Nursing Voices

Monday, July 07, 2008

It's Always the Nurse's Fault

What on earth is going on here? It looks like the police are hauling poor Ronald off to the hospital. Maybe he was hearing bad McVoices telling him to hurt people. Would you like fries with your Haldol, Ronald?

I’m not in a good mood. I’m ready to stick my nursing license into the shredder and go to work at McDonalds. I had a patient go off on the unit this weekend. He wanted to hurt someone, so I put him into locked seclusion. Then I did what I was supposed to do. I called the doctor, but he refused to come to the hospital to do the face-to-face assessment with the patient. Then it gets better. He didn’t ask another doctor to come into the hospital to cover my ass. I told the nursing supervisor what was going on, but apparently that wasn’t enough. What was I suppose to do? Let a dangerous, homicidal patient out of seclusion because a doctor didn’t come see the patient? I can’t make a doctor come see a patient, or do anything else that he or she doesn’t want to do.

Nurses take the fall when things go wrong at the hospital. I'm having a meeting with my boss on Wednesday. I’ll let you know if I’m asking, “do you want fries with that?” at my next job.

UPDATE: Check out It's Always the Nurse's Fault: Part II


Blogger Elaine said...

Good luck with that meeting. I can't believe that someone can call him/herself a doctor and fail to provide meical care when it is needed.

6:55 PM  
Blogger Nervus Rex said...

So sorry to hear that you are dealing with the super-powers-that-be. What a bunch of crap.

There are days when I look at Evelyn Charles and think... hmmmm, I could do pedicures for obese diabetic women for a lot more money, have happy customers, and not get hit or spit at!...

I posted a similar story to yours back in June. It's terrible that this happens to nurses, and so often!!

Stay sane,

11:45 PM  
Blogger Ken Wedding said...

Did you see the NYTimes article, "Nurses Step Up Efforts to Protect Against Attacks"

We ought to send a copy to every policy and lawmaker we can.

8:53 AM  
Blogger Ken Wedding said...

The link to that NYT story is

8:54 AM  
Blogger The Curmudgeon said...

Did someone complain about the patient being placed in locked seclusion?

Granted, the doctor was a jerk for not tending to his patient when you advised of the problem... but... being practical here... if he stayed locked up and no one beefed about it, wasn't that OK?

Pardon my ignorance, but I learn by asking questions.

1:35 PM  
Blogger Mother Jones RN said...

The answer to your question can be summed up one word, Curmudgeon: JCAHO. That’s right. We’re expecting JCAHO to walk through the doors of the Greatest Hospital in the World as we speak. They are going to ask to see the medical record of the last person placed in seclusion and/or restraints when they inspect our unit. Guess who that’s going to be. And it gets better. I talked to a nurse from my unit today. Apparently the doctor signed the seclusion order the next morning indicating that he had seen the patient within the first hour. Then, when he got caught in a lie by hospital administration, he scribbled over his name on the order sheet that was in the patient’s cart. HOLY SHIT! JCAHO is going love that! I’m just waiting for them to ask me to rewrite the order and place it in the patient’s chart, minus the doctor’s handy work. That’s not going to happen. He’s going down with me.

Ken, thanks for pointing out that article. Good reading.


4:44 PM  
Blogger The Curmudgeon said...

This is exactly why God invented photocopy machines. If you know what I mean.

5:41 PM  
Blogger kario said...

Ugh, JCAHO is scary but not being backed up by your co-workers (MD behind their name or not) is even worse. I hope your supervisor hears you and responds and you don't end up pushing Big Macs!

8:23 PM  
Blogger Roy said...

The reason for the examine pt within 1 hr rule is because some have died in seclusion due to unrecognized medical problems. Options to consider:
-call the house officer (the 24/7 doc who is there to put out fires) to examine pt, maybe saying you want to be sure pt isn't going to code
-call the dept chair stating his doc won't come in and will he come in instead (one of my nurses properly woke me up at 3am once for this same problem... I made one phone call and one email and it has not happened again)
-call administrator on call

After the fact:
-submit incident report and copy dept chair and CMO highlighting safety and quality, not the passive-aggressiveness

Of course, sounds like you have a larger overall problem than this one incident. Does your hospital have a house doc overnight? That is the person who should do eval, not the at home psychiatrist. We changed this to the house doc when JCAHO turned up the heat on this problem, and that fixed it.

Anyway, sorry to hear of your grief.

-Dr Roy

1:57 AM  
Blogger Prisca said...

I'm with ya--I may be joining you at Micky-D's. It sounds divine right now.

10:07 AM  
Anonymous Anonymous said...

There are two ways to cover yourself, Mother Jones. Chart that the physician was informed and "No new orders received at this time."

Once had a doctor come behind me with an order and the NEXT DAY, add another order above my signature. Since then, I draw a couple vertical lines between the last order and my signature, or I sign on the line immediately below the order.


10:55 PM  
Blogger Albinoblackbear said...

MJ--I really hope your team/admin backs you up. It is truly the worst feeling when you are hung out to dry for someone else's incompetence.

Keen to hear how the meeting went.

May the force be with you!

2:22 AM  
Blogger naughty said...

MJ, did you know that the quote of the day on MSN is "Pray for the dead and fight like hell for the living"? It is attributed to Mother Jones - you go girl. Kick that doc's butt with your wit and intellect! Fight like hell for yourself and for those you serve. If we allow the "small" people of this world to keep winning these battles, we are doomed!

9:12 AM  
Blogger Cathy said...

Dear N. Ratchet: The "sing song" good morning is always a dead you still have a job? (Nurses are in short supply EVERY WHERE).

12:04 AM  

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