first of all sorry i didn't spell reason right in my title.
to make a long story short, i had a patient who needed abdominal surgery. the patient did and because of other reasons ended up staying for a good length of time. after 4 days the abdominal incision came open a very tiny amount...not much to worry. unless you consider that the wound had been closed for 4 days and the patient had been up and down out of her beed several times a day. then it came open more and more. over the period of 5 days the wound went from approximated to 2 inches wide and tunneling 1.5 inches deep. at discharge no granulation tissue had formed...in fact slough had in some areas, and the wound was still continuing to get bigger. the patient had no underlying diagnosis as to why she would have dehisced in the first place. i work nights so i don't know what the doctor was aware of. i do know i told the shift after me and documented. i knew that when i would give or get report the nurse would say something along the lines of, "they need to quit messing around with this wet to dry dressing change and take her back to surgery and see what is wrong!" i also know that it is the mds responsibility to look at the wound every day. i knew when this patient got discharged that the patient would be back very soon. a few days later the patient was. the patient had to have surgery to repair a bowel that got nicked in the first surgery. the patient is again having complications in a stay that should have never occured had the proper action been taken before the patient was discharged. i told the patient that i did not believe that the patient should agree to pay for the second stay. i'm sooooooooooooo angry about this! do not missunderstand. mds make mistakes and a nicked bowel is a potential of abdominal surgery. i'm mad because to me it was obvious that something was not right and the md should have taken her back to surgery to find the problem before she left. now i'm going to have some of you chastise me for saying anything to the patient, but when do we stand up for the patient? i'm not saying that the patient should sue, i'm just saying that the hospital personnel didn't catch something that should have been caught and thus the patient should not have to pay for the second visit. all we do is cover the hospital's butts for providing patients with sub standard care through poor doctor to patient and nurse to patient ratios. (hospitalists work for the hospital...surgerons and other mds are different i know.) how can anyone feel good about doing this job? the definition of a nurse is: a person who cares for the sick or infirm; specifically: a licensed health-care professional who practices independently or is supervised by a physician, surgeon, or dentist and who is skilled in promoting and maintaining health according, to the merriem-webster dictionary. we don't give care, we tick off tasks and allow doctors to intimidate us and/or talk down to us in a manner that damages our confidence in our skills.
this is the worst profession anyone one could choose to go in to mostly because you are damned in most any course of action you take. you stick up for the patient you get a bad wrap for being hired at hospitals. you tell a doctor who is being a piece of poo to you or your co-worker to back off and you get told by management that you need to work better with people. not to mention that patients can just walk all over you if they feel like it because we are there to provide them with "customer service". i also love all the stories that i read in my nursing board bulletin where a hospital gets sued and suprise, suprise it's the nurses' fault and not only is she/he getting fired but their license is also on probation or revoked. and when i read these stories i clearly see where the nurse is being held responsible for something that i would assume is the doctor's responsibility or that the hospital was making the nurse do some sort of stupid hospital activity that interfeared with the care he/she was giving....not to mention the ones that just sounds like the nurse had too many patients but was probably afraid to say anything because then she could a) get fired b) get accused of patient abandonment or c) be reprimanded for not being a 'team player'. futhermore something like 80% of the stories i read that are not about nurse drug abuse make me feel this way. nursing is not a profession, it's bullying made legal.
I want us to be able to say we are sorry to the patient, Lineartlinker. I'll go in on the blame with everyone, I'm alright with taking my share of responsibility for something that fell through the cracks. No one 'saved the day' in this situation and that's what I'm tired of. This happens all to frequently.
The other things unrelated to this particular incident (the verbal abuse, poor pt ratios, etc.) are just icing on the cake and things that make situations like the one I described possible. What I don't understand is why we let ourselves get craped on over and over again? Not only do we do that, but we tell new nurses that are less willing to play by these rules that it is part of their job to put up with this crap. I want a rally. I want to feel like things are improving instead of getting worse. I'm looking into lobbying and such because these conditions have to change.
My point is, there isn't anything we can say that is going to fix what you have identified as the problems in your career. Only you can do that. I've never in 20+ years been verbally abused by a colleague (including physicians). It must just be something about me that commands respect, I honestly have no idea. Now, I have certainly been abused by patients, but I ignore them and rarely get bothered by it.
