Re: Time to get a few more replies!

Super R N,

Wow! I just came across this forum and when I read your story all I could think of was even though you said you don't have the patience to work with suicidal behavioral patients, you did more for your patient than most of the nurses I've known.

I've been on both sides of the behavioral unit (years ago as a patient and later as a nursing student with my preceptor) and, sadly, the callous behavior of the doctor you wrote about is no surprise. I was surprised and very upset when I worked in behavioral medicine as a nursing student and discovered that the nurses (Most, but not all of them) really did make fun of their patients (a big fear when you're the patient). Many of the nurses I spoke with were mean spirited and cynical about the patients under their care and carried dated ideas and strong prejudices against mental illness but they liked working the unit because they didn't want to do "skilled care" for the patients. That was the only reason they gave for working there.

So even though you wrote your story a year ago and I just came across it, God bless you for caring about your patient. You probably saved her life. Mentally ill people deserve much better than the medical community is willing to give to them.

I wish all nurses were like you.

Peace,

Kathi9

Re: The Pt Advocate Thread--You did it when...

Over a year ago I had a total cystectomy patient with a history of a-fib. Her sats dropped into the 80's, her lungs sounded full of fluid, and her blood pressure was 80's/60's. Her pulse rate was jumping around from 150-200 on the pulse ox monitor. I called the internal medicine doctor who was on call for the night in-house. (He's working in Vegas now, not our problem anymore.) At this point she wasn't on tele, and he wasn't about to put her on it, and he didn't want to do anything but give her Lasix. I told him I really thought she needed to be on tele and needed an EKG, enzymes, etc. He finally said "Fine, we'll put her on tele if it will make you feel better, it won't make the patient feel better, but it will make you feel better." As soon as I got those leads on her, the tele tech was on the phone. Turns out her rate was 180-220. We ended up sending her to ICU for a Cardizem drip. Dr. Hind-End, as we called him behind his back, actually told me "good call"!

Re: The Pt Advocate Thread--You did it when...

Originally Posted by hooterhorse

I finished my first year of nursing school last semester and during the summer break, took a job with a hospice organization as an GPN...hope to be LPN once I passed my state boards (which by the way..I recieved my license today).
Anyway, during orientation....I accompanied a CNA to a home visit of an elderly gentleman with a terminal diagnosis of prostate cancer. He was a spry old guy who hadn't given up on life just yet!
Anyway, when we entered the home there was a wonderful aroma coming from the kitchen. The CNA asked "what's for dinner?"...."it smells wonderful!" The old man replied "bug spray". This was puzzling...but apparently he was brewing up a conconction of homemade bug spray....made with onions, garlic and herbs. We had stopped by to give him a shower, but figuring out how to strain the contents of the pot into his bug sprayer took priority! At first he tried a kitchen strainer...but that allowed too much of the herbs through and it clogged up the spraying unit. Then he had tried using a coffee filter...but that was too dense and next to nothing was straining through.
I thought for a moment and suggested straining through a pair of women's nylons. He looked at me in disbelief, but politely enough to comment "can you imagine what my son would say if he knew I was going to the store to buy nylons?"
I then took off my shoe and removed one of my knee hi nylons....placed it over the opening to the spray tank and poured the contents of the pot through the nylon into the tank. It strained through instantly...much to the old man's surprise. After his shower, he followed us out the door with his bug sprayer in tow. From the car I watched him pump it up and ....voila....it had worked beautifully. As we pulled out of the driveway, I looked back to see him hard at work spraying his yard.

Working for hospice has helped me realize how to "individualize" care plans.
Too often I found myself caught up in the "medical" aspect and searched for diagnosis and interventions in a nursing manual...when all along it was right there in front of me....plain and simple....the patient!
I'm actually looking forward to next semester and the writing of care plans!
Jean & Houdini
Wisconsin

What a heartwarming account Thanks so much for sharing... and for caring.

Re: The Pt Advocate Thread--You did it when...

