Worried about a couple fellow co-workers and what this may mean for the rest of us

[mondkmondk]

So as many of you know, my hubby and I work in the same facility. He is a CNA/CMT going to nursing school. He works full time nights and through the grapevine, I am hearing so many good things about him. The residents adore him, the nurses love him because he never calls in, is always on time, does his job, and coaches other CNA's to be the best they can possibly be. He will be a really good nurse and I'm soooo proud of him!

He came home this morning from work obviously upset about something. I was sleepy but got up so I could listen and help him. He said 2 really good nurses were suspended and he thought it was really unfair. I asked him who and when he told me, I did a double take. One of the nurses used to be our DON and was the one who hired me. She is more than an excellent nurse, so of course I wanted to hear the story. Allegedly, a resident went bad on night shift and was assessed by the night shift nurse, an LPN. Her main symptom was coffee ground emesis, but she had been seen by a couple different aides eating a candy bar right before she vomited, so the LPN called the on call doc. She was basically told to monitor the resident and report any further symptoms. So the RN comes in for day shift and she vomits again, again coffee grounds. The RN does a full assessment and again notifies the on call doc and gets an order to send her to the hospital. They send her out. Hospital sends her back on same shift, saying she is bleeding internally and is to be kept on comfort measures only. She dies a few hours later. The day and night nurse are both placed on suspension pending investigation by our head DON, for allegedly, lack of proper nursing intervention and questionable assessments.

Does this sound justified to you all? After my own write up for the resp. distress thingie, I am beside myself now to make sure I am adequetely assessing and documenting...and I plan to notify our head DON if I have any questions. I sure don't want this happening to me!

Blessings, Michelle

[jmeng]

That doesnt look fair. Pt went to the hospital...it should have been the hospital's responsibility.

[mikolupi]

Hi Michelle I showed your post to my friends, and they all agree you should do something about this. But be careful usually hospitals are very sensitive to these kinds of things and have lawyers advice them.

I hate to say this, but the hospital I work for listen to their lawyers advise more than their staff which makes me really mad.

[mamamerlee, LPN]

There must be something missing here. Seems like the pt was appropriately assessed. Was there already a DNR order? Was the emesis an expected consequence of her dx? Was the family notified? Something is strange....

[katkonk, BSN, RN]

There seems to be something missing. Was she a DNR? Did she refuse care at the hospital? (I am thinking she must have either refused, or had some paperwork on file). Was she terminally ill...on hospice? The hospital sent her back without further treatment for SOME reason!

[mandykal, ADN, RN]

i agree, something here is missing.....

situations like this can be avoided had two implementations been in place. 1) is the involvement of the responsible party aware of the whole event in a timely manner?

from the results of the responsible party being aware, was there a care plan in place?

it does not take a rocket scientist to plan care, just do it upon a change in condition. most importantly, the ultimate decision is the responsible party.

deviate from scope of practice, state and federal regs, and/or facility policy = liability issues... i know how it feels when the lines starts to go thin, keep yourself within the lines and you'll be safe.

[mondkmondk]

I never worked the wing the patient was on, but she was on my wing upon initial admission for about a week. I don't think back then that she was a DNR, but that very well could've changed. My hubby seems to think that when the night shift nurse initially assessed her, they weren't maybe thinking the emesis was blood...because she had just eaten a candy bar. That is the only thing we can come up with. I work this weekend, filling in for someone, and I'll quietly ask around and then let you all know.

Blessings, Michelle

[SuesquatchRN, BSN, RN]

Meesh, you need to stop trying to figure this one out. You don't have the whole story nor will you unless you were there. It's just going to fuel gossip.

[KalipsoRed]

You description of events sounds excatly like what I would have done. I mean really what else can you do?! You assess, if a problem shows up you assess again and call the doctor, from there it seems to me that it is the doctor's choice as to what needs to be done and as long as you cover your self with your charting then that is all you can do.

It sounds like the place you work for is using these two nurses as a scapegoat for the doctor making the wrong call. The family is probably upset and the facility wants to appear to be taking action for the family's sake.

This is the reason that I don't do anymore than I have to for my job. I've seen to many good people screwed over because the healthcare industry is to 'the customer is always right' oriented these days. I have no disolusions that my facility won't put my head on a stake if it gets them out of a bad situation no matter how good of a nurse I am.

[tewdles, RN]

Clearly the info you have and have shared with us does not seem to warrant termination...but what you have shared is not the whole story.

Unfortunately, there is quite a bit of reactionary and sometimes outright horrible management practice in LTC as reflected in a number of threads in allnurses. If this is true in your facility you will want to be very careful going forward in investigating this issue...you too could be gone.

[CoffeeRTC, BSN, RN]

Have to agreee with all of the above posters. Do you have a heme tester at the facility? Could be a very simple way to figure out if it was blood or not.

Did they properly document all that they assessed and what actions they took?

Again...prob more to the story than we/ you know.

As long as you are doing your job...no needs to worry.

[heron, ASN, RN]

I'd also like to point out that DNR is not the same thing as comfort measures only. MDs seldom order comfort only unless the patient is officially on hospice or the family has directed this - ie refused work-up or treatment that they considered too invasive or not likely to improve the quality of the resident's life.

Another point: coffee ground emesis is usually indicative of a slow bleed. It's perfectly reasonable, especially with no guaiac testing available, to watch and wait and see where it's going. IMHO, the doc did not goof.

Personally, I tend to question whether there's some other agenda at work, perhaps a knee-jerk response on the part of admin. to the death of a resident so soon after an ED trip ... perhaps there are other clinical issues with the facility that makes them feel they need to create pretty paperwork with this kind of overkill.