Should patients be allowed to refuse LPNs and CNAs? - page 8

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   flashpoint
    If I were very ill, I would want an RN....can't deny that. However...I would have no problem with anyone from the MD to a CNA or anyone in between helping me to the commode or emptying my bedpan. The patient in question would get angry any time an LPN or CNA even came into her room...she would put on the call light and when someone went in to answer it, the first words out of her mouth were, "Are you a registered nurse?" If you were not, you were told to leave. I think it would have been appropriate for the RN to explain to her that LPNs and CNAs are quite competent at things like emptying commodes...and that while the RN would try to provide all of her cares, do assessments, etc, that she would have to either allow the LPNs and CNAs to empty her commode or she would have to put up with the smell until the RN could ge there. As it ended up, the RN went in every time the light went on...she was late to report, she had to interrupt rounds with a doctor, and one of the LPNs had to resolve a staffing issue because the RN was not available. Not a huge deal, but it did interrupt care for others and upset some staff members when an LPN was scrambling to make patient assigments for the next shift because the RN did not have time.

    BTW...yesterday, the RN was helping the patient up to the commode and she (the patient) fell...broke her hip, sprained her wrist, dislocated her elbow. When she was transferred to a the nearest hospital to see the ortho doctor, she told the paramedics that she fell because was so upset because only RNs would come into her room and RNs don't know enough about moving patients...
    Last edit by flashpoint on Mar 7, '05 : Reason: Spelling, spelling, spelling...
  2. by   SmilingBluEyes
    And folks, so there ya have it. A truly very manipulative person. Did they not cover dealing with manipulative types in nursing school (psych)? They sure did for us. One of those points being, YOU DO NOT CATER TO THEM unnecessarily. Too bad most hospitals won't back up nurses when being firm is what types like this need us to be. There is truly NO pleasing a person like this one, and it's about a helluva lot more than wanting an RN on her case.
    Last edit by SmilingBluEyes on Mar 7, '05
  3. by   UM Review RN
    Quote from cotjockey
    BTW...yesterday, the RN was helping the patient up to the commode and she (the patient) fell...broke her hip, sprained her wrist, dislocated her elbow. When she was transferred to a the nearest hospital to see the ortho doctor, she told the paramedics that she fell because was so upset because only RNs would come into her room and RNs don't know enough about moving patients...
    Whooooooooooooooa~
  4. by   SmilingBluEyes
    I expect she will sue, more than likely. Even if there were no grounds this type always seems prone to do so. She is already "setting it up".
  5. by   renerian
    Oh I am sorry the patient fell. I am sure that was terrible for the patient and the RN. We try our best but we are not mighty power houses.

    Maybe that person had some "mental issues"? I am sorry if I missed the person being defined as only manipulative in nature. Maybe I was reading more into like the patient might have had something bad happen to her with another discipline and she had a great experience with an RN or more than one that solidified her belief in RNs, I don't know... I just think there is more about the patient we do not know.........I try not to be judgemental and think about why the patient has the beliefs they do, what happened to them in life that makes them react one way or another-looking deeper than the superficial comments by a client? Does that make sense?

    renerian
  6. by   flashpoint
    But...you just about have to give in to the manipulations. How do you think this patient would have reacted if she had fallen with an LPN helping her? It would have been the hospital's fault because she knew she "needed an RN."

    We once had a patient who was in the hospital for 112 days...after about ten days, she had picked out her favorite nurses and demanded that only a certain few be allowed to care for her...for the most part, the charge nurses tried to assign her only to the nurses she had requested (occasionally she had to take a nurse who was not on her "list" but it was rare)...on day 112 the one who "favorite" was on was sick of her and requested that she be assigned to another nurse...the patient fell, hit her head, and died...her son filed a lawsuit because he felt that the nurse caring for her was not familiar enough with her to know her habits, etc. The patient, who had never in 112 days made an attempt to walk to the bathroom without help, got out of bed without calling before she fell.

