Why would anyone kept doing this?

southernbeegirl, BSN, RN · Jul 15, 2009

It is unfortunate that some nurses "eat their young" and that some are codependent. When you get out on your own, hopefully, you will find one that will help you learn. What they are teaching you in nursing school is how to pass your boards; that is all. When you get out in the real world, you have to learn how to actually do your job. It is very frustrating at times with hospitals cutting costs and staff, etc. One of the things to look at when evaluating a potential employer or job is staffing. Do your homework; find out what their average patient load is and how much help you will have (nursing assistants). What is acceptable will vary depending on what area you are working in. For example, in ICU, you would not want to have more than 1-2 patients. On a med/surg floor, I don't think it is safe to have more than 5 patients, although I myself have has as many as 9. I no longer work at that facility. In long term care, the nursing assistant ratio becomes much more important. You will ultimately be the only person protecting your license. Staffing numbers are the key to doing that. In the situation you described with the confused patient, this is what I would have done (not saying you SHOULD have done this...you don't know these things yet, because you are new at this..so that is why I am telling you...this is not criticism at all ), I would have tried to assess WHY the man was confused. Is this senile dementia? Drugs? Stroke in progress? Mental illness? What is going on with him? Then, I would have absolutely made him my number one priority. :up:You are very right; if he had fallen and broken his hip, you would be responsible. I would have a responsibility to keep him from hurting himself. After I determined why he was acting this way, I would call the doctor and ask for medication/sedative to prevent the man from injuring himself. If it was senile dementia, then I would ask if I could give him some ativan. If this was a drug related thing, or alcohol, he needs to be in the psych unit or behavioral health. They will physically restrain him there if need be, or have him one on one with a staff member, so I would ask for an order to send him there. If I had no idea what the cause was, I would simply tell the doctor that the man is going to fall and ask him what HE wants you to do. Then, I would document the new orders and/or response after you document that you did notify the doctor. If you are still stuck in the same situation with no improvement after talking to the doc, I would call the nursing supervisor and tell her what took place. At that point, you as the staff nurse have done all that you can do, and it is now HER responsibility to take the reins. I would also document my conversation with her. Then, I would go and try to catch up on the rest of my work. It is true that you have to set priorities, however, it sounds like you were doing that, but your instructor should have been giving you some guidance on what to do next. Sadly, many experienced nurses shy away from teaching, because the salaries are so much lower. So, some, NOT ALL (no nasty comments from nursing instructors paleeze!), but some nursing instructors have very very little real world nursing experience. Last but not least, once you get out on your own, it will be a rocky year, and then it will get better, and easier, etc. It all amounts to figuring things out and solving problems. That is what you do 90% of the time when something outside of the routine comes up. Why would anyone keep doing this? I do it to get paid. I do once in a while feel like I am making a difference in someone's life and I really like it when that happens, because I like to help people. However, the reason I stay in nursing is because I get paid to be doing it. I know they teach you not to say that in nursing school too. :icon_rollNursing school=fantasy land in more ways than one! Good luck!

I got one word for ya....PARAGRAPHS!

i am sure you had something worth reading to say but it is impossible to read as is.

catwoman66 · Jul 15, 2009

catwoman66
I just want to say thank so much for the info of how to handle this without and comments about me being bitter, etc etc. I was upset last night when I wrote that of course.
Thank you for confirming for me that making him my number one priority was the right thing to do because my input from a few of the others students was that I should not have let anything that had to do with him let me ge behind and I differ on that. Proper meds were requested and given, still big problems. Perhaps if this was a real situation and I could have personally called the doc the problem would have been taken care of. But of course I was not. Also, I tried to involves other staff etc to help but this person needed constant supervision that no one had time to give him.
I do have a question though. If I was the real nurse and had called the doc and the doc did nothing about it. Told my supervisor and still nothing was done. Then if he fell would I still be liable? You said in your post that after taking these steps you would go on and do your other work and I suppose check on him as best you could. BUt in order to get your other work done obviously you are not going to be able to check on him enough and sooner or later the chances of him falling would be very high at least in this incidence. Would you still be liable?

