Standing up for your pt

[KaffeineFiend]

I work at mental health facility. It has 2 units in addition to our Intake unit.

We try to keep unit 1 for strictly psych PTs and and 2 for dual diagnosis.

Ive worked here since 2009 but took a 4 year break due to a car accident.

since I'm "new" some staff try to take advantage of this. I pick my battles though, and rarely make it an issue.

However, everytime I get report on unit 1, a common complaint is " this PT is detoxing, dual diagnosis etc, he shouldn't be on this unit"

Today I'm working unit 1, dealing with plenty of issues on the unit. When the intake nurse brings me a chart.

He gives a very brief hx, but I caught he had substance abuse issues. When I asked why the Pt would be transferred to my unit, the nurse said that's how it's done.

I told him, that Id look over the chart and in 30 minutes when my unit comes back from dinner I'd accept the PT.

This nurse and I have a good rapport from before so we've always covered what each other's is missing. But this chart was way incomplete.

Then within 30 seconds the PT is in my unit!

I didn't even have a chance to review his chart.

a quick look at his orders showed he was detoxing from various substances.

I immediately went to look for the nurse, before the PT settled into the unit.

nurse nowhere to be found!

finally I found him, asked what happened, we had a deal. Not only was I not ready for the PT but he is really not appropriate for the unit.

He got upset took the chart from me and said fine and I'll transfer him elsewhere.

Now the techs from intake and unit 2 think this was an issue on my part. That I didn't want the work of accepting a patient. And the unit 2 nurse is also upset.

I apologized afterwards for handling rashly (just in case) and explained I'll take any 1 else that's right for the unit.

He answered: " don't worry it's fine, I won't report this"

report what?? He really believes I'm completely wrong.

This is a long enough post, and it's hard to fit all the details. But I thought I was doing what was best for the patient and the unit

Whas there a better way to handle this?

maybe I'm looking for validation, did I do the right thing?

besides an apology and offering to help, how do I fix things with this nurse?

[sarabellum1]

First: Don't worry about what your co-workers think about you or say about you. Chances are they don't know the full story behind your reasons and actions without having full information on the patient's history themselves!

Was the pt. being admitted because they were actively having SI/HI or A/VH? Or were they being admitted because they were actively having withdrawal symptoms or a potential from withdrawal due to regular benzo, opiate, or ETOH abuse?

Was the other unit full and that's why they were trying to admit the pt. to your unit….in order to fill an empty bed?

I guess whatever the reasons… If you were truly concerned about the patient's safety and you were advocating for appropriate tx for them…..you did the right thing.

As for your nurse friend, were they just having a bad day? If it were me, I would wait til you can both talk in private about it and start off by saying, I just want to apologize if I upset you in any way earlier. Maybe we had different opinions on the situation at the time, but I would really like to hear your side so we can figure this out and put it behind us.” Then hear them out before explaining your thoughts and reasons for not accepting the pt.

I never accept the answer, That's just how things are done around here”. That might be the way everyone else does things around here, but my thought is: Is it right? Is that policy? Is it beneficial for the patients? Or in my case (because of how disorganized my facility is!), Is that why this place continues to be so screwed up?!

[KaffeineFiend]

Thanks for your reply

So I dk if this is common, or just my facility. But if the techs don't like you, they will not back you up when there is a patient that's getting agitated and aggressive.

Obviously it starts with them doing less on their shifts with you and being unhelpful before it gets to that point.

But this is a big reason I don't like misunderstandings with my techs.

ok so about the patient. Since we're a mental health facility primarily, any client will always have a psych issue for admission.

He was Schizophrenic, actively responding to internal stimuli. He was detoxing from opiates and benzos.

Dual diagnosis unit had 5 male beds empty, and no admissions that shift either. Sometimes they have beds but were careful not to overwhelm either unit with too many admissions.

Thanks for looking at all possible angles lol

I needed another pair of eyes on the situation, to make sure I wasn't in the wrong and totally oblivious.

I found out eventually, that the nurse on unit 2 that shift was his wife.

It explains why this happened, and turns out it's a pattern every Sunday evening.

I think I'll be standing up for more patients in the near future.

But this experience helped me to trust my gut a bit more. This patient was being shoved into the wrong unit for the convenience of another nurse. Disregarding the actual needs of the patient. I definitely don't regret making a big deal about it now.