As for your situation, that is why people sign consents for surgery, there are risks. Statistically some people are just not going to have uncomplicated recoveries, and some people will die. Why should e apologize for that? It is what it is. I have not seen anything in your posts that makes it clear this was anything more than a routine complication. Complications happen. I just don't see justification for the vitriol in your OP.
I'm appalled at how people are treated in our health care system. I was talking to a friend the other day who had been laid off from his job and refused the cobra insurance because it was too expensive. a few weeks later he went in 3 times to the er for abdominal pain before the even did a ct scan, then an mri to find out he had intestinal ischemia. he was taken by ambulance to another hospital for EMERGENCY surgery. The hospital he was sent to didn't do the surgery until 4 days later, when his intestine has ruptured.. they had to do take out 8 inches and give him a stoma and told him they would resect it when it was healed..when he went back in to get it repaired he was told that unless he has $50,000 up front they wouldn't do the surgery.
Where's the accountability in situations like these? It wasn't his fault, he did what he was supposed to do. Personally i think this is grounds for malpractice against the surgeon who made him sit in the hospital for almost a week when he was sent in for emergency surgery
I worked only weekends and cared for the same residents every weekend. I had one who had some nasty wounds on her legs that always seeped huge amounts of fluid. It seemed to be status quo for her, the MAR was always the same for wound care. We did the same wound care for months and she was on the same meds for months. She had recurring MRSA infections in these wounds.
I picked up a weekday shift and that day her doctor just happened to be doing rounds. I told him about these wounds and asked him to take a look at her. I went in the room with him and we talked about the wounds and the treatments and the recurring MRSA infections.
Well, he decided that she needed to be admitted to hospital.
Long story short...she went into the hospital for IV lasix, her meds were changed and new wound care treatment was ordered. Once she came back to the LTC she was put on PT and her diet modified to lose weight.
I often got the feeling that some nurses just do their daily job without really advocating for their patients. They became complacent in there jobs accepting the status quo condition of a resident.
I'm really glad I was there that day the doc came in. My resident made terrific progress and was much happier with less pain and increased mobility.
Specializes in LTC,Hospice/palliative care,acute care.
I'm appalled at how people are treated in our health care system. I was talking to a friend the other day who had been laid off from his job and refused the cobra insurance because it was too expensive.....
I have another POV in this scenario-I believe he is accountable and should have continued his insurance-you pay for that and your rent before any other bills IMHO. Stop the extras = phone,computer etc if you must. That's one of the problems with our healthcare system-no one HAS to pay for coverage if they don't want to do so...Then when some unforseen catastrophe occurs everyone is screwed. I have friends and family members who have struggled to keep their insurance up and they have found a way....it's a choice.
The OP is right-how many times have we seen the system used to the physician's advantage but when a nurse makes an error with a poor outcome he or she's hung out to dry? I'm in LTC-I love it when the MD makes his monthly rounds-he never lays a finger on a resident-just writes a progress note. It's a joke-especially when he starts to write "doing well" on someone that is hours away from Heaven's Gate. To cover myself I write in my note that "Dr was in for routine monthly or annual visit"- I NEVER write "resident seen " or "resident examined" because I have never seen it done.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i did not call the md because i knew he was aware of the dehiscense. like i said in my post this was a wound that was closed for 4 days then gradually began to open over 5 days prior to the patient being sent home. this is not a case where in the period of one shift the wound went from closed to dehisced. of course i would have called for that. yes, i and all the other nurses were documenting the changing amounts of dressing needing to be used for the wound. the problem with calling is that i had nothing to call about. there was no visual change between the beginning of my shift to the beginning of another. it was over a period of 5 days that this occured. i don't know what was said to the doctor on days, i do feel from what i've heard from the day and evening nurses that the doctor was aware. i also know from the patient that while the md didn't look at the wound himself everyday he did look at it before the patient left. i'll call a doctor at whatever time i think it needs to be done in this particular instance the i felt that the a) the change to the patient wasn't something that warrented me calling the md and more of a concered to pass on to day shift b) from the progress notes i feel that the doctor was aware the wound was getting bigger c) i'm a traveling nurse and could give a rats butt if any of the mds likes me. i made reference to doctors being verbally abuseive because it happens all the time and none of us deserve to be treated that way. and yes, this 'profession' is still crappy and not professional at all. i wanted to care for people so much when i got out of school. i was misinformed that nurses and doctors actually did some form of caring.