Originally Posted by grace90

Over a year ago I had a total cystectomy patient with a history of a-fib. Her sats dropped into the 80's, her lungs sounded full of fluid, and her blood pressure was 80's/60's. Her pulse rate was jumping around from 150-200 on the pulse ox monitor. I called the internal medicine doctor who was on call for the night in-house. (He's working in Vegas now, not our problem anymore.) At this point she wasn't on tele, and he wasn't about to put her on it, and he didn't want to do anything but give her Lasix. I told him I really thought she needed to be on tele and needed an EKG, enzymes, etc. He finally said "Fine, we'll put her on tele if it will make you feel better, it won't make the patient feel better, but it will make you feel better." As soon as I got those leads on her, the tele tech was on the phone. Turns out her rate was 180-220. We ended up sending her to ICU for a Cardizem drip. Dr. Hind-End, as we called him behind his back, actually told me "good call"!

grace90, you are to be commended. What a perfect example of advocacy. Advocate: One who pleads the cause of another, One who defends, one who pleads another's cause, who helps another by defending or comforting him. http://www.hyperdictionary.com/searc...efine=advocate

Sometimes, as in your case, we have to be quite aggressive in advocating for our patients (stepping on toes, if need be). If the physician will not adequately respond to our concerns, then we must persistently take it up the chain of command until the situation is safely resolved.

http://www.workingworld.com/magazine...ticleno=301&wn=

Speaking of Advocacy....

Nurse As Patient Advocate: Nurse Should Have Questioned Why No Order Was Written.

The discharge instructions for the nurse from the physician included information about a medication the patient was taking in the hospital and
was supposed to continue at home, but no prescription was written for the medication. The nurse should have questioned the physician why no
prescription was written for the take-home med.

http://www.nursinglaw.com/Mar06PageOne.pdf

Great article on patient advocacy

BEING AN ADVOCATE

What does it mean to serve as a patient advocate? Advocacy is defined as "the act or process of ... supporting a cause or proposal." (2) Patient vulnerability often is the reason one serves as an advocate. (3) Since the time of Florence Nightingale, nurses have served in this important role, advocating for health care improvements related to infection control, practice and patient care environments, and access to care. Regardless of the practice setting, every encounter a nurse has with a patient provides an opportunity for that nurse to serve as a patient advocate.

Although nurse advocacy is discussed by nurse clinicians and educators, there is limited understanding of how to teach students or experienced nurses about this role. (4) Nurses generally learn the advocacy role by watching other nurses who provide positive role models by standing up for patients. Through their own experiences, nurses gain confidence in performing the advocate role. (4)

WHEN TO ADVOCATE

Clinicians may decide what is best for patients instead of asking or fully considering what the patient might want. This is most likely to occur in situations in which patients choose to rely on and give their complete trust to their health care providers. Other times, patients may be afraid to voice their concerns or preferences.

Nurses and other health care clinicians must remain alert to times when patients are hesitant or unable to speak up. Encouraging a patient to voice his or her wishes and desires or giving voice to a patient when the patient cannot speak is one of the nurse's most important roles. Nurses should consistently ask the questions, "What does this patient want? What are his or her preferences? What are his or her wishes and values?" This information serves as the foundation for the nurse's role as advocate. A nurse becomes an advocate for a patient by providing care that focuses on meeting the patient's specific wishes.

Nurses also must focus on ensuring that care is provided in the safest manner possible....

http://www.findarticles.com/p/articl...13793213/print

Re: The Pt Advocate Thread--You did it when...

Nursing advocacy at the local level: An Arizona success story

Advocacy has always been a pillar of nursing practice. The Code of Ethics for Nursing charges all nurses with the responsibility to protect the health and safety of the public and to promote the nursing profession. Recently, a group of nurses put the precepts contained in the Code into action when they petitioned a local district school board to revise a policy related to sports physicals. Through their collective efforts in advocacy and public education, the nurses were successful in convincing the school board to add nurse practitioners to the list of health professionals who can confirm that a high school student is fit to participate safely in interscholastic sports.

http://www.findarticles.com/p/articl...n9227682/print

Re: The Pt Advocate Thread--You did it when...

Back few years ago I worked as a substitute for the IV therapy department of a 232 bed community hospital. I was called to the surgical floor to restart an IV on an elderly lady because she was a "hard stick." When I arrived the lady was very upset and told me she felt like she was going to die. The RN assigned to her was a new grad, and she was also scared. She believed the lady, but was unsure what was happening. She proceeded to tell me that she had first complained of SOB and she had just put oxygen on her (after calling the surgical resident and getting the brush off.) I restarted her IV and called the surgical PA, who I personally knew. I flat out told him, better go see this lady right away she look like a pulmonary embolism to me. He went right up to see her as I found out just a few hours later - and she had a PE. The resident got a tongue lashing for not personally evaluating the patient. I stopped to see the patient at the end of my shift, she smiled and thanked me for helping her out - Heparin infusing. For all new nurses out there, when a patient tells you somethings wrong, generally, you need to believe them.

