf, MSN, RN · Sep 6, 2005

The biggest problem here is that it's very possible that someone is willing to sweep serious problems under the rug and two others are willing to go along for the ride. This doesn't bode well for patient safety.
If someone in authority is not investigating this further, they're ought to be.
Good catch on your part. You'll be an attentive nurse to both your CNAs and you patients, I'm sure.

Ditto