Ethical Dilemmas of Agency Nursing

[Sassy5d]

Hello All!

I'm an Ohio LPN who's been working agency for almost 3 years now. (Just 1 agency) What started as something I would be doing as I transitioned looking for a staff job, turned into my only job.

Along the way I've been really lucky to only have less then a handful of "problems" When I say problems, I mean, being so bad that I've had to call my employer and ask them to please never send me to "x" facility again.

The agency I work for is almost strickly nursing homes. I've never worked for a hospital and my only hospital "experience" was clinical.

The perks of Agency work for me has always been not getting involved with facility drama. You go in, do your job and then you go home. If you ever return to the place, great, if you don't, then you don't.

Here is my problem (I'm going to be as vague as possible. I do not want to give away any information which will connect any agency to any facility or to me either.)

I've been working at "x" facility for just about the entire time I've been employed with my agency. It was something I did occasionally since they only needed staff here and there. Changes occured with the management, and as expected, a ton of staff quit (or got fired) My agency was staffing this "x" facility almost 24 hours a day for months now. They only have about 5 regular staff.

They are not a regular facility as all the residents are completely private pay and they are not considered a nursing home.

When I would work 3rd shift.. I would be the only licensed person in the facility. They do not require their nursing assistants to be state tested. I was responsible for approx 45 people upstairs and about another 20-30 downstairs.

(I know this is getting long I'm going to cut it short now, I'm awaiting a call from my agency to find out if I'm going to be fired)

A resident that is on hospice.. He has cancer. He has a doctors order for two minor narcotics for pain. I talked to him almost nightly and he was always complaining of the inability to sleep. A doctor prescribed him a sleep aid. Hospice did not want him to have it. Even though there is an order, we are not to give it per hospice.

When I went to work Monday night, there was a note in the communication book from a staff nurse relaying info from the hospice nurse.

Hospice stated they wanted us to give him water instead of giving him his pain medication. (Not give him water and say it's his pain medication-rather-deny the man his pain medication and give him water instead) Hospice stated he's taking his pain medication for sleep.

I wrote a note in the communication notebook that the man specifically calls me and asks for "x" medication for his cough or "x" medication for his cancer pain. He does not call and say can I have "x" for sleep, nor does he ask just for a pain pill.

In hindsight, I can understand why my words were taken the way they were. One of the gals I work for told me on Tuesday that I completely offended the hospice nurse. The facility had called my boss to say I had no business writing in their communication book. Again, after it's been a few days, I do fully admit that I probably got carried away while I was upset.

Since writing in the book, and never having, in almost 3 years, a problem or complaint at that facility... They dnr'd me. My employee policy states getting a dnr is an automatic termination.

I understand what I did wrong. I should not have written in their notebook. Although I do stick by my feelings on the issue.

It just seems like an ethical dilemma. I'm sapposto be the patients advocate.. but I'm just an agency nurse, not a nurse for the facility..

Although doing what I did probably just cost me my job.. I'm coming here to ask you guys for the future... What do you do when a question of ethics comes up? Do you call your employer? Do you turn the other cheek? Do you call the heads of the facility you're working for?

Becky

[robbsrn]

I have another ethical dilema I would like some input on. I am an agency nurse and I have been going to this particular hospital pretty regularly for about a year. Recently I have also taken some shifts at the nursing home attached to the hospital. (this is a very rural area) Because of my time in the area I have made friends at the hospital, and one of them called me yesterday and told me that there is a person living in the nursing home with Active TB. They had a community wide meeting on the effects of this, and from what she told me it sounds like a lot of uninformed board members are making these decisions and not any medical person at all. I am scheduled to go work in this nursing home next week. I called my agency (who I have had problems with in the past) and told them I would not go to this facility unless they could assure me that I would not be exposed. They told me I could not refuse to go to a facility after I have already been booked, and they thought I would be fine since I'm only working nights.

I have wanted to quit this agency for sometime now I am going to, the question is do I cancel those shifts and quit now? Or am I completely obligated to work them?

Thanks for the outlet.

[precious33]

Is this TB patient in isolation?.Because not only are the nurses exposed but the entire residents and visitors to that faciliity.We have to protect ourself.

