Written up and confused.

Nurses LPN/LVN

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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 breathing, fixed pupils, and a thick green secretion in her mouth. She also was known to pocket food- I found bits of banana pocketed in both cheeks at the time. Without a second thought, I retrieved the suction machine from the crash cart and used a Yankauer to suction the pocketed food from her cheeks and some of the green secretion around her teeth. The family was present and was very grateful and surprised by the things coming out of her mouth. The patient hung in there until the next shift at which time she expired. The next morning my new unit manager wrote me up for suctioning without a physicians order. Her MD had a standing order to suction PRN and the only Hospice orders I could locate in the chart said to D/C all previous meds, not all previous orders. Her hospice has no standing order to suction, however. This supervisor threatened my license and basically called me a lousy nurse for my actions. Am I completely wrong here?

Specializes in Tele Step Down, Oncology, ICU, Med/Surg.

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.

You did nothing wrong! It seems the unit manager needs educated. And she seems like a bully.

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!!

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.

Hi rn/writer...would you mind telling me where a good place to start would be for finding professional liability carriers? I am a new grad RN in New Jersey.

Thanks in advance

Get out NOW. RUN!!!

“The first time someone shows you who they are, believe them.”

― Maya Angelou

She has shown you her ethics (or lack of) and her "management" style.

"Fool me once, shame on you; fool me twice shame on me."

She fooled you once so it's her fault but if she fools you again, it will be yours.

Specializes in Hospice / Psych / RNAC.
My heart goes out to you! I have been in your shoes and in the real "nursing world" please be extremely careful when you venture in

following the so-called "chain of command" path. I got terminated for doing the "right" thing and at times Administrators are in a fantasy world and don't want any employee rocking the boat! If you are seeing " red" flags that managers are piling up derogatory

reports, you need to have an escape plan and look for employment elsewhere as the integrity of the manager is questionable and you are in a very hostile working environment. If you don't have strong alliances at the top , you are putting your nursing career on the line

It caused me dearly and my 25 yrs impeccable nursing career got ruined because of senseless and malicious gossips !!!

I fought hard because of good principle but unfortunately , I was dealing with different caliber of people .... Take care and good luck!

P.S. If managers are issuing Corrective Actions ... make sure you write a rebuttal on the C.A. Statement. Unfortunately, the prevailing rule per institutional policy = refusal to sign is automatic termination on the spot unless you file a grievance with HR and again make sure you have a strong basis to support a claim and always have a witness during any disciplinary proceedings and make anecdotal notes in your memory bank of issues that might back fire.

It appears that we've been there as they say as I absolutely recognize and agree with your posts advice. I've seen the ugly and I'm here to tell you that some people are just plain evil. I have worked and seen "those caliber of people" and raise you by 4. I am now pursuing the matter with the EEOC. I went into nursing thinking we were here to help. Alas, from the get go all I saw was neglect and abuse by all, that culminated into ruined and shattered lives. I like the part about the escape plan...oh so true.

OP, you performed a comfort measure and if I were you I would report her to the BON. Have you talked with the doc to get his take...if not please do so. Doctors can be our greatest allies. Look in the p/p manual; look up your states nurse practice act might be a good idea too. Watch your back.

I know your fear all too well so try to not worry too much. I know that's easy to say but drink nice tea with honey, relax, turn off all the tvs and radios etc...meditate. In silence comes our greatest plans.

You did good.

I'm puzzled as to why any manager, ever, would attack the OP for what she did. Either an honest-to-God mental retardation or some sort of personal vendetta are the only things that come to mind.

Specializes in Hospital, med-surg, hospice.

Shocking!! I worked in hospice for 5 years and mouth care is done on everyone, I would wonder if her LOC was diminished why she was being fed, could be the Mgr did not want to answer questions about her care to family.

Specializes in ED staff.

I have to agree with the others, find a place more deserving of your effort and your skills.

Specializes in Step-Down.

I would go speak with the DON, NOT sign the write up, and seek union representation right away. I would also watch that manager like a hawk and if they did ANYTHING out of line i would immediately report to the DON/ state BON. Give her a taste of her own medicine.

I work hospice now. We have a portable suction machine. We use it when necessary.

You did good. I too have . It's cheap and worth it.

Specializes in nursing education.

So sorry this happened to you. You mentioned the patient's family was glad that you suctioned. In this day and age when families so often delay any mention of hospice and we have to worship the Press Ganey scores, it seems really weird that that the family's satisfaction with your caring action and attentiveness to comfort didn't satisfy your manager.

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