how will you react if you were in my position

[kantony]

hi friends this is an incident happened nearly 3 W ago in my unit which is controlled by the director "T" since the manager post is not filled.

one particular night I was taking care of male patient who was totally confused and about to fall. so I called MD and got an order for restraints. Though charge nurse suggested four point , I insisted upon only two and applied to the hands. there after patient became more aggressive, started to kick using his long legs. any way myself and CNA "C" gave bath to the patient, changed the linen and all other things together since patient was very aggressive even under restraints. Later I found that patient made the bed wet. I told CNA "c" loudly that "patient is wet" who was sitting at a neighboring computer station. what I intended was to seek her help , though i did not tell it specifically since it was clear that two person care is needed due to violent kicking by the patient. I waited there out side for a while and then some other patient called me I went after that and i forgot the fact that patient is still wet and needs to be changed. later I went on break missing this totally. CNA changed the the sheets . I came back from break after 30 minutes and later I assisted her again for everything for this patient till 0600. the very next day director "T" summoned me and asked about it. since charge nurse mentioned about this before. I told T that "I would have been shocked to hear from you about leaving patient wet and passing the responsibility to CNA, I if were not heard about it beforehand since it was quiet unintentional". T was very furious , in the heat of the moment she told me four things

1. my behavior was egregious, did not show compassion; I missed the basics of nursing.

2.She does not want the way I speak to CNAs. I guess it is reported that i am using a " superiority language:' and not using any please.

3. that I do not attend call lights immediately.

4.that she had given me prior warning about my communication. she claims her memory is very good.

any way she told me I have done something that warrants termination but she doesn't want take any decision while in anger and told me to come back after a while and we mutually agreed to meet after 36 hours.

during the second meeting I told her three things

1. I did not neglect the patient completely . I recognized the problem and then I acted to correct it but unfortunately and unintentionally I missed it and I am responsible for that as long as I did not change the bed after recognizing it.

2. I approached her by- self to get feed back about my performance twice before this incident . first when a charge nurse mentioned to me that "T" mentioned to her about my communication to patients. At that time when I approached "T" to know about it she told me that she heard once or twice patients saying I am not clear to them and at the same she does not consider it as a major problem that demands a formal summoning, hence she did not call me formally. Second time I asked " How am I doing? what is the feed back you are getting ? she told me everything going good and I improved a lot"

3. I asked her specifically about the call light issue. She said there was only one complaint and she did not see a pattern of non-response to call light from my part.

she replied that she did not feel from my reply that 'I owe the problem any more'. Any way she told me at the end she is not going to fire me instead she going to take a gamble by retaining me in the unit. she asked whether I want this incident and action to be formally recorded and I said firm "YES" later she said she is not going to do it. she gave me an assignment to write: How will I ensure patient safety, what reward I expect If I do it for the next 90 days without any flaws, and punishment I should be given if I fail.

Still I am working in the same unit very much guarded. I think I should resign other wise this issue will eat me. I feel that I was not treated well and her reaction was not proportional to my mistake.

I am working with the same CNA very smoothly. I had told the same CNA in the very beginning of my job in the unit to call me to do anything with MY patient. Now a days also she calls me while giving bath to any bedridden patient and I help her.This was the way the care was done to the patient involved in the issue even the second night after the incident , just before the director "T" called me.

I request you to analyze the situation with a "fresh set" of eyes. was "T" reaction justified? Is it a "terminable" error? was my response to "T" improper?by the way being a person form one of the Asian countries who came here 6 years ago, my tone of language might be mistaken by T.

I was almost deiced to resign before the second meeting with "t" but my spouse who is also an RN and my friend suggested that throwing away a job is very eccentric reaction. Now this problem is eating me. I sarted my RN job two year ago with much confidence after scoring all "A" except one for my associate degree program and I expressing my ambition to be the best nurse in the field openly( that why I seek feed back from my superiors) and I was trying to do my best . now I am getting more and more frustrated while looking back at this problem. I find a lot of points to justify me, (of course it is a subjective feeling) that make me more frustrated.

[xoemmylouox, ASN, RN]

Your manager overreacted a bit, but perhaps is frustrated with your unit in general? I can see how the CNA would think you had dumped this dangerous and difficult patient on them, and that they may have even thought you had talked down to them. Things come up and you are only human, but this patient was left wet in restraints and that's not ok.

[nursel56]

How would I react? She may well have said that you didn't show compassion in nursing because you loudly said "patient is wet!" It is a dignity thing with a lot of us older nurses even if the patient is confused or otherwise not alert.

