[jadednurse]

My first post on this board, and I have a feeling it is sure to attract some heated debate. Here goes...

I've been a nurse for almost 8 yrs and was working most recently at a Level I trauma center in the SICU. Had been working there about 6 months when I started taking care of a 33yo male patient who was injured in a motorcycle accident. He had suffered a T6 complete spinal cord injury and had to be stabilized before he could have extensive surgery to fuse his spine. He was on our unit for approximately 3 weeks, most of the time on the vent w/ heavy paralytics and sedation on board. I was working like mad back then (12 hr noc shifts, tons of overtime) and took care of him most nights I worked. He was barely conscious the majority of the time I cared for him, but the last few days before he was transferred to a stepdown unit (where they almost killed him I might add) he was awake (no head injury, thank God), extubated and being weaned off the sedation. I recognized early on that while the other nurses and the doctors that cared for him gave him the technical care he needed, none of them were supporting him emotionally through such a devastating injury (paralyzed at age 33!). His only family was his dad and he had some friends that inquired about him, though they did not visit in those early stages after his accident. After being transferred to a stepdown unit I began to visit him regularly before and after my shifts and we talked at great length about his accident, injury, recovery etc. I had become a trusted friend and advocate to him and, since he was no longer a patient on the unit where I worked, I was comfortable with that. His recovery was complicated and there were numerous instances when the care he received was less than optimal (bordering malpractice I believe). I tried to bring these issues to the attention of the staff on the other units he was on but was met with a great deal of resistance. Most of the nurses were extremely defensive (especially when they found out I was an evil SICU nurse!). My manager came to me and said she had gotten some complaints from the nurses on the other units he was on, saying that I was "overstepping my bounds." I tried to explain to my manager about the horrible care he was receiving and she brushed me off. Long story short (too late now, huh) I stuck to my guns and advocated for this person (I was told more than once that I'm not a family member, don't get involved, blah, blah, blah). Both the patient and I got into it w/ the other nurses, managers, administrators (I was suspended for 2 days pending an "investigation"...more like an inquisition). He received HORRIBLE care and gross mismanagement almost killed him. To this day he will tell people that if I hadn't intervened on several occasions he would be dead...the senior surgical resident even told me that himself. I've read all the article about "inappropriate therapeutic relationships" with patients but this was nothing like this. A friendship had developed after the time I took care of him on my unit, there was nothing romantic or sexual in nature, and most of all he trusted me to be his advocate during this awful time. I was so disgusted with the management at that institution. I was disgusted with nursing in general at that point. I ended up getting fired some 5 months after that situation, allegedly for calling in sick too many times, though I suspect that had less to do with it than the fact that I had become a squeaky wheel around that place, pointing out the gross malpractice going on. As I told management during my 2 day "inquisition", I would do it all over again and, if needed, I would hire an attorney. Many of those close to me, who knew all the details, suggested I hire an attorney, but to be honest, my main concern was making sure this patient got the kind of care he deserved. Despite being fired form that institution (trust me, they don't "listen better" as their craft advertising slogan goes), I WOULD do it all over again. And if inquiring minds want to know...my friendhip with this patient did develop into a relationship...AFTER he was discharged. I've seen him progress through rehab and getting aclimated to his new world of paraplegia, and having him become a part of my life means more to me than any run-of-the-mill nursing job in the world. Any comments?

[willie2003]

I think you did what you morally and emotionally had to do for the welfare of your patient and friend. I applaud you . He was lucky to have you at his side.

[jadednurse]

Thank you Willie2003. I'm sure I'll get my share of replies that aren't quite as kind, but thanks for your support.

[ktwlpn]

Originally posted by jadednurse
My first post on this board, and I have a feeling it is sure to attract some heated debate. Here goes...

