Why is it always "Fire the nurse"

[Simply Complicated]

I understand that when things go not as expected, or people don't feel they got the care they deserve, they have a right to be upset. If it was due to a mistake a nurse made, I understand feeling it was the nurses fault. But I don't understand the "fire the nurse" over everything mentality.

I was talking with a girl who went to the hospital thinking she was in labor. They kept telling her she wasn't, 3 different nurses apparently checked her, and said she was only dialated to a "3ish" She was sure she was in labor, a veteran nurse overheard and volunteered to check. Sure enough she was at a 7, and they had to rush to get things ready. Had they discharged her, she would have delivered at home.

Understandably she's upset. But she kept talking about "those idiot new nurses", and other things. She does think the nurses got in trouble, the doctor and the veteran nurse were very upset. She was saying she's was going to "Follow up and she thinks they should be fired"

I and another nurse were talking to her. We explained that while no one wants to be the learning experience, if you fire every nurse who makes a mistake due to being new, than you will be left with nothing but an influx of new nurses, because no one will have a chance to learn and become experienced.

Yes, these nurses should be educated. Yes the situation should be assessed and things addressed, as it could have had a very different outcome. But I just get so frusturated with the FIRE THEM NOW mentality:madface:

Ok, sorry vent over. I just needed to vent to people who would understand. Thanks for listening.

[tablefor9, RN]

I don't like the fire first and ask...well, don't ask, ever...mentality, either. And, I believe any nurse mgr worth their skin will take other action. However, many times, especially in situations like the one you describe, the root of the patient's anger is that they don't feel that they were listened to or treated with respect, and that does require some type of corrective action and staff intervention.

I certainly know about labor, it's how I make my living. If I had a dollar for every time I've seen a pt angry because the shift before me sent them home, or the hospital across town sent them home, I'd take everyone on this thread out to dinner. I also know about crackpots. Literally and figuratively. I've had my share of "cocaine induction" patients, but I've also seen too many times when our cynicism has gotten the best of us, to the detriment of our patient relationships.

The fact is, we can't afford to let that happen. Our patients have all kinds of unrealistic expectations, and we need to use every tool we have to build rapport and stop the problems before they start, especially in an era where our reimbursement is tied to our pt satisfaction.

[VICEDRN, BSN, RN]

Whatever. I think its just an expression people use. I have heard a million people say that before and does that person ever get fired? No. Its just the way they are expressing their unhappiness at the situation. I wouldn't let her get under your skin. I would just smile and nod my head and say, "Its tough on both sides of the equation." and move on. For all we know, her story is bull and really...4 nurses checked her? Sounds like probably not.

[TopazLover, BSN, RN]

I don't recall, or perhaps never worked OB enough to make an intelligent comment on someone almost at transition and not showing other signs of labor? However I agree the patient was probably very frustrated at the time, and for good reason. Lack of respect, that fear that comes when you realize how close you came to a huge problem, etc.

We are not nice as a society. I am surprised the threat of "I'll sue" did not follow.

Recently there was a thread that discussed a generation of people who have been led to believe they are always the best, the brightest, will succeed, and they deserve it. Life is tough if you believe you are right and deserve praise for this quasi fact. I think there may be some relationship between that and the idea that mistakes by others must be punished. While our own mistakes are seen as growth opportunities.

When I opened this I anticipated reading of yet another nurse who followed an MD instruction and gave a lethal or near lethal dose, or some other major issue. We see this mentality in these situations also. Education or re-education is often needed, but sometimes this need is ignored. It is easier to blame the nurse than do root cause analysis.

In the original situation I wonder what happened other than the veteran nurse stepped in. It would be interesting to know how two nurses assigned to L&D could misjudge that seriously and be working without a safety net. Overhear is not the same as review situation.

[teensmom]

I work l & d, it's a good possibility the woman in labor was only 3 cm's when she was checked by the nurses, patients can dilate very quickly-it's happened to me. This is the kind of patient we have that we send walking to be checked again if anything changes or in an hour. She would have been fine at my hospital.

[Meriwhen, ASN, BSN, MSN, RN]

It's "fire the nurse" because it's a lot easier to fire a nurse than it is to dismiss a doctor, resident or someone that the hospital considers higher up in the importance scale; it's a lot easier to replace said sacked nurse than if they fired that doctor, etc.; and (sadly) it immediately satisfies the patient's/family's/doctor's/hospital's thirst for blood to be spilled and punishment to be meted out over the real or imagined mistake.

Was there a mistake here? I honestly can't judge as I'm not a L&D nurse and the only experience I've had with dilation was my own. And my delivery was going to be high-risk so they were keeping me in as a patient come hell or 2 cm. So whether it was nurse inexperience or the patient dilating very fast, who knows?

IMO, it's not very fair, but that's also how things seem to be. Or maybe I'm getting cynical, which is a shame since I'm still a fairly young (careerwise) nurse and I shouldn't already be getting cynical.

[llg, PhD, RN]

Why is it always, "Fire the nurse ..." ?

