There’s no way that I’m going to say that dumping a patient’s urine in their sink is ok! BUT, I will say there may be underlying issues that would lead to this behavior. Sound a little crazy? Check out this letter I received from a nurse manager about dealing with this situation with one of her staff. What would you do? What do you think of my response?
Dear Beth, I need your help understanding a recent event at our hospital in which I tried to do the right thing and it turned out wrong.
I am the team leader of a very busy surgical floor. Due to one surgeon’s prominence in his field, we care for a lot of post-op single and double knee replacements. Over the past year or so we have had complaints from this surgeon’s patients about the poor nursing care they received, some specific to pain management and some to simple lack of basic nursing attention and care. The surgeon has met with us several times and has been quite adamant that he wants these complaints to stop. One of the strategies we developed was to hold individual staff accountable if they were the source of the complaint and act quickly to correct it.
So here’s my problem. Last week, a patient recovering from bilateral knee replacement complained to the surgeon that the nursing assistant emptied the urine from her catheter bag into the sink in her room instead of the toilet in the adjoining bathroom… He, of course, stormed into my office with a litany of complaints about the “incompetent” nursing staff. I must say I was pretty upset and embarrassed and assured the surgeon that I would see to it that that never happened again.
I found the aide at once and reprimanded her for her actions. “How will we ever stop these complaints when you do something as stupid as that?”
Having taken action to rectify the patient’s complaint and admonish the aide, felt I had managed the situation appropriately.
Much to my dismay, the next day the patient reported to me that the aide in question came into her room and said, “Well, you caused a lot of trouble for me yesterday, didn’t you?” I was so shocked and upset by this total lapse in professional behavior. Here I had taken steps to fix the situation and it had backfired, and backfired back on the patient!
Please help me understand what I did wrong, and how I could have avoided such damaging repercussions.
When I hear about errors or actions that are so shocking, I have to catch myself from jumping on what I’ll call “the blame bandwagon.” For example, incidents of “wrong-site” surgeries are outrageous. Yet, not only are they in the news at an alarming frequency, they are repeatedly the most common Sentinel Event listed on The Joint Commission’s Web site. So I wonder, what else is going on here? I don’t have a simple “right” way to address this situation, but I do have some insights that will help to shed light on possible underlying problems.
First, consider all the different blaming that is going on via indirect and accusatory feedback. The patient complains to the surgeon about the nursing assistant, the surgeon complains to you and then you are in charge of addressing the nursing assistant. Terms such as “incompetent” and “stupid” are pretty inflammatory, and as such, are more likely to aggravate defensiveness and resentment.
Second, where is there any attempt to learn more about the situation? Nowhere along this communication channel does there seem to be a place for finding out why the nursing assistant did such a thing, clarifying the patient’s report, or validating the patient’s concern without being judge and jury. Ultimately, it is inappropriate to use the sink as a toilet. But, finding out what was going on for the nursing assistant at the time would give you a chance to hear her side of the story, review, and, if necessary, educate about related expectations, and work to address peripheral issues if need be. It may seem hard to imagine a scenario that would explain such behavior, but is it possible that she was responding to an alarm, or there was an issue with the plumbing in the patient’s bathroom, or she was already running late and on probation because of overtime issues? Approaching the nursing assistant with more curiosity and less blame would help you understand more about the situation, build your relationship with her, support collaborative problem-solving, and, perhaps, provide information about other issues that should be addressed.
Third, I am curious about the bigger picture involving this surgeon and his perceptions of poor nursing care. Is the nursing care any different for his patients and if so, why? Does he have different expectations? Does he invite criticism of the nurses? If his expectations are high, perhaps this is a chance to improve care for all patients on this floor. Is there adequate staff for the heavy physical work with orthopedic patients? I think it may be important to look for opportunities to use his feedback to improve care overall, but would be careful about doing anything different just for him. All patients deserve the best care and that should be what we are striving for regardless of who the physician is. This focus should help to make solutions less personal and more about quality of care versus pleasing or displeasing the physician
Fourth, given the current conditions, it was probably unwise to have the nursing assistant caring for the patient following the reprimand. The patient is vulnerable, and the assistant resentful. Although I can envision a unit where the assistant might be encouraged to apologize to the patient, I think it is crucial for a shift in addressing the overall conflict first.
In summarizing, one strategy that you might consider for addressing the overall issue of complaints would be to gather information from the surgeon, staff, and other physicians. What, if any, are the weak areas of nursing care on this unit? What are the priorities, and what do staff need in order to carry them out? This will help to build a team around improving care as opposed to reacting to complaints from a particular physician.
In addition, training and practice in giving and receiving constructive feedback for yourself and staff would help to ensure more positive outcomes when such situations occur.
By the way, Viki Kind, MA will be hosting an interview with me on Feb 23, 2012 at 12noon EST. Join us for more dynamic conversation about “Improving Communication in Hospitals”! More info