Should patients be allowed to refuse LPNs and CNAs? - page 7

Last night on our med/surg unit, we had an elderly woman who was in wiht consitpation. Very stable patient, vitals within normal limits, fairly negative past medical history, no home meds,... Read More

  1. by   SmilingBluEyes
    Quote from pkapple
    OK, we all have preferences. No one, except some folks with a royalty complex, feels comfortable being exposed or having a stranger perform "intimate" hygiene/procedures. We all learned to provide care with as much regard to dignity as possible. The issue of male/female and race preferences needs to be addressed on an individual basis, BUT addressed and honored are not the same.If a patient has a true fear of possible assault by caregivers, then a family member needs to be present to assist her/him.

    We could of couse start a whole new thread on how helpful these family members are--not!
    I agree. And how is it, we automatically 'trust" same-gender care providers? I don't get this either. Trust and repoire are BUILT, not automatic. And I DO believe we can set each other up to succeed or fail in that area with our patients. It's all in attitude and how we present ourselves and colleagues to our patients.

    I don't think the little old lady in the OP should have the choice here. NOT based on the scenario. The RN is overseeing the care of ALL of these patients if she is the ONLY one on the unit. ONE patient cannot be allowed to monopolize all her time like that. It really comes down to that. And letting her have her way out of some fear of a frivolous lawsuit possibility sets the unit up for trouble and a precendent others will try and do the same thing. If she wants an RN-only on her case, the suggestions others made before me are reasonable. We can help her:

    1. hire a private duty RN for her care.
    2. seek care at another unit or facility where an RN can be assigned specifically to her care.

    It really is as simple as that. And I can't understand why we get so worked up about gender in 2005. Most of here arguing this were born after 1946 (the year mentioned by one poster here). Why are we SO hung up STILL? And is it possible, we can be passing these attitudes (not meaning to necessarily) to our patients? Something to consider. We should also consider ourselves lucky to be in a country where the choice is even able to be discussed.
    Last edit by SmilingBluEyes on Mar 7, '05
  2. by   SmilingBluEyes
    Quote from LPN1974
    Well, Sorrrrrrrrrrrrrrrry.
    My sincere apologies that I have offended anyone.
    I thought everyone here were adult enough to see that it was only a comparison.
    I am thru with this beating this dead horse.

    And no, no one asked you.
    I am NOT offended. I just don't understand what the concept of visiting nude beaches has to do with medical care intimacy issues. Being nude at a beach is NOT intimate contact. It's really got nothing to do w/the conversation, is all. Anyhow have a good day, no hard feeling here!
  3. by   UM Review RN
    Quote from SmilingBluEyes
    Just curious. What do MEN do when they want to refuse a FEMALE caregiver, esp a nurse?
    Men are so straitjacketed culturally, they wouldn't dare for fear of being accused of being gay.
  4. by   SmilingBluEyes
    Quote from Angie O'Plasty, RN
    Men are so straitjacketed culturally, they wouldn't dare for fear of being accused of being gay.
    ruh roh..... :uhoh21:
  5. by   UM Review RN
    I sincerely do not mean to offend anyone. But you asked, and I have often wondered myself.

    A lot of guys get into the braggadacio thing and swagger and leer, but it's really only for show; I can see that they would love to just be honest at some point without fear of their manhood being questioned.

    If I offended anyone, I'm truly sorry. I just feel that it's kinda not fair to the guys. After all, I have known some guys who were abused by women, too. Granted--in the minority, but still.
  6. by   UM Review RN
    And again, I do hope I haven't offended anyone. I'm a tad punchdrunk as I've been awake for almost 24 hours.

    Oh gawd now I'm rambling. I'd better go get some sleep and apologise again when I get up, I guess.
  7. by   Antikigirl
    I am like others..it is a catch 22! Although I do feel that a patient does have a right to have an RN take care of them in situations where that request can be fulfilled, or when they can afford a private care nurse to come in and tend to them in situations where this is not possible.

