Who's at fault here?

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Hey everybody. I'm new here, but this just happened to me last night and it's been eating at me. Alright, the facts first. I have been a RN(BSN) for about a year now. (I went through a SDO/accelerated program, I already had a BS in medical technology.) Anyway, here it is superbowl weekend, I'm working 7p to 7a, the census is 21 (out of 30), so they cut one of our nurses. (This brings us to 4 RNs and 2 nurse assistants.) Great. This isn't a new occurrence, happens all the time. Only this time, there's some confusion as to who is in charge. At about 2330, I find out that that is me. I've been dealing with a pretty ****** assignment (I had 7 patients, 4 of them were very acute) for the last four hours, so admittedly staffing was kind of a backseat issue at that point. The long and the short of it is that one of my (7!) patients died last night, and I'm willing to take some measure of personal responsibility here. It was partially because I wasn't able to assess him more often. (We found him on the can, Elvis-style.) How much of the blame is mine? I've gotten nothing but **** from the house manager about this. (Apparently, it was my responsibility to adjust the assignment more appropriately at 2300, my argument being that it would have been nice for me to actually know I was in charge!) I've only been practicing for a year, I don't know everything, and I'm the first to admit that. Help me out guys, how much of this is my fault?

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I think more information is needed... how often did you check him, and what was the cause of death? We need the whole story in order to answer your question.

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I think more information is needed... how often did you check him, and what was the cause of death? We need the whole story in order to answer your question.

I am more than happy to oblige here. Cause of death? I'm not sure as far as the official cause of death, but since he was found sans pulse and respirations and was eventually intubated, I'd have to guess that MI/AAA/CVA would be possibilities. (There was a history of CHF, but isn't there always?) How often did I assess him? Once, when I first got him. (I did the standard issue assessment, did some education re: assisstance with BRPs, etc.) and again approximately 4 hours later at about 23-2400. After that, I found him at around 0500, dead on the can.

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I think more information is needed... how often did you check him, and what was the cause of death? We need the whole story in order to answer your question.

Also, what kind of unit do you work on?? Are these critical care patients?

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Specializes in Emergency & Trauma/Adult ICU.

Need more info ... if there were 21 patients and 4 RNs, that's 5 pts. per nurse w/someone having 6. Not sure why you had 7 pts.??

The confusion about who was in charge ... what kind of assignment board/sheet/whatever do you use, and did you look at it before getting report on your pts.? (you must have, otherwise how would you know which pts. were yours?) Does that not indicate who is in charge? Or was there a decision during the early minutes of the shift to change charge responsibility due to the RN who was originally assigned to charge having pts. of unusually high acuity?

We're just guessing here ...

Bottom line - I'm sorry this has happened. I hope there's some documentation on this patient in the 5 hours between the last assessment and the discovery of him in the bathroom.

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Specializes in LDRP.

Yeah, its hard to say.

What type of unit are you on?

Was pt on telemetry? Did you notice any rhythm changes/rate changes?

When were his last vital signs-were they normal?

SHould he have been getting up alone? Did he request help, but no one came?

Do you know approx how long he'd been dead when you found him? (the longer, the worse for you)

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Specializes in LDRP.

Was he a DNR? Was there something you could have done had you found him sooner? Was it a private room? When was the last time anyone had been in his room?

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Did you not look in on him at all during four hours? What is your policy? What is the usual patient load for a charge nurse, and why didn't you hand off patients to match that load?

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This could so easily have happened to me. Every night I end up with 7 pts. I've been a nurse for 6 months. There never seems to be any reasoning to how the assignments are made. I'm told in report that everyone is tucked in and ready for bed. I get out on the floor and at least half of them are train wrecks or trying to crawl out of bed to stop imaginary children from playing in the imaginary river. Needless to say the other half of my patients get ignored all night. Half the time we don't even have an aid and are lucky to have one. Two aids are never heard of.

Like I said, this could easily have happened to me. I don't know how anyone in this type of situation is supposed to provide adequate nursing care to everyone. I work in a small rural hospital on the only floor. We don't have any extra staff to pull from in the middle of the night. None of the nurses will answer their phones at home when we try to call for help in the noc. We are on our own.

And the whole charge nurse thing. What a joke. I came on shift two nights ago and found out I was the charge nurse. The other two nurses were even less expereinced than me and one was still on orientation.

P.S. What is Elvis-Style?

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Specializes in He who hesitates is probably right....

P.S. What is Elvis-Style?

Elvis went 10-7 aboard the USS Porcelain (the can).

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Only this time, there's some confusion as to who is in charge. At about 2330, I find out that that is me.

It sounds like THIS ^ is the problem!

If you don't even know you're in charge, how are you supposed to make decisions?!

The NM needs to revamp the procedure or whatever to make sure people know they're actually in charge.

That would help the situation.

As far as "whose fault" is was, I'd say whoever didn't TELL YOU THAT YOU ARE IN CHARGE.

:rolleyes:

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