Re: The Pt Advocate Thread--You did it when...

Originally Posted by rnwaller

Back few years ago I worked as a substitute for the IV therapy department of a 232 bed community hospital. I was called to the surgical floor to restart an IV on an elderly lady because she was a "hard stick." When I arrived the lady was very upset and told me she felt like she was going to die. The RN assigned to her was a new grad, and she was also scared. She believed the lady, but was unsure what was happening. She proceeded to tell me that she had first complained of SOB and she had just put oxygen on her (after calling the surgical resident and getting the brush off.) I restarted her IV and called the surgical PA, who I personally knew. I flat out told him, better go see this lady right away she look like a pulmonary embolism to me. He went right up to see her as I found out just a few hours later - and she had a PE. The resident got a tongue lashing for not personally evaluating the patient. I stopped to see the patient at the end of my shift, she smiled and thanked me for helping her out - Heparin infusing. For all new nurses out there, when a patient tells you somethings wrong, generally, you need to believe them.

Excellent post... your advocacy saved this patient's life...

I got one! I was working of a med-surg/tele/step down unit in a very big and popular hospital here in Miami. I did walking rounds with the day nurse,(she hated that). In the last room at the end of the hall, did I fail to mention that I had gotten on the bad side of the charge nurse so I steadily got "the most challenging patients". I did not mind, I like to stay busy. But I digress, at the end of the hall was, oh lets call her Senora (Mrs) Lopez. CHF, uncontrolled DM, HTN, PVD, and sundowners/dimensia. All around mess. But a charming lady with the usual gaggle of family hovering over her. She was on everything and had horrible veins and insisted. when she would feel better after a treatment, to get out of bed and that she had to " hacer cafe para mi marido"/ make coffee for my husband. Husband had long since passed over. I said good night to the day nurse and checked my charts and meds. Some little voice in my head said check on Sra Lopez. So I did. Sure enough the family was out looking for me just as I walked toward her room. "Something is wrong with my mother, she cannot breath," I went into her room and to this day, I can still hear her breathing. I called the tele room to check on what her heart was doing. Sinus brady with 2 brief pauses. "Why did you not inform me?" I was told that she had been doing that all day and the day nurse told them that pattern was part of her sleep wake cycle. She would be drifting off and then pause and wake up again. Imagine! Besides, the tech told me, isn't she DNR? I looked in the chart to see if it had been documented and it had not. Neither had cardio been told nor the primary. I paged the house MD when she did it again. I got vitals and stayed with her until he called me back. That is one good thing about working there and having worked there while I was in nursing school, I knew almost everybody. "Doc can you come up and see her please, something is not right." He came, assessed her read her chart, talked to her family through me, and told me to page cardio if it happens again. Meanwhile, the patient is getting excited about all the attention and the handsome suitor that has come to see her, (she meant the house doc). I passed my other meds and checked on my labs for the am. It happened again. This time it was a looooong pause and I did not think she was coming out of it. I had to get help for my lady. I called everybody I could think of. I ****** off the cardio and attending who told me why am I worried, I will just be postponing the inevitable! "Doc you must come and talk to the family, they are not ready for her to go and they do not understand about the problem. I cannot tell them without you and we have to tell them." "Who do you think you are? he shouted. "How dare you talk to me that way!" What is your name nurse, your manager will be hearing about this." I told him my name and that I am the only nurse on the unit with red hair and everybody knows who I am. ANd, are you coming doc? He came, he was not happy, we talked to the family and early that morning, she joined her husband. I stayed to take care of her and the family was happy that I did. I was not about to give her over to that same nurse! That was one of the best things I have ever done as a nurse. I was concerned about who I upset but I fight for my patients. I try to be the kind of nurse that I would want if I were in that bed. I will never apologize for that. I will defend my patients to my last breath and that doctor apologized to me and told me I did the right thing! Doc, DNR does not mean ignore and let go. Humanity is our business.