how die you know the physician was aware? did you tell him? watch him examine the wound? read his notes? if you don't know what was said to the doctor on days, you don't know what he knew. "feeling from what you've heard from day and evening nurses" isn't the same thing as knowing.
from the tone of your posts, i'm sure that you do encounter verbally abusive doctors "all the time." however if you're encountering all that much abuse in the course of your work, you'll have to consider that you are the common factor in all of the interactions you have. perhaps you're doing something that irritates the people you encounter.
and lastly, you seem to be very negative about nursing . . . very negative. are you burned out? i cannot help but think that if your attitude were to undergo some change, your experience interacting with health care professionals might change as well.
I have another POV in this scenario-I believe he is accountable and should have continued his insurance-you pay for that and your rent before any other bills IMHO. Stop the extras = phone,computer etc if you must. That's one of the problems with our healthcare system-no one HAS to pay for coverage if they don't want to do so...Then when some unforseen catastrophe occurs everyone is screwed. I have friends and family members who have struggled to keep their insurance up and they have found a way....it's a choice.
The OP is right-how many times have we seen the system used to the physician's advantage but when a nurse makes an error with a poor outcome he or she's hung out to dry? I'm in LTC-I love it when the MD makes his monthly rounds-he never lays a finger on a resident-just writes a progress note. It's a joke-especially when he starts to write "doing well" on someone that is hours away from Heaven's Gate. To cover myself I write in my note that "Dr was in for routine monthly or annual visit"- I NEVER write "resident seen " or "resident examined" because I have never seen it done.
Actually he may truly have NOT been able to afford it. 450-800 a month is one hell of a lot of cell phone bills maybe especially for someone who just lost their job.
PS - Kudos for you on the charting. I'd do the same.
I'm appalled at how people are treated in our health care system. I was talking to a friend the other day who had been laid off from his job and refused the cobra insurance because it was too expensive. a few weeks later he went in 3 times to the er for abdominal pain before the even did a ct scan, then an mri to find out he had intestinal ischemia. he was taken by ambulance to another hospital for EMERGENCY surgery. The hospital he was sent to didn't do the surgery until 4 days later, when his intestine has ruptured.. they had to do take out 8 inches and give him a stoma and told him they would resect it when it was healed..when he went back in to get it repaired he was told that unless he has $50,000 up front they wouldn't do the surgery.
Where's the accountability in situations like these? It wasn't his fault, he did what he was supposed to do. Personally i think this is grounds for malpractice against the surgeon who made him sit in the hospital for almost a week when he was sent in for emergency surgery
Is he sure he wasn't covered? Even laid off many companies will cover the full month's worth of health premiums and occasionally even a few weeks longer. That's a terrible story. I'm no expert on this but am inclined to agree if they did a CT and there were no signs of perforation and he was in that much pain then they should have ordered an ultrasound, scope, lap explore or something - whatever his labs were aside.
As for getting the ostomy reversed, have him ask around - write every surgeon and facility in the country. First find out if it's even feasible - did they leave enough colon and rectum? Does his condition make it unlikely to be a success? If it's viable maybe someone will give him a break. It's not like a lifetime of ostomy supplies and care is exactly low budget, and unfortunately could qualify now as a "pre-existing condition" if I'm correct.
Our system is just screwed. This is exactly why I hate people having to be dependant on employer-provided coverage.
