Elaine Miranda asks for help in finding an argument to bring to a meeting with
her supervisor and a staff nurse.  Elaine had left the nurse a note, including
her home phone number:
"I would like to know why you told so & so not to bf her baby last night
because you have no milk yet!  The next time this occurs it will have to written
up as if it was a med. error. If you have any questions please feel free to call
me anytime."  

I can see where this note could have caused problems, and if I had received
such
a note, I think I would have been more inclined to contact my own union rep
than
to phone the person who left the note, especially if I knew they were going to
be gone from work for over a week.  I would not have felt that the person was
going to be interested in hearing my version of what transpired.  I would feel
belittled and humiliated, and knowing me I'd probably be mad as h*** besides. 
My response would also depend on the note-writer's and my own standing in the
administrative structure of the institution.  Was it my boss?  Was it someone
in an allied health field who is not in the line of command that ends with me?

It's risky to write a note like this, without being 100% sure that you have the
facts straight.  If this information is taken from the care notes, then go
right ahead, because anyone who charts that they gave such advice, needs to be
spoken to, in the presence of a supervisor. But just because the mother says to
you that someone told her not to BF because her milk wasn't in, doesn't
necessarily mean they told her that.  It might be less inflammatory in such a
case to say 'Ms.X in room Y seems to have gotten the impression that staff
discouraged BF because she had no milk yet.  Do you have any idea how she could
have misunderstood our policy so completely?'  That way, you are not playing
prosecutor, judge and jury, and holding court without the defendant present,
which is sort of what your note tells her you did.

If night feeding is not mentioned in the standing protocols for the ward, you
don't really have a leg to stand on.  If, OTOH, you have good standing
protocols that specify what on-cue feeding is and also specify that this is the
policy for the ward, then any deviation from procedure would need to be
documented according to whatever requirements the ward has for such things.  It
isn't equivalent to a medication error, but it would be a deviation from
written
procedure and policy and thus subject to whatever quality assurance measures
the
ward has.  

Even if the nurse said the things you believe she said, as a colleague she
deserves the same respect you would want from her in a situation where the
tables were turned.  Writing yourself a note to remind you to talk to the nurse
in question when you return from your week off, with a few words describing the
problem as you perceived it, would allow you to wait until you are available to
hear the nurse's concerns as well.  Again, if this practice is actually
occurring, it needs to be dealt with, but how urgent is it?  

I think if it were me going to that meeting, I would be prepared to apologize
big time if I had made assumptions based on hearsay that could not be
documented in other ways.  I would also be prepared to spend a considerable
amount of effort if I wanted to salvage any kind of working relationship with
that nurse, and I would be hoping that my relationship with all the other staff
nurses was not going to be jeopardized either.

Rachel Myr
Kristiansand, Norway, where I am MUCH more diplomatic by e-mail than I am in
Real Life

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