I would refrain from arguing over decisions you don't agree with and insisting on your own plan. Sounds like her advice may have been correct in this case.

I would write the paper she asked me to write.

I would make my communication skills a top priority and seek feedback on that issue as it seems to be important to "T". Ask your coworkers to tell you if you are coming across as "superior attitude" because it is not intentional on your part.

I believe what she may have said is that you are not "owning the problem". That means you are not accepting responsibility but being defensive. I think you are lucky she didn't fire you, you must obviously have a lot of qualities she values. Best wishes!

[kantony]

thanks nursel56

[kantony]

thanks a lot xoemmylouox

[Jory, MSN, APRN, CNM]

Sounds like you have an arrogant manager on a power trip.

God only knows the things that I have forgotten when called away....it happens to all of us.

The bottom line is that while you forgot about the patient, the CNA shouldn't have. You could have explained why you called out from the room, which is understandable, but the question that I would have had for the CNA is, "So, the nurse told you promptly that the patient was wet..so how long was it before you went into the room to assist the patient?"

The CNA is equally to blame if she let the patient lay there b/c she had a chip on her shoulder.

[kantony]

thanks Jory

[xoemmylouox, ASN, RN]

Sounds like you have an arrogant manager on a power trip.

God only knows the things that I have forgotten when called away....it happens to all of us.

The bottom line is that while you forgot about the patient, the CNA shouldn't have. You could have explained why you called out from the room, which is understandable, but the question that I would have had for the CNA is, "So, the nurse told you promptly that the patient was wet..so how long was it before you went into the room to assist the patient?"

The CNA is equally to blame if she let the patient lay there b/c she had a chip on her shoulder.

I don't understand how you can say that it's ok that the nurse forgot about the patient, but then say it's not ok if the CNA did???

[jadelpn, LPN, EMT-B]

All of the he said she said aside, I would ask that instead of a "paper" format, you think about the questions that the manager asked you to, and to make it into an improvement plan.

That you have meetings with the manager regarding the plan on a regular basis, and have things in writing. For instance, she can say that you have improved, but without anything in writing, she could deny that ever was said.

You should never speak loudly to anyone in an area different than yours. If you required assistance with cleaning the patient, you could go to the CNA, ask if she can assist you. I can see how the CNA felt you were ordering her to take care of it herself. And with that being said, an agitated patient who is kicking would need more than 2 people. Someone could get hurt. And if patient was totally confused and about to fall, then a 1:1 sitter needs to be at bedside. I am a little taken aback at right to restraints. If patient was confused no wonder he was acting out when strapped down. Perhaps he needed to use the bathroom to begin with? The unit could use re-education on confused patients and their care.

If you understand that your professional behavior was inappropriate, then use the "paper' request as a guideline for improvement. That you got good grades in school doesn't automatically mean one is a effective nurse. I would use this as an opportunity to amend your practice. If you still feel as if it is not working for you, then look elsewhere.

And as a final thought, nurses are human. We make errors in judgement. To acknowledge that this was one of those instances and that you are willing to find ways to improve can go a long way.

[gcupid]

Don't take criticism personal. We are all human and make mistakes. Forgetting about a patient that needs to be changed is not life & death. The CNA could have just asked another coworker to help while you were at lunch or simply waited till you got back. Personal safety is priority over any patient care in my eyes. Calm down!

Just try to do the best that you can with the resources that you have in place.

[jadelpn, LPN, EMT-B]

In re-reading this again with fresh eyes, I think that it is a bit inappropriate to give you assignments about "rewards" and "failure". Not to mention humiliating. Do you belong to a union? If not, is there a policy about discipline?

I am not quite in tune to this manager's style. Nor her power trip. Taking out of the equation any lack of judgement, he said, she said, I did, I didn't of your situation, to ask you to present to her a paper regarding your "reward" and "punishment" is over the top. Plus, no one can give 100% certainty that an error (and what constitutes an error--if you don't chart 100% correctly...there's some subjectivity in errors) will not happen in 90 days.

I still maintain that the "paper" should be in a re-education/improvement plan form. I would ask in writing for exactly what she is looking for. I would discuss with HR. To single you out to complete this strange assigment is just odd.

Know your policies, know your contract if you are in a union. Ask for a delegate's help if you are union. I am not too keen on speaking loudly across the room to a CNA that someone is wet, however, taking your delegation style out of it--you were well within your scope to delegate to the CNA. NOT that it was done in a way that is ideal, however, it was still well within your scope. So the act of "leaving someone wet" is never good practice, that you delegated while you took care of the needs of another patient just may be.

[kantony]

thanks jadelpn