    Also, I really do believe in INFORMED CONSENT! A patient has the right to refuse or decline things medically, that includes staff...however...they must be INFORMED of the consequences of this and still say yes! I would have told this lady the situation behind staffing and inform her that her certain care needs (like ADL's) will be severely delayed. If she still said yes and was of SOUND MIND to make this choice, then I would document that I told her, her words quoted, and WITNESSED and have them chart as well. Yep, takes time, but then you have proven that you have informed the patient and they still wish to have only the RN care for them even knowing the consequences of that choice!

    Also being nurses we are to find the reasons behind such requests! Is there a dynamic here that will effect her care? Obviously there is, and something that may be good to know and discuss! Is she being treated poorly at a facility by LPN's or CNA's (potiential abuse???). Is she unsure of the duties of either and their roles in healthcare? Was she an RN, LPN, CNA or even MD when she worked (oh brother would that open a door or two..LOL!).

    The reasons can be simple to complex, and may point to potential probelms that need to be addressed (ie potential elder abuse, or even noncompliance issues when she leaves if a nurse doesn't directly care for her).

    Personally I have had a patient like this..she was an LPN and will only have RN's work on her. Found out via talking to her over time, it actually was for spite! She had to take on RN roles so much when she didn't feel comfortable that she said "fine, then when I need help, those darned RN's can take care of me...I am not going to bother those great LPN's and CNA's...let those lazy nurses do it!!!!!!". Okay...not very cool, but at least we understand why! But then she had a case where she needed to go to the ED, and an LPN was the floor nurse...now she is totally trusting of this LPN and now when full opposite...no nurses only her...uhhhhggggggg! Oh well..still working on her..LOL (somehow she will find the balance..LOL!).
  8. by   GLORIAmunchkin72
    tell her that it's going to cost this much more"dollar quote" to bring in an extra RN just for her. And tell her you charge xtra for red hair.
    Quote from cotjockey
    Last night on our med/surg unit, we had an elderly woman who was in wiht consitpation. Very stable patient, vitals within normal limits, fairly negative past medical history, no home meds, independent with ADLs...again, a very stable patient. No BM for 8 days...came in to ER via private vehicle with complaints of abdominal pain.

    We are a small rural hospital, average patient census of 10. Last night we had nine patients. This woman decided that she did not want any LPNs or CNAs in her room. OK...we try to accomodate such requests, but on nights like this, we have one RN on med/surg and one in ER. ER was pretty busy, so the ER nurse did not have time to come to the floor to help. Other than the charge RN, we had two LPNs and one CNA...staffing well above what we normally have. Certainly, the RN had time to care for this patient, but this woman didn't even want the CNA or one of the LPNs to do the simple things like taking her vital signs, refilling her water pitcher, or emptying her commode. So...the RN not only was charge over 9 patients, but had to do all cares for this patient, simply because she did not want anyone but an RN.

    I agree 100% that there should be an RN available for all patients, but not all patients require an RN as their primary nurse. In a small rural area like this one, sometimes you have to take an LPN, especially if you are stable and have a predictable outcome. Had we been busier or had an unstable patient, would we have been out of line to explain to this patient that there was an RN available if anything unexpected happened, but that due to staffing reasons, her assigned nurse would be an LPN? This happens every now and then and usually we are able to accomodate the requests of RNs only, but what about when we just can't do it?
  9. by   ProfRN4
    wow!! what a thread. i'm glad it kind of came back on topic by the time i stumbled upon it. my first question is this: do the patients rights guarantee that every patient is assigned an rn, much less, for every aspect of care? i'm sure the hospital was not asking the lpn or cna to perform the duties of the rn. if a pt. insisted that the doctor check her vitals and administer her meds, how would that fly? if the person is performing the duties within their scope of practice, i don't think the pt has a leg to stand on (as long as the pt remains 'stable').