I do believe I am burnt out on nursing, however I'm burnt out because the conditons are terrible. I mean I put this along the terms of slavery. What, because it was normal for black people to be slaves and mistreated they shouldn't have complained and continued to fight until fairer laws and treatment were made for them? What kind of nutzo thinking is that?! I trust my gut (guess what, it's more accurate as to telling me whats going on than papers and lip service. Shocking, no?) and the doctor knew the patient's condition just like the rest of us who were caring for her. I'm mad at ALL of us involved in the scenerio including myself. The patient shouldn't have to pay for falling through the cracks and that's why I said something. Believe me it was painful to sit there and have the patient ask why I didn't do more, because the patient did. (Little side note, I even defended the MD some in my OP.) And then some of you will want to turn my post around and say I'm feeling guilty and thus pointing the finger at others. And my honest to god issue is that our work environment fosters this sort of fallout. I pointed out some of the obvious problems with our work environment. When I say the majority of doctors are verbally abusive, I mean it. Why everyone is so focused on this issue and not something else I said like doctor/patient and nurse/patient ratios I have no clue. I've met some doctors who aren't, but by enlarge most of them are condescending, demeaning, and repeatdly talk down to nurses. What is sad is that a lot of older nurses think this is normal and don't see it as verbal abuse. Younger doctors are less likely to be this way...mostly because I think they were trained differently. I pointed this out because it is a factor of care because it is a confidence destroyer for nurses, especially new nurses. This whole 'your gonna have to get tough' talk is a bit silly because when a nurse finally 'gets tough' and stands up for him/her self he/she is likely to be reprimanded for it. (Little side note for those of you who wish to point out my 'attitude'. I've never been written up for bad behavior, 'spoken to' about it, OR any work/care related issues for that matter. This is what I've seen happen to to my friends, my co-workers who are very good, but newer nurses who haven't been educated properly because no one has the 'time' to make sure it happens. Or very good middle age nurses who finally have had enough and stand up for themselves, but it's usually worse for them, they get fired.) Nursing is like an abusive relationship where the tension builds and builds until he/she goes off. Then he/she gets reprimanded or fired, goes into a honeymoon period, and then the cycle starts again. I've seen it happen over and over again. My only saving grace has been I've known when I was about to blow and changed atmospheres before it came to a head.
What some of you see as 'normal' post op complications, I know to be due to a damaged system that the patient should fight having to pay for. Yeah, health care is dying due to lack of payment. The pressure is building like puss in a pimple and eventually the whole thing is going to blow. People cannot pay for insurance when it is as costly as their house payment. Doctors and nurses don't want to work for free (rightly so) and insurance companies are making out like bandits and hurting both the medical staff buy tying our hands and the patient by dictating care. I frankly think we should get rid of insurance all together or make it something people shop for like car insurance. This way the insurance company would at least be more interested in provding service to the patient instead of the patient's company. I also think that hospitals should have a posted 'menu' of services with an estimated expected cost. In this manner patients can shop for their services more easily. My dad has no insurance and is a type II diabetic so I know after shopping with him how big the cost differnece can be for the same procedure at two different hospitals.
For those of you who have posted about the horrendous care that was given to someone you know. I'm sorry, it shoudn't be that way.
Younger doctors are less likely to be this way...mostly because I think they were trained differently. I pointed this out because it is a factor of care because it is a confidence destroyer for nurses, especially new nurses. This whole 'your gonna have to get tough' talk is a bit silly because when a nurse finally 'gets tough' and stands up for him/her self he/she is likely to be reprimanded for it. (Little side note for those of you who wish to point out my 'attitude'. I've never been written up for bad behavior, 'spoken to' about it, OR any work/care related issues for that matter. This is what I've seen happen to to my friends, my co-workers who are very good, but newer nurses who haven't been educated properly because no one has the 'time' to make sure it happens. Or very good middle age nurses who finally have had enough and stand up for themselves, but it's usually worse for them, they get fired.) Nursing is like an abusive relationship where the tension builds and builds until he/she goes off. Then he/she gets reprimanded or fired, goes into a honeymoon period, and then the cycle starts again. I've seen it happen over and over again. My only saving grace has been I've known when I was about to blow and changed atmospheres before it came to a head.
linearthinker, DNP, RN
1,688 Posts
My point is, there isn't anything we can say that is going to fix what you have identified as the problems in your career. Only you can do that. I've never in 20+ years been verbally abused by a colleague (including physicians). It must just be something about me that commands respect, I honestly have no idea. Now, I have certainly been abused by patients, but I ignore them and rarely get bothered by it.
As for your situation, that is why people sign consents for surgery, there are risks.
Statistically some people are just not going to have uncomplicated recoveries, and some people will die. Why should e apologize for that? It is what it is. I have not seen anything in your posts that makes it clear this was anything more than a routine complication. Complications happen. I just don't see justification for the vitriol in your OP.