You are welcome. :nuke: I'm new on here, and so I hope I have gotten the quote thing around your reply. By calling the doctor and then the supervisor, you are spreading the liability, it is not completely off of you until you go as high as the Medical Director of the hospital. I have only seen that done one time, thankfully, I was not involved. A pt. had a heart cath done and BP was dropping during the night. The doctor was a resident, the RN called him. He wanted the pt. discharged in the AM. The resident would not listen to the RN who was asking that the pt. not be discharged. The RN then called the attending physician (they are over resident MDs), and the attending backed up the resident. The RN then called the house supervisor, she was satisfied that all bases were covered. The RN was not comfortable with discharging the patient, and she called the Cheif Medical Officer/Medical Director of the hospital at home. :bow: He agreed with the RN and stopped the discharge. They had to call a code blue on the patient a short time later, and this would have been past his discharge time. He lived. If he had gone home, he would have died. In most situations that I have been in, I have found that when I call the doctor and give him/her all of the assessment data that I can; vital signs, known medications, known conditions from pt. history, other physical assessment signs, and also why I am concerned....what it is that I think might happen (in this case a fall/broken hip), I get a very good response, because they know what I have just done...I have put them in a position where they have to do some kind of intervention. If they do not, then they risk being seen as negligent. (lawsuit for them) They know I am going to chart what I have just told them, and that they have been called. Very rarely have I had to go beyond this step. Also, you will get to know the docs at your hospital and they will get to know you...they will develop trust in your judgement. If you do have to go beyond this, it is because the doc may not know you/trust your judgement yet, or he may just be a jerk/idiot on a power trip. That is when you have to contact the supervisor. She, if she is an experienced nurse (and she should be in that position), she will know that you have done all that you could. She may have suggestions for you to try, she will ask what you have done so far, she may place a nursing assistant one on one with the pt. or she may call the doc herself, and he will most likely know her better, and he may trust her judgement more than yours. Also, she knows you are going to document all of this and she does not want to be found negligent. (lawsuit and termination possible for her) In cases like this, I have seen the supervisor move the patient, take over being one on one with the patient, or pulling a staff member to the floor to be with the patient. I have never been left hanging. They know you cannot do your other work and this also, and they are going to get called on the carpet if you are there 4 hours after your shift ends and no one got their meds until then. So, I just cant envision it going beyond that...it never has for me. If it did, then I would call the risk management officer at home. Every hospital has one and their job is to protect the hospital from a lawsuit. The position is often held by an RN, but in larger hospitals the person may have a law degree. Tell the risk manager your problem and the Chief Nursing Officer should be pulling up in the parking lot within 10 minutes. That is what I would do. Someone would not have a job the next day though...most likely your supervisor. :nono: I don't think you are bitter at all. I think you are a smart person in a tough business, but you will be alright. Hang in there. :up: I just re-read your response to make sure I didn't miss anything. I would not leave the man unattended unless their was another pt. getting ready to code or something. That happens too. I had two codes at once....very bad day. Anyway, I have in the past put pt.'s in a wheelchair and brought them up to the desk with me; I would do something like that but I would not leave him. However, I don't think it would take long to resolve once the CNO pulled up. Seriously, I have never seen it get to that point...it would most likely end with the supervisor coming up with a solution. Hope this helps. :typing

catwoman66 · Jul 15, 2009

Sorry about the paragraphs...I'm new on here and wasn't thinking about that; didn't realize how long my answers were.

Also, I didn't realize the pt. was in long term care...for some reason, I thought we were on a med/surg floor. In LTC, the pt's potential for injury (from falling) needs to be adressed in his care plan. Medication isn't a long term solution; just a short term fix. Also, restraints are only used in psych/behavioral health, and in ICU. I would not restrain him in another area either. In LTC, you can put a resident in a wheel chair with a "lap buddy", which is a soft cushion that wont allow them to get up...but it is not a restraint...it is their FRIEND! :yeah:

Anyway, in LTC, you would notify the Director of Nursing of the problem so that she could consider various interventions and discuss them at the care plan meeting & then with family. You have less liability for a fall in LTC than you do in acute care, because the nursing home should have a care plan developed in the first 24 hrs, and then they may need to adjust it after that. In the current situation, if meds did not work, I would call the doc and then the DON. Chart it. If you are left in that situation, and you do the best you can...I mean, I would put a CNA one on one with him and document that too, then you should be fine. He will probably need to be in a dementia special care unit with a much lower staff to pt. ratio.

I have had LTC pts fall on my shift and have also had them break hips. As long as you have followed their care plan, and have done all you can to keep them safe, followed with a thorough assessment and charting after the fall/incident, you will be fine.

ChristyRN2009 · Jul 16, 2009

In acute care we do restrain patients on occasion for their protection. I too assumed you were speaking of an acute care patient, so I apologize for that assumption. If the patient was truly such a high risk for falls every person up the chain of command should've known and ways to prevent his fall should've been of his plan of care.

And I said you were bitter because of the tone of your post and title of this thread. Honestly, asking why anyone would want to do this struck me as belittling and somehow implying that me and everyone else who does it is stupid FOR being a nurse. Good luck in your studies and future employment, in whatever field you choose.

GadgetRN71, ASN, RN · Jul 16, 2009

OP, there are other specialties besides LTC or med/surg. Many take new grads as well..I have much respect for med/surg nurses but I'd want to gouge my own eyes out taking care of nine pts at once. In my area, we have one at a time. Prioritizing and time management are still important but at least you aren't run ragged all the time. Plus, no obnoxious families/visitors for the most part(sometimes in PACU).