[SEOBowhntr]

As a nurse, nearly every day we are patient advocates when we call a doctor to question an order, or make a reccommendation based on what we see. On many occasions I have told many doctors "which way is up." One thing that will come with experience is confidence!!! The more confidence you have the better Pt. Advocate you will be. On many occasions I have called doctors back and told them for other nurses that the orders they gave were not appropriate or adequate. On most of those occasions, I got appropriate orders. Being a patient advocate means getting the job done regardless of whose toes you step on often times.

[VickyRN]

Originally Posted by SEOBowhntr

As a nurse, nearly every day we are patient advocates when we call a doctor to question an order, or make a reccommendation based on what we see. On many occasions I have told many doctors "which way is up." One thing that will come with experience is confidence!!! The more confidence you have the better Pt. Advocate you will be. On many occasions I have called doctors back and told them for other nurses that the orders they gave were not appropriate or adequate. On most of those occasions, I got appropriate orders. Being a patient advocate means getting the job done regardless of whose toes you step on often times.

Excellent post. Advocacy means, "the act of pleading or arguing for something; support, urging, intercession." http://www.hyperdictionary.com/searc...efine=advocacy

Patient advocacy is a vital role of nursing, but it is often hidden from the public eye. Patient advocacy means standing up on behalf of our vulnerable patients, and this is not an easy role. We must often stick our necks out and step on toes. The patient must always be front and center to everything we do in nursing. We must continuously strive to ensure the highest quality of care, safety, and that the patient's holistic needs are being met. I think patient advocacy is best captured by this immortal quote from Virginia Henderson (1968), "the nurse is temporarily the consciousness of the unconscious, the love of life for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion for the infant, knowledge and confidence for the young mother, a 'mouthpiece' for those too weak or withdrawn to speak."

http://www.findarticles.com/p/articl...39959#continue

[pickledpepperRN]

I was working a registry shift at another hospital. The RN who was to be my resource had a VERY agitated critically ill patient.

I was in the room helping with her patient so she could call doctors requesting ABGs, medication, labs, and restraints.
She got a call that she was getting an admit from the ER!
She said, "She told me I have no choice, I'm getting the patient. I told her if she doesn't believe me to come assess the patient herself."

That manager did. From several yards she saw the multiple drips, toes pulling at the chest tube, hand trying to grab the ET tube, the other pulling IV tubing, patient sitting up, turning, tachycardia, impossible to get an accurate BP with the agitation and so on. Just when the manager came to help the patient kicked me in the face.
She helped us with that patient until the docs came and treated the hypoxia, DTs, and anemia. Then she called for registry and admitted the patient caring for the new admit until the registry RN arrived about an hour later.

I was so impressed with that ICU nurse who knew her manager needed to be there.
Without a third pair of hands that patient would have pulled out the ET tube, central line, or both.
Not only that patient, my patients and the new patient would have been in danger if the manager had not been made aware of the true situation immediately.

I also found out that some, not this nurse, "call wolf" about a patients condition to avoid an admit. Her past willingness to accept an admit without complaint probably influenced her manager to come to the bedside.

[ELKMNin06]

Im a student and recently had a patient on a surgery floor who had just had a gastric bypass surgery. I took care of her one week and then she came back the next week and I was assigned to her again.

Well, this time when I entered the room I found her door shut and an awful smelll...I went in and she was in there crying!!

She had an NG tube coming from her nose and at the end there was a balloon which was leaking gastric contents..she had tried to make it stop but little by little it was leaking. It was all over her, stained her skin even.

I cleaned her up, changed the sheets and got her a new gown. She said she had been sitting in the mess since the night before (not during the night, during the evening)....

She said I was t he first one to offer to help her get clean (she was too embarassed to ask).

[super_rn]

I work in ICU and am about as far from a psych nurse as you can be but here's my story...

Had a 34-year-old female admitted in the middle of the night after an attempted suicide by OD. The woman's two-year-old son found her and wandered outside crying, which woke the neighbors, who discovered the woman. I think sometimes people think I am harsh, because I just don't have the patience for these patients. I understand they have problems, it's just that I am not comfortable in dealing with them. Give me an AMI, resp. failure, or train-wreck surgical patient anyday, but an OD?! Yikes!
Anyhow, we had to keep her until she was medically stable to transfer to a psych hospital (no one would accept her until then). Come to find out this was the third time in two months she had attempted to kill herself. This woman had some serious issues. She told me she was sorry that she woke up because she was tired of all this....and so on.

The doctor comes in the early morning and writes discharge to home orders!!!!! It gets better...she writes full prescription refills for all the drugs the patient had attempted to OD on! Give me a break! I said, "I think she would benefit from some psychiatric care instead of going home".
Doc--She said she'll follow up on Monday (This is Saturday)
Me--This is the 3rd time in 2 months, she has issues.
Doc--No one will accept her on a Saturday (real issue? Doc didn't like transferring patients and had NEVER transferred a psych patient)
Me--Have you even called to ask? Her psychiatrist in ____ town has already called and wants her transferred.
Doc then proceeds to slam the chart on the desk and say "I'll leave it up to you since you appear to be the expert here". Waltzes back in the patient's room and back out to me and says "I am sending her home".

At this point it gets ugly and I say "I am not giving her discharge instructions. If you don't want to transfer her, then I'll get Dr. _____involved in the transfer."
Doc--You know, if you wanted to be a doctor you should have went to school for it.
Me--I'd rather be a nurse who cared about my patients then a doctor who didn't want the bother.

Childish? Yeah, probably but the patient got transferred and the doc doesn't tangle with me anymore

[cursenurse]

Originally Posted by super_rn

I work in ICU and am about as far from a psych nurse as you can be but here's my story...

