Accountability

I had an encounter with an RN the other day that was somewhat interesting. I had ordered that a patient be skilled and IV antibiotics started for an infection. Residents living in Nursing Homes under their Long Term Care (LTC) Medicare benefits have a different payor arrangement when they need a higher level of care than just drooling down their chin. That may sound confusing but writing further about payor sources for LTC residents will cause all of my readers heads to explode.

I wrote the order to skill the patient and start an IV the night before and called the following morning to check and make sure it was done. I was told by the LPN who is not IV certified that nothing had been done and she could not convince the RN to come to her unit and care for the patient. This was on a Saturday, my day off, but I got in the car and drove to the facility to speak to the RN and make sure my patient was getting the care he needed.

After arriving at the facility I spoke with the patient and determined he did not have an IV and no one had come to help him.  I went to speak with the RN and ran into the Associate Nursing Director in the hall. We talked and she immediately went to start the IV while I went in search of the wayward RN. I found her on the Skilled Nursing Unit. That is a unit where patients who are too well to be in the hospital but too sick to go home spend their time rehabbing.

I walked up and in a nice calm tone asked her when she was going to start the IV on my patient and give him the antibiotics? It had already been 20 hours and three RN’s since writing the order and nothing had been done.

RN: I might get to it when I get done here (waves hand in the air to indicate the unit she is standing in)

Me: Look, my patient was supposed to start IV antibiotics last night and now its noon and nothing has been done.

RN: Well I’m too busy and I have too much to do here.

Me: As the RN on duty it’s your job to care for all the patients who have IV’s and I need you to go start an IV on my patient and get his meds started.

RN: (with mounting attitude) You said you were a Nurse Practitioner, why don’t you just go start it yourself!!!

Me: What is your name and what registry do you work for?

RN: (Turning nametag face down so I can’t read it) I don’t have to tell you who I work for.

Me: When I call the registry you work for, what do you want me to focus on, your patient neglect or abuse?

RN: (Now yelling at me) YOU’RE A NURSE PRACTITIONER YOU CAN START AN IV CAN’T YOU!!!!

Me: (Still using quiet conversational voice) We’re not discussing my qualifications as a Nurse Practitioner, we’re discussing your patient neglect, abuse, and incompetence.

RN: (More yelling at my back as I walk away) You can just start it yourself.

Me: Thank you I’ll just get your name and agency from the Associate Director of Nursing.

RN: (More yelling as I walk away)

If any of you reading this are in nursing school this is an example of how, not to act, lose your job, possibly lose your license, get on the registry (DNR) employment list. In laymans terms get blackballed.

This RN took no accountability for her actions and became belligerent and angry. This type of defensive behavior just can’t be tolerated in nursing. Fortunately this patient did not have a bad outcome from the three RN’s who just ignored the order to start an IV on this patient.  One of the RN’s went so far as to mark off that he gave the medicine last night. I asked the ADON the next morning what did he do, squirt it on the patient’s chest and hope it would absorb by osmosis?

Good nurses have their patients as their prime focus not themselves. If one makes an error as a nurse the first thought should be “is the patient going to harmed by the mistake?” If one is immediately concerned that they may be fired or lose their license when an error is made then they should not be working as a nurse.  Everyone who is human makes errors and the appropriate response to an error by a nurse should be accountability for the error. Failure of one to do that prompts me to ask them to leave the profession before they kill someone I love.

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