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.
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???
Here is how I look at it:
Two people knew the patient was wet.
The RN got called away and that is why the patient wasn't changed.
The CNA didn't change the patient because she had a chip on her shoulder.
One is understandable, one is disciplinary.
A GOOD CNA would have went to the RN in a few minutes and said, "I am ready to help you change that patient, do you want to come with me now or in a few?"
If this was an RN who did this all the time...I could understand the CNA's frustration. But the bottom line when it comes to patient care, ego needs to be checked in at the front door. We all forget things. If the CNA had got pulled away and momentarily forgotten but didn't do that all the time that is very forgivable. We are all human.
It is 100% unforgivable, for any patient to lay there and suffer in discomfort, because any healthcare worker, regardless of which letters they have after their name, to delay OR refuse care because of ego.
The RN got called away and that is why the patient wasn't changed.
The CNA didn't change the patient because she had a chip on her shoulder.
One is understandable, one is disciplinary.
A GOOD CNA would have went to the RN in a few minutes and said, "I am ready to help you change that patient, do you want to come with me now or in a few?"
If this was an RN who did this all the time...I could understand the CNA's frustration. But the bottom line when it comes to patient care, ego needs to be checked in at the front door. We all forget things. If the CNA had got pulled away and momentarily forgotten but didn't do that all the time that is very forgivable. We are all human.
It is 100% unforgivable, for any patient to lay there and suffer in discomfort, because any healthcare worker, regardless of which letters they have after their name, to delay OR refuse care because of ego.
But the RN was not "called away", she went on break and forgot about the pt.
But the RN was not "called away", she went on break and forgot about the pt.
She was called by another patient. Then she went on break. I agree that loudly speaking from another area is never ideal, however, it was delegated for whatever reason and the CNA chose to focus on the delegation method as opposed to the patient needs.
With all this being said, I wonder if the patient was taken to the bathroom on the first sign of attempting to get out of bed that perhaps this all could have been avoided. NOT to mention exactly how long is someone restrained as a way to make a confused patient less confused? I would be more concerned about the fact that I have a patient in 2 point restraints for however long a time due to confusion and fall risk, (Seriously? How does one explain that) and in fact, the patient had to urinate himself due to being restrained. That is a HUGE violation a patient's rights. So perhaps it is not so much about the telling the CNA to change the bedding and clean the patient, but more to do with asking for restraints to begin with. That would NOT be most nurse's first choice in intervention. If OP was directed to get an order from a charge RN, then that is an issue.
I still maintain, however, that writing a paper about this nurse's practice is a bit over the top. Perhaps the charge RN needs to write a paper about when it is appropriate for restraining patients.....
The state regulating authorities would have a field day with this.....
kantony
11 Posts
thanks jadelpn