When your nurse won't listen.

[MidnightTang]

I am a CNA who is in nursing school currently. Recently my hospital did away with all restraints and instead has instituted one on one sitters at the nurses discretion. Yesterday I had an older, confused, nearly deaf man with an unsteady gait. He was impossible to reorient at times he had a history of psychosis and dementia. I checked on him frequently and in the first hour had to get him back to bed 3 times. He would get up, get tangled in his IV trying to get to the bathroom and urinate on the floor. On top of this he was determined to pull out his IV. On each of these occassions I went to my nurse and told her. When I explained the difficulties I was having and my very real concern that he would fall she said, "Oh, he's able to follow commands. He's really pretty sharp." He clearly was not. I suggested she might want to call for a sitter before shift change. She disagreed. I mentioned the problem to my Charge nurse and she said it was up to his nurses discretion. By the time my shift ended, he had removed his IV and nearly fallen multiple times. My other patients suffered because I had to give this man priority. HOW CAN I GET THEM TO LISTEN TO ME!!!! Sorry for the rant. I just wanted to complain.

[CHATSDALE]

hopefully you won't be on same shift with this pt/nurse combination but sometimes people really can look at the same thing and see different things

if this nurse continue to not trust your judgement request a different team

[Chaya, ASN, RN]

First of all, good for you for being so persistant as a pt advocate. As a nurse I have been on the receiving end of similar situations and I confess that sometimes my first thought is "Oh no! I don't have time to deal with this" Especially if I have previously assessed a pt as A + O. This was a sobering reminder to me that a five minute assessment early in the shift may give only a partial picture. Moreover, the pt's MS can easily change over a few hours- I work eves and I don't know how often the day nurse will report to me that a pt is "with it" (and maybe they are during the day), then we see some serious "sundowning" on our shift. All you can do is tell your nurse that his MS has changed and ask if s(he) can re-assess the pt, hopefully with you present to clarify what behaviors you saw. If the nurse in question is too swamped or otherwise unwilling you might ask them if you could get another nurse's opinion. If you really feel the pt is endangered, pt safety comes first. Try to act as neutral as you can but then you need to go up the food chain to the Charge nurse and use the proper buzzwords- that you are concerned for his safety and would like another assessment. There might well be some resentment but you have to decide which is worse- a pissy nurse or an injured patient.

[chadash]

Good for you! You advocated for your patients!

[jelorde37]

hey sorry that that had to happen to you. im a lvn right now and i really appreciate it when my aides give me input on patients like you were doing with your nurse. i believe that the nurse made a wrong choice. i had a patient like the one that you described. i called the doctor and got an order for haldol. acouple minutes after the injection-haldol ineffective. i called my charge nurse to assess, she suggested more haldol. i argued with her and i ended up sending the guy out for an evaluation. 4 hours later, the patient is diagnosed with subarachnoid bleed. my DONS thought really greatly of me, but i put my CNA's in the spotlight because if it wasnt for aides like you, my patient couldve died. soo thanks.

[TheCommuter, BSN, RN]

Unfortunately, the patient will have to fall a couple of times in order to get this particular nurse to listen to you. It truly is an unfortunate situation, because the patient will experience pain that is preventable.

After this particular nurse is forced to do a few time-consuming incident reports that document the falls, she is likely to finally listen to you.

[morte, LPN, LVN]

does the pay for the "sitter" come out of the unit budget?

[Tweety, BSN, RN]

does the pay for the "sitter" come out of the unit budget?

Where I work, this kind of patient's sitter would come out of the unit's budget. A person who is involentarily committed, for example a suicide watch, it comes out of the nursing department's budget but not the individual manager's budget.

Sadly, this is a consideration sometimes. We'll get a sitter, and later the manager comes along and decides the patient doesn't need it, and clearly it's a budgetary consideration and not always in the best interest of the patient.

[buildingmyfaith57]

my biggest concern is why isn't that most places don't suggest that when you report something to the nurse about a resident or patient that the c.n.a's don't document it and than have the nurse initals it that she got the report?

[jelorde37]

good idea and nice car.