They are saying because you are booked you cannot cancel but facilities cancel nurses sometimes almost immediately.That is why upon employment we need to lay out exactly what we need base on our right to be protected and our right to be obligated to family in times of needs/emergency.

We are working for these agencies without us there will be no agency so we need to state our needs and our wants.

[bethin]

Just a CNA speaking here, but isn't the purpose of hospice to make the patient as comfortable as possible? What's the point of him receiving hospice if hospice doesn't want him to have pain pills at night or to take an ambien? I bet if you got hospice out of the picture and just had the MD order proper pain meds he would be alot more comfortable.

IMO it isn't up to hospice to decide when the patient needs the pain med. If he needs it to help him sleep so be it. The poor guy is on hospice - which to my understanding means that you are terminal.

In our hospital hospice is quite liberal with pain meds, ativan, ambien, etc and it is ordered that they are to be given routinely no matter what.

[graysonret]

I worked as a nurse with Hospice for 3 years, and, quite frankly, I don't understand this. Withholding pain meds? And violating doc orders? We NEVER withheld pain meds from a patient. In fact, pain control was one of the primary goals and if we had to go up in dosage, we did. If the patient needed a sleep med because of pain, it was given. If the doc wrote an order and it was within appropiate dosage and time, it was done. A doc didn't write an order, and some nurse decide everyone needs to ignore it. I can imagine the team meeting on this patient must have been quite interesting....it would have been to me. This is an issue that needs to be addressed. Something is going on here...and it's wrong.

[nurseinnystate]

Oh boy, is this ever an interesting situation. I just love how they say "you aren't suppose to do this because you are agency".... BULL..... I was working in a facility one day when the state was there. This woman walked on the floor with the Director of Nursing. She proceeded to ask me a question and want the answer. The director piped in and said, "She's just an agency nurse."....... the State woman then said, "So what, a nurse is a nurse, you have her on staff right now caring for your residents, therefore is responsible for each and everything your facility hired nurses are." Inside i just giggled to myself because that is how lawyers, judges, state personnel, and the outside see it..... therefore we best be aware and act in that manner...... YOU absolutely were correct in writing in that communication book. You absolutely had the right to communicate...... this was an important issue that needed resolving and you wouldn't be a good nurse if you ignored what you knew about the patient. That hospice nurse, if she were being professional would have appreciated your input...... where do people learn that if someone disagrees or has another point of view that it is a personal slam...... it's not....... we as nurses are problem solvers and you were just doing your job as a nurse....... they have no right to dnr you because you communicated somthing . you saw that they were assuming one thing , when you SPOKE to the patient so had another point of view.......that facility can put you in CHARGE? but not allow you to write in the BOOK?......... they should be ashamed of themselves....... that is where your manager of your office is vital to your career...... My agency is there for us to the best of their ability to defend us or attempt to..... I wonder if they could put some pressure on the facility to change their mind? Show them this message........it can't hurt right?........keep your chin up.......... remember the first person they try to blame is the "agency nurse"....its one of the very few downfalls of this line of work....... Best of luck to you and keep me posted because i do truly care about your outcome..... perhaps we can all learn from this in one way or another.

Sincerely,,

ny

[bluesky, BSN, RN]

You should never take a problem like that into your own hands. You pass it off to your Recruiter and they decide what should be done.

The problem is this... you are not an employee. You are now thinking staff vs. agency. Your job is to do the job and go home. You are now getting into politics and shouldn't be involved with their problems and issues. Whatever the Hospice Nurse does, she is responsible for and it's possible the family has some input with what was ordered. Whatever happened, it's always a learned lesson and then you move on.

Wow. Sorry but I couldn't disagree with you more. An agency nurse is still a nurse and a nurse's first priority is the wellbeing of his/her patient.

OP, I applaud you for advocating for your patient. Shame on that facility for not having a clear cut set of orders. Shame on that turfy Hospice nurse for letting her ego and her pride get the best of her.

If you were the only LPN in that joint it was NOT a safe place for you to be anyway. Getting DNR'd was probably a blessing in disguise.