I agree with the previous poster who said that our culture is "not very nice." That's a big part of the explanation. We are also not very mindful and/or intellectual as a culture -- and by "mindful and/o9r intelectual " I mean that people shoot their mouths off without giving much thought to the deeper issues involved in a situation.

In other words, our culture is not very nice or very smart. We don't think about things deeply before we speak or act.

[HouTx, BSN, MSN, EdD]

wow - just wow.

i am not an ob nurse & have absolutely no expertise in that area. however, i am a nurse educator, so i have quite a bit of expertise when it comes to developing and maintaining clinical competence. in the original scenario, there's one statement that really sticks out for me "

the doctor and the veteran nurse were very upset. "

& to me, this is a red flag. veteran staff members are a fail-safe for patient care. their role is to facilitate the development of new staff & monitor/supervise patient care so that established quality standards are not breeched. repeat . . this is their role. their role is not to throw 'learning' staff under the bus to make themselves look good in front of the patient.

we are all human. humans make mistakes. this is a fact. health care systems should be designed so that the patient is never just one human error away from bad problems. this is why we - double-check important meds; double-check blood infusions; do chart checks; have or time-outs; use pre-op checklists; etc...

in the aviation industry, the op's scenario would be interpreted as a "good catch" with kudos for the veteran staff and constructive feedback & learning opportunities for the new nurses to help them improve their competency. instead, have an environment laced with punitive actions and blame, increasing everyone's anxiety and pretty much ensuring that targeted nurses will never openly report any similar issues in the future... if they escape being fired. can we all work to turn this around?

[Simply Complicated]

Thanks everybody. There was more to the story of course. I asked why she had 3 nurses check her. Like someone else said, it is possible she over exagerated the story. But she said the first nurse wasn't sure, so she got another nurse to double check for her. Who happened to be another less experienced nurse. She was having contractions, but apparently she was having back labor as well, so they thought she was not in active labor, when she actually was. She also said they had refused to check her again before discharging her, as she asked them to do. So had the other nurse not checked, even with a fast dilation they would not have caught it.

It's not a huge deal in reality. But I am pregnant and hormonal myself, haha. It was just one of those things I needed to get out for minute, as sometimes things just rub you the wrong way. Affecting me in the big picture, not so much. At the time, just got to me.

HouTx, that is a good point. She said the doctor was upset because the nurses were not able to follow his instructions and the veteran nurse had to do most of what he was asking. The way you explained it though, saying it would be a "good catch" is exactly what I was saying. There are so many factors that could have influenced this situation, and I'm sure those nurses will be more careful next time! Hopefully this was a learning experience anyway.

Thanks again for listening. Also the input from the L&D nurses. I know nothing about that field.

[Esme12, ASN, BSN, RN]

Because we are expendable and easily replaced when someone wants satisfaction. Because we are the least respected and disposable. We are the quickest, easiest, cheapest solution when someone is demanding a head on the platter. We cost the hospital money everytime we are paid. We don't bring in any direct revenue and our services are not directly billable.

So when the time comes to place someone's head on a platter......we are the first thrown under the bus. As long as we continue to argue amongst ourselves we will have a difficult time gaining the respect we deserve.

This particular situation seems to be missing key information. Why did the patient keep getting checked. What was the symptom that prompted her to keep getting checked. For the "senior nurse" to be finally called to the bedside I would assume sometime had passed and she very possibly progressed to 10.......the constant stimultion from frequent checking I would think help move things along. It has been my personal experience that when it comes time to deliver there is this sense of suprise and urgency that amused me even in labor.......like they didn't think a baby would be born eventually. The first time I delivered I think they thought at first I was hysterical bacause I bust out laughing at the hilarity inside my head. I turned and looked at my husband and said...." I don't know what all the fuss is about, I mean they knew why I was here....."

read this and see how little we are respected

Arizona Nurse Has License Threatened By Doctor After Providing Patient Education | The Nerdy Nurse

[THELIVINGWORST, ASN, RN]

this totally makes me question whether or not I really want to go through with this....so many nurses are afraid to do anything and are afraid to talk to doctors for this very reason....smh the world we live in

[OCNRN63, RN]

I recently had a situation with my physician's office. A nurse (RN) there treated me very badly over the phone when I was in a crisis situation. I never said anything to the doctor, but she must have gotten wind of it, because she called me a few days later to apologize.

I didn't say it, but yeah, I really did feel like the nurse should have at least been strongly disciplined for what happened. It caused me undue distress, and what she said was absolutely contrary to what the physician wanted. Ultimately, I left that practice because I felt like I never wanted to deal with that nurse again.

When you have people who are in extreme situations, they can lash out. I'm dealing with cancer, and the last thing I needed was more upheaval. While I held my tongue about what happened between myself and that nurse, I wasn't able to get past it. Even now, I'm still unhappy about it. I chose not to say anything because she was a fellow nurse. It's probably different for the public; they don't have a sense of loyalty to the nurses.

Had I been the pt. described in the OP, I think I would have been pretty p.o. to have been told I was a 3 when I was actually a 7.