Why I Cannot Sleep
When patient neglect becomes so appalling, so gut-wrenching, what do you do? How do you make it up to a patient whose existence has become no less than a horror movie? I don't know about you, but I'm not interested in thickening my skin any more.
I need to talk about my patient today. My days in the hospital are frequently hard and heartbreaking, but nothing I haven't learned to shake off by the time I walk through my front door. Occasionally, I need a good cry on the drive home, but it's cathartic. I may hear monitor alarms in my sleep, but I don't see my patients.
I need to tell you about her twisted body. I need to tell the world about the pressure ulcers that took up the entirety of the flesh of her back. I would call the news, tweet, post, and blog about her single-digit BMI, but HIPAA holds my tongue. I wish I could tell you the full horror of this woman's condition, though, share the deformity of her tiny, fragile body.
This is not my first contracted patient, not my first cacechtic one. There is something about them all though, isn't there?
These neglected bodies- before I worked in a hospital I never even conceived this could be done to a person.
Neglect is a strange crime- so benign sounding for an act so utterly malevolent. And I cannot stomach it anymore. I cannot whisper "I'm sorry," into this woman's ear and just be that. For her, yes. I will treat her and advocate for the woman she still is within the contorted shell, whether she needs cure or comfort. I shouldn't say I- We.
My fellow nurses, whose hearts broke for him long before he came into my care, and the rest of our team- managers, doctors, social work, all trying to give whatever they can to make up for the crimes committed on this woman's body. She may or may not be "okay," but she will be well cared for, whether that means every intervention in the book or comfort care.
But I am not sated. Maybe this means I am making his pain about me, but I cannot shake this. Rather, I am shaken. When I was 17 I was Antigone in my high school play. My director had me work with this crazy, performance-artist friend of his, and she wanted me to do these primal screams. I never quite landed it, I think. But it's in me now. And I am out for blood.
No, that's not quite right. I need to see this injustice fixed. I need this to not happen. Maybe, most importantly, I need the "people" who "cared for" this woman at the nursing home to know what they've done and get the hell out of health care.
To every nurse, aide, doctor, therapist, hell, administrator who laid eyes on this woman in the past several months in the nursing home: you are a monster. Thanks to the wonder of electronic charting, we all know the condition she came to you in. And it is clear, it is brutally clear, no one has touched this woman in months. You passed her by because she could not complain. You thought the next shift would take care of it. She smelled bad. I don't know. I do know that this woman has gone through hell. You did this. And I can't fix it.
Can someone tell me what to do? A hint, a nudge, in the right direction? I need to do something about this nursing home. Fix it, shut it down, expose it, something. I have no experience in this area, and when I reach out to those immediately surrounding me, who might know the way, I'm told the red tape is insurmountable. Quite frankly, I worry about overstepping and putting my job on the line. But I can't let this happen again. I know it's only one facility and there are patients like this all over the country, the world... but I must try. I must. Please.Last edit by Joe V on Jan 9, '1510Mar 1, '14 by SlightlyHumerusInform your supervisor. Call in Case Mgmt. Then make an anonymous phone call to your state's Ombudsman- go here for a listing by state:
NORC - Locate an Ombudsman and State Agencies. :: Locate an Ombudsman
FAQ about the US Ombudsman program:
I am appalled for you. Thank you in advance for taking action, while maintaining privacy for your dear pt. Good luck to both of you. p.s. it's a blessing she got you as her nurse!Last edit by SlightlyHumerus on Mar 1, '14 : Reason: added website4Mar 1, '14 by SHGR, MSN, RNQuote from SlightlyHumerusThe ombudsman is a number that you can give to a NH resident or family member also for self-advocacy.Inform your supervisor. Call in Case Mgmt. Then make an anonymous phone call to your state's Ombudsman- go here for a listing by state:
NORC - Locate an Ombudsman and State Agencies. :: Locate an Ombudsman
FAQ about the US Ombudsman program:
I am appalled for you. Thank you in advance for taking action, while maintaining privacy for your dear pt. Good luck to both of you. p.s. it's a blessing she got you as her nurse!17Mar 2, '14 by Esme12, ASN, BSN, RN Senior ModeratorHow horrible.....You are a mandated reporter....report them for elder abuse.
