patient advocacy

  1. Hi, I'm a new poster but have been lurking for awhile, finding lots of wisdom and solace here on the boards, what a great place!

    I am working at a long-term care facility and am having trouble getting the care manager to heed any of my input, concern about my patients. I work eves, so do not see this person for very long, but leave voice mail messages, write in our communication book etc. but to no avail. . .

    The issues are getting more and more critical ie) a patient who is obviously in pain in her w/c d/t hip issues (wait and see attitude from DR and care manager); but the last straw was when I wrote a note about a post-surgical incision that was opening with scant drng, sl. erythema. The following day there was a chart note from the care manager (who fashions herself a wound expert) was no drng, no erythema, and no s/sx of infection and an order to cover with an occlusive drsg!!!! When I approached her she became defensive and verbally questioned my assessment skills; well a week later the non-existant drng was pustulant. I felt horrible for not standing up to her right then and there. How else can I approach this? I plan to speak with our DON when she returns from vacation. There is some satisfaction in being right, but not at my patients expense. I can bring issues up till the cows come home but they seem to be blown-off. I don't know if I can keep beating my head against the wall here, although in all other regards I love my job.

    Thanks for your input!
    •  
  2. 11 Comments

  3. by   dosamigos76
    Welcome to the board! I wish I had words of wisdom other than document, document, and then document some more. I'd be careful staying at a place like that though. It doesn't sound like the clients are the priority and it sure puts you at risk.
    Good luck,
    Cheryl
  4. by   MelRN13
    I totally agree with dosamigos. Complete incident reports and document! If your problems aren't resolved with your DON, I would consider finding a different job. Obviously, patient care is not a priority at this facility.
  5. by   live4today
    Ditto to the above comments. I would also add that you could call the Board of Nursing and report them for the patient negligence and how it could possibly reflect poorly on the type of care being given to the patients by that person. I did this once when I worked in a nursing home, and they sent someone to investigate.

    I would have also called that patient's doctor and told him/her about my findings. When you know you are right in regards to what you assess on a patient, and it is not being addressed, fight for that patient who can't obviously fight for themself until someone takes notice.

    Let us know how your DON handles it when she returns.
  6. by   ainz
    kidluvinRN--this is a great topic. Standing up for what is right is why nursing remains one of the most trusted, if not the most trusted, professions by the American public.

    I concur with the above--document, document, document, but do it objectively without interjecting an accusatory tone. And please let us know how the DON handles this.
  7. by   Tweety
    I was going to say document, document, document but that's been said. Be sure to write that you've communicated to the higher ups and what the response was. Good luck and welcome!
  8. by   angelbear
    Tweety beat me to it but that is what I was going to say. Whenever I have a concern about one of my res be it health or safety related I notify the powers that be via voice mail and then I document that to. Like: Resident found numerous times attempting to climb out of bed repositioned and reminded to use call bell. So and so informed per voice mail. Hope that helps unfortunately it is a matter of covering you hinney.
  9. by   jenac
    Here's what you do- next time yo encounter this-DOCUMENT, DOCUMENT,DOCUMENT. "Post-surgical incision to right hip open with scant serous drng, sl. erythema surrounding. Odor? Resident c/o pain to site. Temp?" Than call the Dr. yourself for a tx order. It's hard to undue another nurses documentation and order. Don't wait-do it yourself. And every time you see the wound-document it, regardless of what anyone sees. CYA-always. Good luck.
  10. by   pickledpepperRN
    Absolutely document.
    Chart what you see & smell, who you notified, and a direct quote of what they said.
    I once charted, Dr. *** notified. Then wrote "Lets wait until Monday." as a doctors order. I then called and told him so. In 20 minutes he was at the bedside examining the patient and doing the right thing.

    Incident report? Absolutely! Also write who you told and what time on a separate paper. Give one to the DON keep a copy.
    I believe the Oregon Health Department is supportive of patient advocacy so along with the nursing board I would report to them. A telephone call first but send a letter and keep a copy. HIPPA does not apply when reporting to a regulatory agency.

    Good for you!

    The profession and our patients need us to remain advocates.
    Last edit by pickledpepperRN on Jul 16, '03
  11. by   live4today
    Originally posted by spacenurse
    Absolutely document.
    Chart what you see & smell, who you notified, and a direct quote of what they said.
    I once charted, Dr. *** notified. Then wrote "Lets wait until Monday." as a doctors order. I then called and told him so. In 20 minutes he was at the bedside examining the patient and doing the right thing.


    :chuckle :roll :chuckle :roll You go girl! I like your style! :chuckle
  12. by   kidluvinRN
    Hey thanks all for your replies! I do try to document as best I can to cover my butt, but sometimes my butt seems to big!!! I had never considered documenting the "wait and see" as an order, great idea spacenurse!!!! I have three years of practice under my belt, but am still learning every day!

    I have been considering looking for a new position due to this issue, and its sad because it comes down to this one care manager. Our other care manager is great, there are no ongoing issues with her load of patients because things get dealt on!!

    I did talk with my supervisor about all this, and she agreed with my concern but wouldn't touch it and told me to talk to the DON, the care managers supervisor. I plan to do it as soon as I can. In the meantime I'll keep fighting the good fight and wearing my fingers out with documentation!
  13. by   ceecel.dee
    Originally posted by kidluvinRN

    I have been considering looking for a new position due to this issue
    If your standards are higher than the standards accepted by your employer....it may be time to look for a new one.

    Just know that you are doing the right thing...for the patients....for the nursing profession....and for your employer, whether they know it or not! Keep up the good work!

close