Written by: Yvette Cheeks
1. Not documenting conversations, requests regarding lack of staffing, supplies or, other patient safety issues. When working it is your facility/supervisors job to provide what you need to do your job. But, often we either just verbally complain and it is often looked at as venting or do nothing. Start emailing or leaving notes with dates and times and keep a printed or computer copy yourself. Don’t be threating just state the facts and keep going until you get what you need. Document who you spoke to and when. For example, you are a private duty nurse doing home pediatric patient with a tracheostomy and there are not enough supplies and no replacement trach if something goes wrong. Call the respiratory or supply company whichever is the go to for this need, write a time and a full name (make sure this person understands the urgent nature of your request, notify your supervisor and notify the patients contact person of what the issue is and what you have done.
2. They get lax about reporting changes especially in patientswith chronic conditions or repeated non-compliance. For example, the patient is a non-compliant diabetic whoseglucose is often elevated above the parameters the MD has set to call. So, what goes wrong? It is above almost or every day. So, the nurse stops calling, MD is ho hum about it and what can we do anyway? We are required by law to report changes in condition, abnormal labs, etc. by our BON even if the MD raises the parameter to call which helps there are still some legal issues. The nurse should continue to provide teaching and guidance in the way of handouts, document the issues and teaching providing and to who especially noting possible consequences if it is related to non-compliance. Inform the supervisor. Refer patient to websites, programs, social worker, dietician, etc.
3. Not following policy. It is the facility/supervisors job to provide policies to direct the care of the staff and protect the facility, the patients and, the staff. It is every nurse’s responsibility to read the policies and keep abreast.
4. Not knowing or using the full Nursing chain of command. So, you looked in the policy book and there was no direction for the issue you are having. Then, go up your chain of command to get what you think is best to do officially blessed. Call your manager/director or house supervisor. Document what you say and what they direct you to do somewhere. It may be a communication note or an incident report or the patient’s chart depending on the situation. If they don’t give you an answer you are comfortable with and you feel the patient is in jeopardy then, go up another level like the administrator on call. For more information or for our what to or not to do in bad clinical situations register Nursing Jurisprudence Class, FENS Program or Nurse Refresher Program in Houston, Dallas or San Antonio.
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