State Elder Abuse Hotlines12Mar 2, '14 by HeathermaizeyPlease don't hide behind HIPPA in this situation. Your state should have a link on it's website to report elder abuse. It needs to be done. My neighbor across the street is a nice sweet elderly lady. A few years ago she let her grandaughter, her husband, and her three kids move in. The state of the house went downhill, the parents don't work, they take all of her money to where my neighbor has to come to her neighbor's begging for money, they do drugs, and the police are called out all of the time. When my neighbor showed up with bruises and a black eye, I called the elder abuse hotline to get something done. But my neighbor won't press charges. But at least now the police in my area are on alert and hopefully we can get something done. I know I could not sit back and watch someone get abused like that. It's a crime against humanity.7Mar 2, '14 by gonzo1Thank you for being her advocate. This is the kind of stuff we see and it breaks our hearts. Get to work on all the steps the other posters have offered and then go to sleep with peace in your heart knowing that she is getting awesome care from you now and that her torturers are going to be investigated. And hopefully punished.4Mar 2, '14 by IowaKaren, ADNThankyou for advocating for this woman. It's the quiet ones, non-verbal that get forgotten b/c of the noisy, demanding, anxiety ridden, poor pain control, etc Residents that take up so much of your precious time (we have to address each and every non-essential demand of the Residents that can verbalize) or fear that they will report the facility to state and state saying it would be a violation of their rights if not addressing a request within a minute since it's spelled out as 'Resident rights'. But the rights of the nonverbal are nonexistant, it seems. Such a viscious cycle that's been created and keeping a resident to their highest level of functioning is not implimented where I work d/t 'it's their right to have do whatever they ask," even though it is harming them.13Mar 2, '14 by Nola009It's not the nurses, it's the fact that the demands placed on the nurses are completely unreasonable. While you were on this narrow-sighted rant, you failed to mention coorporate greed and the completely unrealistic expectations that are shoveled onto nurses at SNF and LTC. I have yet to figure out HOW one nurse can provide adequate care to 25-30 patients per shift.4Mar 2, '14 by SHGR, MSN, RNQuote from Nola009It is not all the nurse's responsibility- it is the team. Here is an example of one state's guidelines as far as nutrition Nursing Home Care Standards - Fact Sheet - CANHRIt's not the nurses, it's the fact that the demands placed on the nurses are completely unreasonable. While you were on this narrow-sighted rant, you failed to mention coorporate greed and the completely unrealistic expectations that are shoveled onto nurses at SNF and LTC. I have yet to figure out HOW one nurse can provide adequate care to 25-30 patients per shift.
Obviously a lot of this falls under the purview of the dietary department. CNAs and social work have a part also.11Mar 2, '14 by jojo489I agree that this should happen to no one. But I've also got to add, as far as LTC goes, a 1:30 or even 1:20 nurse to patient ratio is extremely hard if not impossible when you're trying to care for your patients. But what we're forgetting is the 1:12 CNA to resident ratio. It's almost impossible for them too. And while I completely agree that it should be handled as a team, the problem lies with having 2 dietitians for a 180 bed facility and social services consistently being preoccupied with admissions, discharge planning and customer service issues. As far as pressure ulcers go, it all boils down to not enough staff on the floor for the patients because the dietician and social service worker are not going to turn and reposition my contracted patient. I try to be as attentive as I can to all my patients, but even with me as the nurse myself repositioning a patient as often as possible and keeping up with my aids to do the same and keep them clean along with tending to their wounds and updating treatment orders and seeking advice and guidance from the wound team....it's fruitless if the other shifts aren't as vigilant.
As terrible as it sounds, I cringe when I think of what I'm coming back to when I have a day off. If I could do it without losing my mind, I think id work every day so I knew my patients got the care they need and deserve. Even the quiet ones.2Mar 3, '14 by vianne, RNReallyRosie I, like others, think you should take comfort in the fact that you are able to speak out and do something about it, it lessens her pain not very much but at least she has you now - and that will be so important to her. I would howl too; its very sad and shameful ...is it better to leave places like that because you know you can never deliver the care? or is it better to stay and try to make a difference? I left a place where they only allowed the patients (all incontinent) 4 pads per day, I reported it to the agency and left by lunchtime, but I can still remember the poor people who had to live and work there ... we're all poorer when profit is put before people...1Mar 5, '14 by cherryames1949As long as healthcare is "for profit" these horrors will continue to happen. Corporate greed, not death panels, should be our fear. As long as these facilities are understaffed,neglect will persist and good caregivers will cry all the way home because they cannot give the quality care they know that their patients deserve. We must advocate for our patients as best we can and try not to beat ourselves up for the flaws and failings of our healthcare system.3Mar 5, '14 by maginoirI can't advise you what to do, I can only tell you my story;
In 2006 I worked in a facility for at risk youth in which they were over-dosing, physically abusing, & allowing these kids that they were supposed to be providing rehabilitation to to harm themselves without stopping them.
as a nurse, I attempted to inform nurse supervisors, risk managers, & even the CEO of the immoral & unethical practices going on in this facility.
In Dec. Of 2006, 2 of the other nurses set me up for a med error, they called me in & fired me for things that never happened & I was done.
Because they were due for CARF evaluation a reputable law firm represented me & took it all the way to the Supreme Court which ultimately refused to hear it.
Because the facility was owned by a Mega Corporation (UHS) & their money & lawyers were able to keep the case from being heard. In the end, I was just one whistleblower nurse, & the kids were in their eyes "throw always" so big profits & high dollar stocks were more important than anything.
They discredited me, & made me look bad so anything I said would not tarnish their precious million dollar profits.
they deal in psychiatric & at risk youth because "who believes crazy people & "bad kids?"
I attempted to go back into nursing homes but unfortunately I found things such as what you are describing here & I realized then that being a patient advocate, which I have always been, had no place in "wealthcare" & just like that 30 years of nursing changed for me.
I still renew my license, I do some medical consulting on my own, but nursing has become something I no longer recognize as "patient centered" & I miss it, I truly do.
Good Luck, I will think of you & say a prayer.
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