Written up and confused. - page 3

I have been a nurse for 2 years now and have been fortunate enough to avoid any deaths on my shift until recently. Last week I had a hospice patient with a DNR who was exhibiting Cheyne-Stokes... Read More

  1. by   artsmom
    I have had to suction w/o an order before in emergency situations. If there was no order, I called after to update the doc and get the order. What did she want? Let the pt cont regurgitating/choking on food while you called the doc?
  2. by   tewdles
    I agree that you acted with the intent of providing comfort for the patient who was in the process of actively dying.

    There was no way this poor individual was going to swallow the food pocketed in her mouth. At best it was going to sit there, rot, and smell bad. At worst it was going to actively choke her and cause an uncomfortable death.

    If you had an active medical order on the chart, which had not been discontinued by hospice, to suction as needed I believe you are covered.

    It sounds as if, perhaps, hospice had a conversation with your manager about how much the family appreciated your efforts. You acted like a nurse who could provide good compassionate care for a dying patient again.
  3. by   amygarside
    I think you should consult a lawyer and if you are a member of a nurse's union consult with them also. I think that you are just doing your duty and what you believe is best for the patient.
  4. by   applewhitern
    Wow. In my 23 years of experience, I've never heard of having to have an order to orally suction a patient in this manner. We suction our hospice patients, and hospice actually set up a portable suction machine at my house when my son was dying. To not do so is simply inhumane. Your manager needs to educate herself.
  5. by   martymoose
    Your manager needs to go jump off a bridge. Maybe you should reconsider, and get a job in hospice, and run away fast from where you are. I would never be able to trust that manager ever again.
  6. by   Pheebz777
    Ask your NM if you need an order to change diapers, bath a patient, apply skin lotion, brush their teeth and provide perineal care. Just to be on the safe side. And while you're at it, ask the DON to look into her profile.
  7. by   rn/writer
    This is why I encourage people to get professional liability insurance. For less than one day's pay you get a year of coverage. In a situation like this, you can call and receive legal advice about how best to protect yourself.

    If you don't already have a policy, starting one now wouldn't cover you for this incident. But it might be a good investment for the future. Things happen. Patients and family members can be looking for a windfall. Management could be clueless or corrupt. The sad reality is that no one is entirely safe.

    I'm glad the DON is supporting you on this. That's the most encouraging sign in your posts. Make sure you write that rebuttal and have it reviewed by real life people you trust. Keep details to a minimum on this board.

    I hope this passes quickly and the outcome is good for you. Thank you for giving your patient capable and compassionate care.
  8. by   Esme12
    Quote from pageturnstyle
    I spoke to my DON and she advised me to attach my own written statement to the write up. She said signing the write up only indicates that it was read to me, not that it was an admission of guilt. She agreed that I was providing comfort care and said she would look into the matter. She also said she would do an inservice for the unit managers to help prevent intimidation and other inappropriate behavior in the future.
    Oh, Honey.......you did good. Threatened your license.......what an idiot. When is the last time this poor patient had oral care. If I was the manager I would have the floor on the carpet at the next meeting informing them that oral care is rendered on the dying.

    I agree with rnwriter.....get malpractice insurance. It is cheap and will help your when some idiot does something crazy. It will provide you with legal advice to protect your license as a part of your policy. It's worth the approxamate 0.5 cent a a day. (about $200.00/yr)

    The manager was also inappropriate in her attitude and in dealing with the issue...you don't use intimidation tactics and threaten the staff. Watch out for this one for they are insecure and in charge and a power hungry control freak....the worst combination in a Supervisor.

    Signing or not signing a write up is not an admission of guilt......it is just acknowledging your met with the manger regarding the matter ask the DON to remove this from your file for it is utter nonsense and at the very least write your response.

    You did good....((HUGS))
  9. by   Whts_Ur_Emergency?
    I dont see how that was a heroic measure but maybe your facility has a policy in place that states what a heroic measure is or that you need a doctors order to suction. I would demand to see the policy that backs up her claim. Policy can work to your advantage. If she can not produce it then take it to the DON and if not resolved there say you will contact the board of nursing.
  10. by   rn/writer
    Quote from Esme12
    I agree with rnwriter.....get malpractice insurance. It is cheap and will help your when some idiot does something crazy. It will provide you with legal advice to protect your license as a part of your policy. It's worth the approxamate 0.5 cent a a day. (about $200.00/yr)
    My last renewal in September was just over $100. It's inexpensive peace of mind and covers me if I volunteer or if I'm called to testify against someone else. Facility policies only take care of you if you did everything perfectly and there is no conflict of interest. That's a rare occurrence. If your employer can cut a deal by tossing you to the wolves (as evidence of their "corrective" action), you'd better believe that will happen in a heartbeat.

    Some specialty areas are more vulnerable than others--OB, peds, surgery. But even an area like hospice is open to misunderstanding and confusion. Besides that, every area has people in it and when there are folks like the one who threatened the OP, it's good to have someone in your corner.
  11. by   Testa Rosa, RN
    WOW--as a former oncology nurse familiar with last stage DNR patients, I can't tell you how many times I used suction as part of my daily AM oral care without MD orders to do so. We even would have oral care kits hanging on the PCA/IV pump pole time stamped for just such oral suction care to ensure it was done Q8.

    In these time stamped kits, the toothbrush for oral care came made to attach to suction (after you have this liquid pouch broken up and mixed). I can't tell you how many times I pulled out secretions just from superficial oral care suctioning.

    While I've not had to deal with an actively dying pt often in Cardiac now, I would use suctioning for oral care again in a heartbeat as my pts seemed so much more comfortable after suctioning and swabbing and applying some oral moisturizer via the swabs that came with the kit. I also always used some vas aline for their lips (usually family members had some lip balm and after seeing me do AM oral care would often initiate the swabbing and oral moisturizer themselves).

    Often you would have dying pts who were mouth breathers needing to suck on the oral swabs with a little bit of water that then wouldn't go down either because family members at bedsie were so eager to do anything for their loved one they gave too much water or because their swallow reflex was so weak as they neared their end. Rather than drying them out with the scope patches I would just use a little suction to help them get rid of the excess water with the thinking that the less medical intervention the better for them.

    I consider this part of good nursing care done in good faith to improve the comfort of my dying patients and would want the same care extended to me or my family members.
  12. by   TJ'sMOM
    You did nothing wrong! It seems the unit manager needs educated. And she seems like a bully.
  13. by   cienurse
    I'd go right to the DON about this one.

    And I wouldn't waste any time doing this!! That manager is way out of line and apparently not in touch with end of life care!!