This is sort of a ranty long post. . .just a warning
A few weeks ago, I was floated to an "overflow unit" (in other words, a lonely little floor with no real staff or support or manager just sort of shoved in a deep dark crevasse of the hospital) and I had a pretty sick patient. Tons of co-morbidities (DM, CHF, pnuemonia, AMS, hx of cva and about a million more I don't remember). From a SNF. Oh and on contact for EVERYTHING, like things I had never even heard of and had to look up. Picc line, peg tube, foley, oxygen NC.
Anyway, so I go in to assess her and turn her (by myself, because on this floor there was no CNA, no charge nurse, no unit secretary - NOTHING, just me and one other nurse. Thank god I only had 4 patients that day because it was primary care, baby!) So I assess her and her lungs sound awful, like she is freaking drowning. O2 sat is 99 on 2L so that is ok. She had had a thoracentesis the day before and they had taken off 1,500cc. Upon further search in her records, she had had a previos thoracentesis 5 days prior where they had removed 1,700cc. She needed to cough but couldn't do it.
More than that going on, but you get the picture.
So. . .the primary comes in and discharges her back to the SNF! I was shocked, I ventured a "Do you think she is ready? Did you listen to her lungs?? Did you see her labs???" and he just shot me a dirty look and said, "we aren't doing anything for her here, she can go back." and I said, "has pulmonary signed off?" and the MD wasn't happy about that and stalked off. THEN, he returned a few minutes later and rattled off all of his reasons for sending her back to SNF and ended with "she will be back, probably next week, she will be back for sure" and I said, "well then WHY ARE WE DISCHARGING HER??"
THEN, I took it upon myself to call the pulmonologist to say, "um, the primary is discharging this patient" and the pulm said "WHAT?!!? I was going to order a follow up chest xray tomorrow and this patient needs aggressive RT therapy that they don't have at the SNF!" so I was relieved and thought maybe the pulm could stop the discharge. ..nope! He sighed and was like "well, if he discharged her, that's his issue" and I was like "NO! please, call him! tell him you want to keep her here!" Nope. No, he just signed off. I even called the primary back and told him what the pulm had said - Nope.
So. . .off the patient goes back to the SNF. I felt so so so bad.
AND. . .the next week I come back after about 4 days off and the patient's name was still on my list and. . .there she was. . .back after only 2 days at the SNF. . .and this time in the ICU.
I hate things like this. I told my nurse manager and she just shrugged her shoulders and was like "well, the patient is very sick"
UGH UGH UGH!!!!
THEN MY NURSE MANAGER HAS THE AUDACITY TO TELL ME I HAVE A SPECIAL VIP PATIENT COMING TO ROOM XXX AND THE FAMILY MIGHT MAKE A BIG $$$ DONATION AND TO TREAT PATIENT EXTRA WELL. . .
How do any of us survive this job?
(I am going to make a separate post about this lil VIP patient)
Thanks for listening! sometimes I just need to "talk" to others who get it.
Nov 11, '13
Quote from SaoirseRN
However, then they need to clarify the direction of care because the revolving door of admit, discharge, re-admit is hardly improving quality of life.
I agree with you, but pts and family frequently want "everything done" when it comes to code status. Doctors talk to them. Nurses talk to them. They consider "giving up" as failure.
What other options do doctors have? When the pt's best condition is still not good enough to go home, and they refuse to become a DNR.
You can't live in a hospital. Or can you?
Last edit by imintrouble on Nov 11, '13