I had a pt's daughter come to the ED telling me she had given her father his third nitro and he was still having chest pain. I asked her where her father was and she said in the lobby. I had no patients pending so asked for his name. She gave it. I went looking for the chart. I tracked it down to walk-in clinic. The complaint for walk in was cough, runny, nose and chest pain with cough. I went to my charge and asked what he thought we should do since the daughter was so insistent. He told me to go to talk to the walk-in doc. Could not get a hold her talked to her nurse. Her nurse said if he was taking nitro he should go to the E.D. (I already thought this myself but was trying not to step on senior nurses toes).
I was going out to reassess the patient when I ran into the triage nurse. I asked her why she thought this was appropriate for walk-in. This nurse is awesome so it would surprise me that she would triage someone like this to walk-in if in fact he was having chest pain indicated of heart attack. She told that the patient came in by himself and basically complained of cold symptoms he did give a history of a heart attack 3 months ago but that he said this did not feel like that at all. He did not take the nitro when he was triaged.
I pulled the patient into triage. I know that this patient is fluent in English because I have treated him before but the daughter refused to let him speak English. She was doing all the talking and explained why she thought this was his diagnosis. I told her I needed for him to tell what was wrong with him since I was recieving so many conflicting stories. I asked for a medical interpreter so that I could get the complaint straight from the patient. He ended telling us runny nose, cough, and epigastric pain.
The daughter started screaming at me and telling me she was nurse and that I was a racist. It was so frustrating. I could care less about her. I need to know what is wrong with the patient. She is not a nurse by the way. She apparently has come into our facility several times and raised hell when her family was not seen in immediately through the E.D. for things that could wait for an appt or could go through our walk-in clinic. But it's not the point. I feel like I got caught in this woman's frustrations with her own inability to become a nurse. Allegedly she had worked at our facility sometime ago as an NA but could not pass the first semester of nursing school. I know that she was scared for her father but she can't just go around lying about people's symptoms so that they get through faster.
So anyway, the charge nurse that told me to reassess the patient and to get the complaint from the patient. Backed the daughter up when he saw that she was writing people up. The EKG, the labs, the echo, the x-ray, the u/s. All came back normal but because this lady wrote me up...the doctor elected to send the patient on 50,000 flight to a higher level of care. His only abnormal lab was a alk phos of 146?!
Now, I am afraid I will be expected to write an apology. I am so ****** because I first tried to help this lady and her father to ensure he got the appropriate care. Second, my charge instructed me to follow these procedures even though for customer service reasons I knew it would be easier just to pull the guy back do the work-up and send his ass home. Instead, we spent all this money that could have been used on other patients who might need elective surgeries and the such to make this woman feel better about her assessment skills.
Grrrrr. I feel even worse that the meditation and relaxation techniques I have been working on and trying to let things at work bother me is not effective.
Any suggestions from people? It's okay if you tell me I was a jerk. But that guy would have still been sitting in the lobby if it had not been for me trying to give good customer service.
Aug 20, '09
It is never wrong to do the right thing for the patient. In this case, you wanting to get a correct subjective assessment was the right thing to do. Your superiors should know this is necessary in order to appropriately triage and assign him. There will always be those who will manipulate the system- all we can do is the best we can do. Follow policies, protocols, and standards of care and you will (for the most part) be ok. Good luck.
Last edit by cookienay on Aug 20, '09
: Reason: clarity