Well, its not really a dilemma, I just want your input. Here is the situation:
We have ALOT of older, some very sick patients right now. We have 10 catheters out of 26 patients....so obviously our labs all the way around stink right now., URR's are lower, KT/V's, phosphorus levels (mainly due to the long-term patients who just really don't care anymore and are non-compliant or due to new patients who haven't been able to get theirs under control yet). SOOOOO..
our director is in a bit of trouble due to our labs and I think she is more focused on how this will affect her BONUS rather than the patients well-being. So, she is starting a "Contest", each staff member will get a certain number of patients to "work on" for 2-3 months to improve their labs. I don't really have a problem with the concept, HOWEVER, the staff member will get monetarily compensated if they "win" the contest.
We have at least 4 patients that are so ill, and have lost so much weight, the doc/myself have takent he patient off of their dietary restrictions (Except for K+ restrictions).
Most of these patient are not likely to live through the summer, and I will adamantly refuse to FORCE them to change how they eat during their final months so my boss can get a BONUS. If that is one SMALL area in which they can find some joy, they should have it. Period.
I told the boss I didn't see the purpose to making these people eat the low phosphorus diet, (their labs aren't that bad, most 4-7 without restriction) when they will die before negative effects can be felt by them.
Am I off base here? Sometimes I think I get tooo emotionally involved with the patient and perhaps I am not seeing the entire picture.
Questions, comments, suggestions?