H1N1 patient dilemma

I've seen that too. I know it happens. But I think writing someone up without investigation is a little bit knee jerk.

Yes, I have seen this as well. But, I also feel that whereas patient's in isolation rooms deserve proper care, I do try to do as much as I can with one visit to the room to avoid constantly going in and out. It is time consuming, and even with proper technique and being very careful you may still risk taking germs to other patients. (And no, taking all a days meds at one time if that was done is not appropraite).

That being said, when I have an isolation patient, I usually do AM vitals while I do my initial assessment to save the tech time, since I'm "in there already".

But, this is all off of the topic at hand, so feel free to move on now.

I know a couple nurses at my job that are ridiculously afraid of germs. It's very annoying. I do try to be extra good about combining trips with isolation rooms to avoid donning the gear every few minutes, but you still have to go in there. I wouldn't be surprised with H1N1 panic to see people doing stupid stuff out of fear. But patients often think we're not in there enough, even when we're in as much as we can possibly be.
I think it needs to be investigated, because isolation does bring out stupid in a lot of staff, but definitely get the nurse's and aide's stories before rushing to judgement.

Okay, I know I over analyze, but...

If the pt could tell the CNA was holding her breath, were they wearing PPE? Did they have any? I know I've had to chase down PPE when we've had noro outbreaks, and if I had to go into a pt's room when I hadn't had the disease, I'd probably try to do as much "one stop shopping" as I could. Maybe the nurse was afraid she might be pregnant, or knows she is and hasn't told everyone yet? We know what happens when a pregnant woman gets Rubella, we don't have a lot of experience with lots of pregnant H1N1 positive moms, and possible effects on fetal growth/development and won't for another 6-9 months. I don't freak about stuff, but if I thought I might be pregnant, or knew I was especially in that first 8 weeks where the fetus is most vulnerable, I'd probably be hypercautious, too.

I've looked after flu A, presumed H1N1 positive pts. Honestly, I'm not in there every 5 minutes, either, because they simply aren't that sick. You're sneezing and coughing and wanting morphine for a headache vs. a cardiac pt who is throwing pauses or a GI bleed who's getting blood and has a plummeting Hgb, you're not going to see much of me either. If she's "needy" it's going to tick me off if she's pitching a fit for a gown when I'm doing an emergency 12 lead on someone who's trying to die on me.

Most of our presumptive H1N1 admissions were to keep them away from immunocompromised family members or kids until we could get the fever down and they were no longer contageous; usually, they are on our floor less than 36 hours.

Of course, the nurse and CNA could have just been lazy useless people, too.

Slightly off topic -- I was H1N1 positive, sick for a day. I'm now on the hospital's "can go in without PPE if kept as a dirty nurse" list if we get slammed.

Agree with nerdtonurse. H1N1 patients are generally barely needing hospitalization, so we're definitely not going to be spending tons of time in the room, even if we're not worried about catching it! (Which having already had it, I sympathize, you feel like total poo, but while you think you're dying, compared to a truly dying patient, you're not at the top of the priority list.)

In our hospital our manager makes patient rounds every morning and regardless of the nurse's story the patient is always right. We would be written up for violating our "core values". But then, we also get written up for telling the patients the truth, for example, your ED stay is longer because we are waiting for the CT scan to come back from the place we fax them. Supposedly, that's placing blame. Sorry, whole different politics.

If the trays weren't picked up, she had to sit in vomit for an hour waiting for a gown to change into, and she called home because she couldn't get her pain meds. It seems to me that the evidence is pretty clear that she wasn't getting proper care, no matter the nurse's reason.

I'm trying to think of this situation from the standpoint of a thepatient. It wasn't too long ago that I was stuck in a hospital bed and made to wait over an hour for a bed pan after I was loaded with fluids (by the time my ortho made rounds, I was in tears from holding it in--he went to the desk and my nurse then came immediately to help me). That same nurse couldn't find the time in five hours to bring me a towel, some soap, and a pan to bathe myself with. The night nurse that same day kept me waiting three hours for pain meds, and when she did bring them, she dropped them on the floor then proceeded to pick them up and hand them to me to take. I was desperate by that point, I swallowed them without question and prayed I didn't end up getting an infection along with it. I was even left without water for hours because the nurse forgot to bring more when she came in and never did come back to fill up my pitcher (despite using the call button and asking politely TWICE, two hours apart). I was extremely patient during my stay, because I understood that there were people on the floor that needed a lot more help than me and the floor was busy. I didn't complain, eventhough I was slighted on more than one occassion. I finally did have one nurse who was really responsive, and even did things for me without asking (like the simple act of bringing me water or asking if I needed a clean gown), so it wasn't all bad. I must say, though, that I was shocked by how poor my care was, especially when it came to such simple tasks as filling a pitcher of water. I can see how easily a woman who "only" has the flu could be forgotten, and that is a shame.

That was my long way of saying that sure, patients do exaggerate sometimes. The nurse should absolutely have an opportunity to speak for herself (due process and all) and the situation investigated. That being said, no matter the reason, I don't believe that it should be acceptable to leave a patient sitting in a vomit covered gown, surrounded by partly-eaten food trays, and in pain.

I don't think anyone here thinks that is acceptable.

As as charge nurse, I would have found out every single person that entered her room and I would have reported them to my supervisor.

Those people should NOT be working in healthcare.

If that woman dies from neglect, it is a lawsuit waiting to happen...because she isn't getting cared for...she is being neglected...the physician mine as well give her meds and send her home.