Had a 34-year-old female admitted in the middle of the night after an attempted suicide by OD. The woman's two-year-old son found her and wandered outside crying, which woke the neighbors, who discovered the woman. I think sometimes people think I am harsh, because I just don't have the patience for these patients. I understand they have problems, it's just that I am not comfortable in dealing with them. Give me an AMI, resp. failure, or train-wreck surgical patient anyday, but an OD?! Yikes!
Anyhow, we had to keep her until she was medically stable to transfer to a psych hospital (no one would accept her until then). Come to find out this was the third time in two months she had attempted to kill herself. This woman had some serious issues. She told me she was sorry that she woke up because she was tired of all this....and so on.

The doctor comes in the early morning and writes discharge to home orders!!!!! It gets better...she writes full prescription refills for all the drugs the patient had attempted to OD on! Give me a break! I said, "I think she would benefit from some psychiatric care instead of going home".
Doc--She said she'll follow up on Monday (This is Saturday)
Me--This is the 3rd time in 2 months, she has issues.
Doc--No one will accept her on a Saturday (real issue? Doc didn't like transferring patients and had NEVER transferred a psych patient)
Me--Have you even called to ask? Her psychiatrist in ____ town has already called and wants her transferred.
Doc then proceeds to slam the chart on the desk and say "I'll leave it up to you since you appear to be the expert here". Waltzes back in the patient's room and back out to me and says "I am sending her home".

At this point it gets ugly and I say "I am not giving her discharge instructions. If you don't want to transfer her, then I'll get Dr. _____involved in the transfer."
Doc--You know, if you wanted to be a doctor you should have went to school for it.
Me--I'd rather be a nurse who cared about my patients then a doctor who didn't want the bother.

Childish? Yeah, probably but the patient got transferred and the doc doesn't tangle with me anymore

good for you! i don't think what you did was childish at all, you did exactly what every nurse is supposed to do for his/her pt. being a pt advocate means often being unpopular when you have to do things like you did. if you had d/c'd that pt to home, and that pt hurt herself, you would have been called on the carpet so fast because you knew that sending her home was not appropriate. i would have written that ignorant dr up for his behavior, and would think seriously about reporting the incident to the appropriate medical board. if there had been another nurse there that was not as assertive as you, he may have bullied him/her to send that poor pt home, which would have been detrimental. if i ever have to be in the hospital, i pray to have a nurse that not only knows what's going on, but will get very assertive when she/he sees things being done that aren't right.

[super_rn]

Originally Posted by cursenurse

good for you! i don't think what you did was childish at all, you did exactly what every nurse is supposed to do for his/her pt. being a pt advocate means often being unpopular when you have to do things like you did. if you had d/c'd that pt to home, and that pt hurt herself, you would have been called on the carpet so fast because you knew that sending her home was not appropriate. i would have written that ignorant dr up for his behavior, and would think seriously about reporting the incident to the appropriate medical board. if there had been another nurse there that was not as assertive as you, he may have bullied him/her to send that poor pt home, which would have been detrimental. if i ever have to be in the hospital, i pray to have a nurse that not only knows what's going on, but will get very assertive when she/he sees things being done that aren't right.

The thing is this doc is a female. She complains about us nurses discriminating against her because we are jealous!! Jeesh! The board was made aware, believe me!

[cheerfuldoer]

Great stories! I always act as a patient advocate as well as a nurse advocate. If either side is twisted or off balance, patients will suffer either way. So to me...the two go hand in hand. To keep a happy patient is to keep a happy nurse and vice versa. This is just one reason why nurses need to stop cat fighting and start dog loving. Be ye kind one to another and watch the units shine like the sun.....or SON.....for those who believe in HIM.

[VickyRN]

I have been very proud of several of my students in clinical this rotation. They have taken the time, in many situations, to be patient advocates extraordinaire.

[hooterhorse]

I finished my first year of nursing school last semester and during the summer break, took a job with a hospice organization as an GPN...hope to be LPN once I passed my state boards (which by the way..I recieved my license today).
Anyway, during orientation....I accompanied a CNA to a home visit of an elderly gentleman with a terminal diagnosis of prostate cancer. He was a spry old guy who hadn't given up on life just yet!
Anyway, when we entered the home there was a wonderful aroma coming from the kitchen. The CNA asked "what's for dinner?"...."it smells wonderful!" The old man replied "bug spray". This was puzzling...but apparently he was brewing up a conconction of homemade bug spray....made with onions, garlic and herbs. We had stopped by to give him a shower, but figuring out how to strain the contents of the pot into his bug sprayer took priority! At first he tried a kitchen strainer...but that allowed too much of the herbs through and it clogged up the spraying unit. Then he had tried using a coffee filter...but that was too dense and next to nothing was straining through.
I thought for a moment and suggested straining through a pair of women's nylons. He looked at me in disbelief, but politely enough to comment "can you imagine what my son would say if he knew I was going to the store to buy nylons?"
I then took off my shoe and removed one of my knee hi nylons....placed it over the opening to the spray tank and poured the contents of the pot through the nylon into the tank. It strained through instantly...much to the old man's surprise. After his shower, he followed us out the door with his bug sprayer in tow. From the car I watched him pump it up and ....voila....it had worked beautifully. As we pulled out of the driveway, I looked back to see him hard at work spraying his yard.

Working for hospice has helped me realize how to "individualize" care plans.
Too often I found myself caught up in the "medical" aspect and searched for diagnosis and interventions in a nursing manual...when all along it was right there in front of me....plain and simple....the patient!
I'm actually looking forward to next semester and the writing of care plans!
Jean & Houdini
Wisconsin