    So...was anyone at fault? Not really, but the patient died...the family is obviously pretty angry. The nurse who was totally burned out on this patient feels guilty, the nurse who was assigned to the patient is angry...not only at the situation, but at the family, at the nurse who asked not to be assigned to the patient and at the charge nurse who made the assignment. Could the incident have been prevented had the patient had her choice of nurses? Maybe...perhaps had she not been angry, she would have called for help...she was angry and bitter that day...maybe she got out of bed without help out of spite...maybe her condition was just declining and she forgot...maybe she thought that she was getting better and could do it without help...
  7. by   SmilingBluEyes
    Well no easy solutions here. Unless you are backed up, you have no grounds and will continue to get types like this able to play your system. I wish I knew the magic bullet. There is none if admin won't back up its nurses. The patient who died, is this the same as in your OP or a different case? Just curious. I am sorry either way this happened. Awful for her, the family and that nurse.
    Last edit by SmilingBluEyes on Mar 7, '05
  8. by   renerian
    Wow that is a sad story. I am sure everyone feels horrible about that......

    So sorry,

    renerian
  9. by   flashpoint
    In general, I think requests should be accomodated whenever possible. I once had a patient tell me I was too short to be a nurse, I switched assignements with the tallest nurse on the floor...somewhat because the patient was rude and his comments honestly made me mad, somewhat because I thought he might sincerely be uncomfortable with someone as short as me helping him, and somewhat because we were being silly that night and it sounded like a good idea at the time. However, had I been the only nurse available, we both would have had to accept the assignment...
  10. by   flashpoint
    Quote from SmilingBluEyes
    Well no easy solutions here. Unless you are backed up, you have no grounds and will continue to get types like this able to play your system. I wish I knew the magic bullet. There is none if admin won't back up its nurses. The patient who died, is this the same as in your OP or a different case? Just curious. I am sorry either way this happened. Awful for her, the family and that nurse.
    Different patient...
  11. by   SmilingBluEyes
    Ok thank you. sorry for the confusion.
  12. by   ktwlpn
    Quote from cotjockey
    If I were very ill, I would want an RN....can't deny that. However...I would have no problem with anyone from the MD to a CNA or anyone in between helping me to the commode or emptying my bedpan. The patient in question would get angry any time an LPN or CNA even came into her room...she would put on the call light and when someone went in to answer it, the first words out of her mouth were, "Are you a registered nurse?" If you were not, you were told to leave. I think it would have been appropriate for the RN to explain to her that LPNs and CNAs are quite competent at things like emptying commodes...and that while the RN would try to provide all of her cares, do assessments, etc, that she would have to either allow the LPNs and CNAs to empty her commode or she would have to put up with the smell until the RN could ge there. As it ended up, the RN went in every time the light went on...she was late to report, she had to interrupt rounds with a doctor, and one of the LPNs had to resolve a staffing issue because the RN was not available. Not a huge deal, but it did interrupt care for others and upset some staff members when an LPN was scrambling to make patient assigments for the next shift because the RN did not have time.

    BTW...yesterday, the RN was helping the patient up to the commode and she (the patient) fell...broke her hip, sprained her wrist, dislocated her elbow. When she was transferred to a the nearest hospital to see the ortho doctor, she told the paramedics that she fell because was so upset because only RNs would come into her room and RNs don't know enough about moving patients...
    "Borderline" personality disorder is an under-utilized dx IMHO-these people thrive on disrupting routine everywhere they go-any kind of attention they receive- negative or positive -is their fuel...and to top it off I can't imagine how horrible it must have been for an LPN to have to handle a staffing issue and upset the staff....Rough shift all around
  13. by   LPNer
    Quote from ktwlpn
    "Borderline" personality disorder is an under-utilized dx IMHO-these people thrive on disrupting routine everywhere they go-any kind of attention they receive- negative or positive -is their fuel...and to top it off I can't imagine how horrible it must have been for an LPN to have to handle a staffing issue and upset the staff....Rough shift all around
    Borderline Personality Disorder is where they clump folks that choose to be rude, crude and socially unacceptable because it is easier than assimilation into the mainstream. I don't believe in any Borderline Pshych Dx.

    Go ahead and flame me... I'm ready for my opinion to get blasted, but I will hold firm to it.

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