    many have mentioned the lawsuit possibility here. i tend to agree that this would fall under the 'frivolous' category. one thing we have forgotten, is that someone would have to agree to represent this person. lawyers are not stupid, they only take cases they feel they will win. we're not talking about civil rights here (ie gender, race, or religious preferences). if anything the patient is being somewhat discriminatory here. judging the quality of care merely by a title. she is basically saying 'only an rn is good enough to provide care for me'. do we give that option to all of our patients? hi, i'm your nurse tonight. would you like me to provide total care for you tonight, or is it okay for the pca to do the vital signs? after all, my assignment is heavy enough as it is, and the aide doesn't mind doing squat while i bust my butt and wait on you (and all my patients) hand and foot'. [font=courier new](sarcastic rant over).
  10. by   SmilingBluEyes
    Quote from MUNCHKINgloria72
    tell her that it's going to cost this much more"dollar quote" to bring in an extra RN just for her. And tell her you charge xtra for red hair.
    sweet, but you CAN'T charge her for the extra nurse in her bill in most hospitals. That is part of Nursing's problem. Our dollar value is unknown and unrecognized most places. Until nursing is billed separately and in itemized fashion, you can't do a thing about this situation in the way of charging "extra" for people like this who want to buck the system for their own selfish reasons.
  11. by   KRVRN
    When I was in nursing school, one of our male students had his 30-something aged female pt complain about him. She complained that he had listened to her lungs from the front of her chest and no other nurses had done that in the 4 or so days that she had been there! So she concluded that he had been somehow inappropriate because all of the other nurses (most of which had been men) had only listened to her back. The nurse manager was livid, because how can you chart that you listened to all lung fields and heart sounds without ever listening to the front of the torso? So from then on she only wanted female staff, which was somewhat of a non-issue since she did all her ADL's by herself.

    So does the nurse-manager agree that the student was inappropriate or does she admit that for 4 days, 3 shifts a day, the nurses had been doing substandard assessments? I know this doesn't fully pertain this thread but it shows that apparently even nurses can be a little weird about caring for the opposite sex. Unflattering behavior for a nurse.
  12. by   renerian
    Tough call with no easy response and no agreement needed. Each of us has our own opinion and thats all that really matters to us....live with our choices.

    I am sorry LPN you edited your posts away. I wanted to read them..

    Yes I think a patient should be able to refuse anyone they do not want touching them, caring for them and such. I have done it myself but my issue was safety and once for personality. For me if I am of sound mind and body you better believe it if I don't want someone caring for me, they won't. Take it for what it is worth. Maybe this person felt that the RN was the highest educated (defined in years ONLY) caregiver there and wanted the best.....that could be a compliment to the RN and in reality not a slight to anyone.......If you think about it would you prefer an RN? I would if I was truely ill, yes I would.

    Good thread. Interesting to see flames...inherent in nursing which is very sad.

    Blue eyes always nice to read your posts.

    renerian
    Last edit by renerian on Mar 7, '05
  13. by   Antikigirl
    Well..I don't work in hospital...I work in assisted living where they ARE charged quite a bit more for a nurse walking into their rooms. So guess this hits again on informed consent...I want my patients to know what their desires are going to cost...most folks don't tell them, I find it is part of my job (not NOT one I like...I find it horrid to charge more, but I can't change that, and I don't sway patients from what they want..I only inform and help make choices based on situtation for that particular patient).

    But alas..my facility would have the Admin down to their room if they demanded only an RN...and would explain the reasons why that is not possible and help point them to a private nurse agency and funding to make that possible despite income or lack there of.

    In hospital..heck..I had no voice, and no choice...I did what I was told..if a patient said "jump" I had to say how high and consult my administration to make sure they weren't liable for me jumping too high or too low! LOL!!!!!! If a patient requested RN only...I had to be it all..and yes, I have been asked several times...sometimes I rather liked that because I knew the patient well and it was in the benifit of them to have me for continuity!

    But if I was the only RN in a Rural ED on a busy night...nope! Can't do...my job as a protector for ALL patients outweighs one persons desires that go beyond safe practice for all concerned..but again..I would explain that and get INFORMED CONSENT...legally and educationally for my patient! I am only one, they are many...I know my limitations, although I wish they were gone and I could take them all!

    LOL, I guess I can SO go Treky on you all..and remind you that Spock once said "the needs of the many outweigh the needs of the few"...then was switched through great situations to the "needs of the one, outweigh"...which leads me to believe..I am nothing but a red shirt..and just sent on an away mission! LOL!!!!!!
    Last edit by Antikigirl on Mar 7, '05

close