Saturday, September 17, 2011

Priorities, seriously

So I got called into the Boss Man's office this morning, because the floor wrote me up and he wanted to address the issue.

At this point, my feet hurt, I haven't peed yet tonight, I didn't get to eat anything, I have blood on my scrub pants (which I just now noticed), I have poop on my scrub pants (which I just now saw but have been suspiciously smelling for the past two hours), I haven't finished charting on that last arterial bleeder that came in, and my coffee from 7pm is still sitting full on the counter next to my computer. It's been a rough night.

During the night, we moved a patient out of a trauma room and into one of the smaller rooms. The patient who was moved had some fairly big issues going on, but nothing that was going to kill her in the next 6 hours. The patient we cleared the room for, however, was very much going to die if we didn't act. He would probably have died in the next 25 minutes if we didn't get moving. So we got moving, did our ER thing, and eventually sent him off the OR. At the very same time, a cardiac arrest AND and an MVC came in - so our ER staff was split between three very critical patients. The patient who was moved next door was then quickly taken upstairs, as she had a bed assigned already and we needed the space in the ER.

I got written up because, in all the madness, I missed a skin tear on this patient. One skin tear, out of many. And actually, it wasn't my patient to begin with, so really I never did anything for this patient except wave goodbye as she was on the way up to the floor. Although I didn't even really wave goodbye, because I was slightly preoccupied with running the Level 1 Rapid infuser with mass quantities of blood products.

There really isn't a point to this story, except that I'm royally annoyed.

Dear floor nurse: I'm sorry I didn't dress a skin tear. I was busy. You know, actually doing something to save a life. Not that a skin tear isn't, wait. It's not that important. Not in the grand scheme of the ER.

Fortunately, the nursing sup was in the ER the whole night, and backed me up regarding the madness. No thanks to Boss Man.


Solitary Diner said...

Wow - the person who made the complaint must have had some major issues to have had a problem with a single missed skin tear. I've seen much more important things missed in ERs when crises are happening (like starting antibiotics or IV fluids). It's just physically impossible to do everything for every patient when there's a major event taking place that requires your full attention. I'm glad that the nursing supervisor was able to back you up.

Dee Dee said...

Totally love your blog, have followed since the early days of Fundus Chop. Have had more jobs than I can count on both hands and feet, ranging from ed to home health including a stint in peds. Considering a return to ED (funny that I thought this meant Education some 2.5 years ago)...still in search of my bliss as I near middle age....ok that's a lie...I am middle aged which tends to lend itself to indecision as well as copious amounts of forgetfulness. Best advice I ever got was a Hooters wet nap that said "Indecision is the key to flexibility" Who knew that wing night would be so prophetic?!?! Still have that wet nap...unopened and perched on my bathroom mirror. As the floor nurse your EDness gives report to...your right, the skin tear should have been no big deal, she must have been having another shitty day as a floor nurse...imagine that.

Anonymous said...

I'm a floor nurse and would never dream of busting your ass for a skin tear. I don't expect ER nurses to worry about that stuff unless they present bc of a wound. That's some petty bs.

Shrtstormtrooper said...

@DeeDee- yeah, I imagine her night was probably hectic too. I'm just annoyed I was formally written up for something ridiculous, and then not supported by the manager.

But really this is why I have a blog - so you all get to listen to me whine! :)

hoodnurse said...

Obviously not so hectic that she didn't have time to write up the ER over some ticky-tacky bullshit. I call shenanigans. I've been shafted in report many a time by our day shift to where I probably should have written someone up, but I had more important things to do like take care of patients.
Reports like this set us so far back in communicating like adults. Unless something is a serious issue of judgement and safety that needs to be addressed by management, I'm not real sure why we can't just address this stuff face to face or at least over the phone instead of sending a report to someone's manager like we're 6 again. Just sayin'. And the fact that big boss didn't back you up? Messed up. You need to move and come work with me, my manager probably would have laughed at that crap.

Meg said...

Bet the Nurse that wrote you up is one that eats the young and students for dinner. Petty stuff.

Tyah said...

Im following from AZ. Im a CVICU nurse and can TOTALLY relate!! I just got written up YESTERDAY from our CT surgeon. I called him to report his stitches ripped and she now had a sucking chest wound that was spurting out foul yellow nastiness. I also had poop on my scrubs, and my tea was already cold. After he literally screamed at me, with many choice words the other patients on the unit could word-for-word recite... were so much enjoyed! Apparently it was none of my f*ing business according to him, that I am just supposed to give the meds he ordered and not worry about anything else.

I have my annual eval tomorrow... supper excited for that!

Ps. love following your blog! Totally cracks me up!

Anonymous said...

Writing you up personally? Uncalled for and total BS. But I have worked places where the admitting RN would be written up herself for any new skin issues. So if tear wasn't previously documented, her choices may have been take the hit herself or write it up. I've never seen a "ER was having a crappy night and I hate to do this but the tear was there before I got the patient and I have no other way to document that it isn't MY fault" button on the drop down menu. Going out of her way and making it personal? Oh hell no. Covering her own ass the only way she can? I can see that. Boss man should have said no more than
"rules say I have to discuss it with you. It's discussed. Carry on.".

rapnzl rn said...

It's hard for me to say this, but you got your "Written Up For No Freaking Reason" out of the way. EARLY.

After 30 years in nursing, I got my first WUFNFR. I was royally annoyed, too. Especially since I was the one who had to WRITE MYSELF UP.

The Boss Man has been replaced by "Manglement". Cheers!

Glad you had a sup to back you up!