Accused for having patients best interest at heart

[DJ-Adia]

It wasn't until today that I got to thinking, "Am I really in the nursing profession for all the right reasons." I've been an RN for 15 years and believe that nurses are a patients best advocate until today..... I have been caring for an elderly patient who was admitted status post dehiscense of a portion of her incison from a fem-pop bypass arterial graft that was performed 1 month prior. The portion that is open has been debrided several times , with a few times while the patient lay in her bed & premedicated with nothing other than 20 mg of Oxycodone given several hours prior. The patient has reported repeatedly that the medication she been given since in the hospital has not even come close to relieving the pain she has.

The last few shifts that I cared for this patient, her husband has been sitting at her bedside crying. He says, "I can't handle seeing her in so much pain - it just tears me apart". I have been trying to advocate for this couple much as I possible can, relating to them with professionalism, & empathy. The patient was referred to a pain specialist for management of her generalized pain r/t bone Cancer & recently has seen him for management of post-op pain r/t dehiscense of her inscision located on entire top portion of her left foot. He reccomended a medication that currently is not a part of our hospital formulary so attempts in obtaining this med have not been pursued.

A wound vac has been recently applied to the area with dressing changes scheduled every 2 days. The pain is excrutiating each time the physician removes the dressing that is adhered to the exposed wound bed. I decided to meet with the Director of patient care services for the hospital to make her aware of the issue. I told her that

I could nolonger continue to watch this patients husband cry each time he visits his wife because if it were my loved one I'd be irrate!!. Her response was: that I acted unprofessionally by empathizing with this patient & her husband. It is my job as a nurse to represent the hospital & assure them that we are doing all we can do to assure that her pain is effectively managed. By empathizing with this couple I was implying that the hospital was not doing their job thus createing more tension.

Needless to say, I left her office being accused for advocating for the patient and not professionally representing the hospital. What are your thoughts on this issue?

[TCASII, ADN]

You don't want to know my thoughts, but I'll give them anyway. Medicine is a business. The higher up the ladder you go in a hospital, clinic, or other institution, the lower the compassion or empathy for patients. These people are generally isolated in a job that gives them no insight into patient contact and therefore they have little concern for patient health barring legal implications. Even those who've worked in direct care positions in the past probably moved onto a non-contact job because they were jaded and didn't like dealing with the hassles/patients. Jeez, I mean look at all the direct contact workers who you can tell just hate the patients.

To be honest, I was expecting this to be related to a physician. You have no idea how many of them have no empathy or concern for patients with pain. The attitudes among doctors about certain disorders/medications is downright scary.

[DJ-Adia]

Do you feel as if I handled the situation "unprofessionally" by not Representing the hospital & in turn caused the patient & her husband unnecessary distress. ? Who is suppose to represent the patient if nurses can't. It seems to me that a hospitals reputation is the role of the nurse to defend. How do you suggest I handle this situation? Any advice would be very much appreciated. Thanks for your response.

[Bumashes, MSN, APRN, NP]

Here is my UNprofessional advice:

F*** THEM!!! Your JOB as a nurse is to ADVOCATE...which is what you were doing. How were you "implying" that the hospital wasn't doing enough? Unless you said something to the effect of, "Gee Mrs So-and-so, this place sure does suck for not doing something about your pain issue." You simply took your VALID concern about a pt's pain to a higher authority who could have used her position to properly advise you or (God forbid) help you. At the very least, she could have merely suggested that you call to inform the physician that your facility doesn't carry the specific med and ask if there is a suitable substitute. At my hospital, if we don't carry a med and there's no substitute available, we allow pts to bring in the med and we count it and lock it up and then dispense as we would any other med.

This has burnt the hair clean offa my butt!

[Birdbr]

I know it's bad to switch jobs. But, if I were you, I'd find a new job where the hospital cares about where you care about.

[noreenl]

Where is teh followup by the pain mamagement specialst? A physician orders a med that is not part of teh formulary he is supposed to be notified and either change it or fill otu a request with Pharmacy to obtain it. where is your JCAHO Compliance officer since her rights to PROPER Management of her pain is being violated. maybe the patient advocate should for the patient should be contacted. the number is supposed to be on the admiision packet.

[iluvivt, BSN, RN]

That is bunch of BS....that manager needs to look up the nursing code in your state...ADVOCATING for one's patient is a critical nursing function. Yes you are employed by the hospital but you earned your license and MUST practice according to the laws in your state. Do you not have a pain policy that states what to do when a patient has an unacceptable level of pain? Do you have a pain RN? How come this patient is not on a PCA? This sounds like a combination of acute and chronic pain and should be managed as such. What did the MD say..there are so many available options out there that if one medication is not available there are others. How come the pts husband does not ask to speak with the MD and director of nursing...work the way up the chain. The sad part here is that when you are the sick one in the bed...it is very difficult to advocate for yourself...been there a few times and it is awful to be in pain and feel no one is helping or listening....GOOD for you for helping..you can be my nurse any time

[tewdles, RN]

Your "director of patient care services" is apparently not directing any actual patient care and clearly isn't providing any service to this patient...what an embarrassment to nursing she is! She is likely getting paid big bucks to talk like an idiot.

Your obligation is to contact the pain specialist and request follow up because his/her medical plan was not implemented and the patient has not had her pain relieved.

I hope I am never a patient in your hospital!