I've been a nurse for almost 8 yrs and was working most recently at a Level I trauma center in the SICU. Had been working there about 6 months when I started taking care of a 33yo male patient who was injured in a motorcycle accident. He had suffered a T6 complete spinal cord injury and had to be stabilized before he could have extensive surgery to fuse his spine. He was on our unit for approximately 3 weeks, most of the time on the vent w/ heavy paralytics and sedation on board. I was working like mad back then (12 hr noc shifts, tons of overtime) and took care of him most nights I worked. He was barely conscious the majority of the time I cared for him, but the last few days before he was transferred to a stepdown unit (where they almost killed him I might add) he was awake (no head injury, thank God), extubated and being weaned off the sedation. I recognized early on that while the other nurses and the doctors that cared for him gave him the technical care he needed, none of them were supporting him emotionally through such a devastating injury (paralyzed at age 33!). His only family was his dad and he had some friends that inquired about him, though they did not visit in those early stages after his accident. After being transferred to a stepdown unit I began to visit him regularly before and after my shifts and we talked at great length about his accident, injury, recovery etc. I had become a trusted friend and advocate to him and, since he was no longer a patient on the unit where I worked, I was comfortable with that. His recovery was complicated and there were numerous instances when the care he received was less than optimal (bordering malpractice I believe). I tried to bring these issues to the attention of the staff on the other units he was on but was met with a great deal of resistance. Most of the nurses were extremely defensive (especially when they found out I was an evil SICU nurse!). My manager came to me and said she had gotten some complaints from the nurses on the other units he was on, saying that I was "overstepping my bounds." I tried to explain to my manager about the horrible care he was receiving and she brushed me off. Long story short (too late now, huh) I stuck to my guns and advocated for this person (I was told more than once that I'm not a family member, don't get involved, blah, blah, blah). Both the patient and I got into it w/ the other nurses, managers, administrators (I was suspended for 2 days pending an "investigation"...more like an inquisition). He received HORRIBLE care and gross mismanagement almost killed him. To this day he will tell people that if I hadn't intervened on several occasions he would be dead...the senior surgical resident even told me that himself. I've read all the article about "inappropriate therapeutic relationships" with patients but this was nothing like this. A friendship had developed after the time I took care of him on my unit, there was nothing romantic or sexual in nature, and most of all he trusted me to be his advocate during this awful time. I was so disgusted with the management at that institution. I was disgusted with nursing in general at that point. I ended up getting fired some 5 months after that situation, allegedly for calling in sick too many times, though I suspect that had less to do with it than the fact that I had become a squeaky wheel around that place, pointing out the gross malpractice going on. As I told management during my 2 day "inquisition", I would do it all over again and, if needed, I would hire an attorney. Many of those close to me, who knew all the details, suggested I hire an attorney, but to be honest, my main concern was making sure this patient got the kind of care he deserved. Despite being fired form that institution (trust me, they don't "listen better" as their craft advertising slogan goes), I WOULD do it all over again. And if inquiring minds want to know...my friendhip with this patient did develop into a relationship...AFTER he was discharged. I've seen him progress through rehab and getting aclimated to his new world of paraplegia, and having him become a part of my life means more to me than any run-of-the-mill nursing job in the world. Any comments?

NO flame from this direction-It sounds like you were well aware of the possible consequences of your actions and proceeded to do what you thought was the right thing.I admire the courage it took for you to stand up and advocate for this patient....I hope that you are not black-balled in your nursing community.The fact that you have a relationship with this patient now will be the source of some conjecture-but you know that...I hope everything works out well for you both...

[navynurse29]

No flames here either, I can only hope if I ever get in a situation like that I would have a nurse like you to stand up for me. It 's nurses like you that make me want to be not just a nurse but a better person. You go girl!

[LaVorneRN]

It seems to me that one way to protect your self while advocating for the patient would be to advise the patient of the proper channels to report his concerns. It seems like your motives were pure and I am a big time believer in being an advocate for the patient. That can become complicated in situations like this where you see things going on that are not right but you are in a difficult position. I have been in a less intense situation where I had to suggest to a patient to contact the charge nurse then nurse manager to address some issues she had with her care and inappropriate behavior by the doctor. I was a CNA at the time. She felt the nurses were ignoring her and after talking with the nurses, she WAS being blown off. Eventually another R.N. reported the doc and went to managment and the ethics committee. The problem was solved. Are there any such committees in this facility? Are you considering getting an attorney? If you believe you were right you should persue this legally with the same fervor you advocated for this patient. Was he in a position to be transferred to another facility? If the doctor agreed with you, did he speak up on his patients behalf or raise some kind of hell since he does have some pull? Was anything documented as a complaint from the patient to management? A care conference could have been suggested with the social worker/case worker present as well as charge nurse, nurse caring for him, doctor, and patient. I know you said you complained to mgmnt but were they documented complaints/concerns? Occurence/incident reports? There is a way to do things and get results while protecting yourself.
Perhaps some would say you did cross the line and you may have let your compassion go into overdrive, I don't know. When you see an injustice and no one doing anything and there's no one to look out for the patient it's possible to overreact emotionally and without thinking things through as well as throw caution to the wind. I am not judging you and I wasn't there so I don't know. I am interested to see what others have to say.

[LaVorneRN]

After reading my own response, I want to let you know that if you had exhausted all the possible options and got no results, of course you should be commended for standing up for your patient. My opinion is that of justice for the patient and you had a lot to lose, yet risked it. Good luck in your career! It's not easy to go against the flow or stand when everyone else is bowing.

[nrw350]

I PRAY if I ever am in that patient's situation, that I have a nurse such as yourself to help me! You are an angel in scrubs!

[altomga]

I commend and applaud your efforts to ensure safe and effective nursing care to a patient that you cared about. You exemplify the meaning of beig a Patient Advocate!! That is what we as nurses are supposed to do!!! The patient is obviously better off for having you as his NURSE, HIS FRIEND, AND HIS ADVOCATE!!
Thank you!!

[jadednurse]

Thanks for your replies. With regard to your comments LaVorneRN...my experience w/ "the system" during all of this were very discouraging, to put it mildly. I only wish there was enough time in the day while all this was going on (mind you , I was working 3-5 12hr night shifts per week!) to pursue to "proper channels" during all of this nonsense. Perhaps now that I am not working (taking some long-needed time off) I will have some time to reflect on the situation...though I fear my window of opportunity for affecting any change has passed.