As I have been figuring out how to do my job without becoming a complete emotional wreck, I continue to receive some distressing advice from the more seasoned nurses on my team.
“Spread the liability.”
Document to the hilt and show everything you did and tried to do and identify the other providers with whom you collaborated. So if it does hit the fan, no one can point the finger at you and say that you didn’t do your job.
In other words, cover your a$$.
I know, I know. You can only do so much. There will always be clients who cannot or will not work with you (I refuse to use the phrase “noncompliant”…it’s judgmental and doesn’t acknowledge the fact that every action – or lack of action – is a form of communication).
I know I’m not here to save the world. I know that despite my efforts, clients will have crises. Some will die. I am not a superhero, I’m a nurse.
I know this.
But when did the journey of helping people become about us? When did we become more worried about covering our own butts than supporting the client in crisis?
I may document thoroughly. I may spread the liability. But it doesn’t help me sleep at night when a client is found down with critically unstable blood sugars. It won’t make me feel better when I get the phone call that a client with uncontrolled hypertension finally has that stroke.
My license may be safe.
But it doesn’t mean I’m resting easy.
3 comments
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Karen Harrington says:
May 7, 2011 at 4:32 am (UTC -8 )
Love your focus! Will keep you balanced and caring, even on those really tough days!
clairesmum says:
June 2, 2011 at 3:33 pm (UTC -8 )
Individuals make choices, and take the consequences. No one is immune to the laws of the physical universe. As a presumed competent American adult, each of us has the right to make poor decisions – BUT NO ONE ELSE IS REQUIRED to protect someone from experiencing the consequences of their actions.
It’s taken me a long time for me to truly live these statements, not just mouth them and in my mind think ‘but I am special and I am the only one who can help/motivate/inspire the client to change’. Lots of us nurses come from families where we were caregivers before we got to kindergarden, so we have to learn the importance of taking care of ourselves (like putting on your own oxygen mask first and then your child’s) and of respecting the autonomy of each client. For a client to experience a combination of education and nursing care and caring attitude is sometimes what helps the client feel hopeful enough to make a different choice that may lead to health.
Read James Prochaski’s and Carlos Clemente’s work on stages of change, readiness to change, and process of change – not used so much in nursing education – also look at motivational interviewing strategies.
Sharing the liability can also be sharing the worry, and learning from others with more experience. It does take time to learn whose judgement I can trust and whose values/judgements of clients are not congruent enough with my own to be really helpful to me.It also allows that I may be only part of the client’s care/experience, I may not be ‘the one’ who is there when the client makes a different choice.
Think of gardening, the soil can take a lot of preparation before anything can grow, and the same crop receives all the same treatment but does not all come to harvest.
Sorry this is so long, don’t want you to give up or feel judged by me, so if this doesn’t work for you just delete it.
Nurse Teeny says:
June 5, 2011 at 3:04 pm (UTC -8 )
I completely agree that we are not responsible for the decisions that our clients make. I also agree that collaboration and learning from others is definitely part of the process.
My point was that I felt there was too much focus on covering ourselves. I absolutely believe in comprehensive and accurate nursing documentation but my primary motive for this has nothing to do with liability. I am worried about the client and making sure I indicate what happened, what efforts were made, etc. so that if the client needs support in the future, my colleagues can potentially pick up where I left off or find a better way.
I know full well that clients will make decisions that can be harmful to their life or health (boy do I know this). I know I can’t change this…like I said above, I’m not a superhero, I’m a nurse. But regardless of the efforts I make or the documentation I provide, it doesn’t ease the sadness or frustration when those decisions have devastating results.
Best In Nurse Blogs: Happy Nurses Week Edition | The Millionaire Nurse Blog says:
May 15, 2011 at 2:01 am (UTC -8 )
[...] Teeny at the Makings of a Nurse writes about covering your ass… Interesting perspective. Documenting good care is not the same as CYA to [...]