[Nurse Ratched]

Originally Posted by robinregisterednut

O.K. - Let me explain a few more things with this situation. The patient had just recently been given her pain med, and it really hadn't had time to work. This had been explained to her, but she is confused, had just been admitted the previous day, and had repeatedly expressed to staff that she did not want to be there, she wanted to go home. She had also been shown numerous times how to use her call light. I don't know anymore than this. Like I mentioned in my first post, it was a very hectic night, she was new, and I didn't get much info. when I was called in for suspension, which is my fault, but at the time I had a migraine and could not even think to ask questions, and then it was the weekend when no one in authority was at work. I have written my letter, explained my actions, and read everything I can on patients' rights. In our facility statement of patients' rights regarding a phone it states - it is a residents right "obtaining regular access to the private use of a phone." She had her own cell phone, regular access, to me, does not mean in the middle of the night - harassing people, which is against the law. Thank you guys for raising these questions, which has helped me write the letter. I just hope I can keep this job. Robin

It sounds like this is a case of poo rolling uphill. I'm sorry you got caught in this. I agree that my definition of "regular" access wouldn't include calling whomever she chose in the dead of night, particularly if a recipient of said call wasn't happy about it.

If you haven't already turned in your letter, I might suggest adding something about the least traumatic/least restrictive stopgap measure given the hour was to remove the phone until the situation could be cleared up in the morning via the interdisciplinary team, while continuing to monitor the patient for response to pain med and adjusting accordingly.

[LoriAlabamaRN]

I just wanted to thank you for alerting me to this. I'm also the night shift supervisor in a nursing home, and if I had a resident causing this type of situation, my reaction would have been to unplug the phone or remove it entirely. I'm so sorry that you've gotten stuck in this. Hopefully the letter will just be for a CYA folder and you'll be back at work soon.

[Noryn]

The difference with nursing homes is that they are often considered the patient's home. Therefore they have the same rights we all do in our homes to an extent that it doesnt infringe on others rights or safety. How did administration find out you did this? Did the patient complain?

It is frustrating for this family to be called in the middle of the night but this is a family issue. I would have told the person that asked me to stop her from calling that I was sorry but as a nurse I simply wasnt able to take the phone away from her.

I am also getting mixed signals on if this patient was confused or not. It sounds as if she knew who she was calling, she knew she was in a nursing home/rehab center she didnt want to be in, etc.

This can be such a grey area, if she was calling strangers and threatening them then I would have called the person on call and got permission to remove the phone but again calling family members in the middle of the night is much different.

Patient rights can be really tricky. I was reading a question in AJN a few years back. A nurse asked if she could crush a patients cardiac medication and put it in applesauce because the patient was confused and wouldnt take it otherwise. They responded that it was inappropriate to do this and even a confused patient can make decisions affecting their care. So I am still kind of confused over this.

I personally would have given the pain medication about 30-45 minutes to work. If it didnt work then I would have called the doctor, gotten an order perhaps for something like Xanax or Ativan or maybe even additional pain medication. I would also ask them if this was ineffective could she be sent to the ER.

[Nurse Ratched]

Wondering how the OP is doing.

[ljds]

My impression is that harrassing phone calls *are* illegal, aren't they? Even if the person doesn't know they are being harrassing. I mean, if you are confused and you have a car wreck, you are still at fault.

[FrustratedLPN]

interesting question that is raised..as a charge nurse on the 7p to 7a shift, I've seen this happen on more than one occasion. Usually the phone calls are made to family members or 911.

I would have to agree, although repeated phone calls in the middle of the night are a bother and nuisance to the families and to 911, we, as nurses cannot be expected to assume the responsibility of "soothing" everyone's frayed nerves.

Family members should confer with one another on how "they" will handle the issue, perhaps the last family member to visit in the evening should remove the telephone. This is not a nursing issue, but rather a social services/administrative/family issue. As long as the patient was given their pain medications as ordered (documented of course), pain rating scale was implemented (again, documented), monitored for effectiveness of pain management, (uh huh, again), and documentation supporting physician contact if necessary, then we have satisfied our responsibility to the patient. 911 Supervisors and Management should contact the LTC Administrator who, hopefully, will put them in touch with the Patient's family.

Too often, we spend more time putting out fires and catering to the families demands than we do with our patients. First and foremost, our duty is to the patient.. NOT the family. We cannot "make" Mom take her meds (all we can do is document she refused). We CAN suggest alternative medication administration such as topicals and document this.

Again, Social Services and Administration should step up to the plate and meet with family members to discuss expectations along with care plans. The disease process, pain management, ratio of nurse to patient in LTC needs to be understood throughly before admission. It seems all too often families and patients expect 1:1, 1:3 care. Very unlike the 1:35 it actually is.

[ArizonaICU]

just curious... did the lpn get suspended also? who initiated the investigation?
Is your facility being sued? is the board of nursing involved?
I am by no means an expert in the LTC area, but I do concur with others that future instances might warrant creating a policy on phone usage consistent with applicable statutes, with complaints from outside callers dealt with by social work 24-7.
also possibly relevant:
1. pain assessment by an RN
2. PRN Pain Med/ PRN Anxiolytic yes page the doc at night- sorry but thats their job, even though they complain about it.
3. Maybe the facility is at fault here as well for not properly staffing with enough RN's and or NP's. It definitely sounds like they are scared to death of a lawsuit. Perhaps thats due to a systemic breakdown in regulatory compliance, with you as an easy scapegoat.
4.Do a root cause analysis through risk management and invest more money in training and devolopment for all staff and mgt. They should take this as an opportunity for learning and increasing awareness of resident's rights. Instaed it sounds like the typical blame game scenario. Facility won't invest in fixing their system problems, easier to make an example out of somebody and rule through fear and intimidation.
5. I think it would be helpful to us all to hear how this case progresses.

[earle58]

the real issue here is the resident's needs; why was she so agitated? was it pain? did she need to be toileted? was she frightened? whatever it was, her needs were not addressed.

and whether it was due to negligence r/t short-staffing or any other reason, the facility's higher ups know that ultimately, it's their responsibility. i hope they don't use robin as the scapegoat. but whoever took care of this pt., it was poor judgement not to assess her needs and why she was so anxious.

leslie

[barbyann]

I am in CT and the LTC's here all have pt's Bill of Rights which clearly state that the pt is allowed to make and receive phone calls at all times. If the pt is making harrassing phone calls then it is up to the police to act appropriately. If the family is annoyed by the calls then they should turn their phone off. I had a arguement with my supervisor not to long ago about this same issue in our city hospital situation. She took the phone away from a mentally ill pt we had on our orthopedic floor. He was there for surgical treatment and not for mental health issues. He repeatedly called for food deliveries and when the delivery man would arrive he would say "let me make sure everthing is here" he would proceed to touch all the food and then tell the delivery guy "get out of my room I have no money". Her answer was to take the phone away. I gave it back to him every shift I had him because I knew it was his right to have what every other pt. had on the floor. I also encouraged the delivery guys to call the security department, then legal got involved, then decisions were made to let him have the phone 10 min. out of every hour under supervision. Point being, don't ever take a phone away from a patient. Let the legal department handle it.