Assessment and Urgency a thing of the past?

TheCommuter, BSN, RN · Apr 19, 2008

Here's a hug. (((HUG))) :icon_hug: I'm sorry for your father-in-law's suffering.

I have worked at facilities where unreturned phone calls are the norm. Many of the physicians have poor bedside manners, and some will even tell boldfaced lies to family members as a way to quickly appease them (and blame the nurses in a roundabout manner). I even had one doctor lie and say to the patient's daughter, "Your mother has not been to dialysis in months!" The daughter replied, "Mother has been to dialysis, because I visit daily and watch the nurses send her off to dialysis."

When speaking to some physicians, I have to ask, "How do you wish to proceed?" If I dare make a suggestion, it will be ignored by some docs.

lindarn · Apr 19, 2008

Hi All,
Truly disgusted today!
Tuesday Father in law found lethargic, and having aspirated while vomiting-brought to our local hospital (not mine) where I swear they manufacture Stepford-like nurses aka the doctor's handmaidens-not allowed opinions, recommendations, or questioning of procedures.
As he vomited and aspirated more, no one came...I caught, suctioned, cleaned up, etc all while he was in an untreated rapid afib...when the nurses came to ASSIST-remarks like 'so glad we have windows to see the day,' and 'yeah it's really not busy here were spoken' all while his oxygen readings plummeted due to additional aspiration. WHAT? The man was dying, and yours truly was getting the doctor, asking for respiratory and what ever else while the nurses waltzed around the ER in the slowest state of movement I have ever seen! When the physician finally got into his room-maybe 20 minutes later-after much fussing by me-he was satting 83%-he finally realized they may have to tube him(YOU THINK?)-guess what? DNR! Oh well, the doc says we'll see what respiratory can do. WHAT? Thank God the respiratory therapist was able to deep suction him(I swear it was like a bronchoscopy)-tons of crap removed-immediately his oxygen went up. SHE WAS GREAT! Reluctantly they returned with digoxin to slow his HR....I swear even though this is a Catholic Hospital they were trying to help him along to the next life!
After being stabilized, and me up their butts I watched as patient after patient came in and was left to be seen. Some were not seen for an hour or more-screaming in pain. I was truly disturbed by their lack of urgency and what turned out to be crappy assessments. When we arrived to the floor and I started filling out the admission assessment with the nurse-many of the entries made in the ER were incorrect and seriously lacking in information. The doctor's information was wrong too! How can the floor nurse get the right picture, if the ER nurse doesn't take it? Tele did a great job for the 24 hours he spent there-he was stable-looked good-and had rebounded-THE MAN HAS NINE LIVES!
Unfortunately, he was moved to a med surg floor where nursing 101 needs to be retaught and doctors need to remember that "Do no harm" includes keeping a patient comfortable and safe!
Thursday, came to room late in afternoon-he looks miserable, hallucinating (trying to put pants on/talking to people not there), jaundiced, and occasionally moaning. I say "dad are you okay-he says no -helped myself to pulse ox and listen to lungs-rales everywhere, oxgen 89%5Ln/c. Has anyone called respiratory-of course not-no tx all day. Then he tells me he is nauseous and his belly hurts. Remove blanket-HUGE BELLY-no BS-Tender to touch.WHY? Before I can call nurse Vomiting like crazy 600 brown bile laced vomit, aspiration AGAIN! No NG tube orders, nurses had no idea of his condition or history of sbo-not reported. BM smear for two days-did anyone think to do a head to toe? Doctor called no answer-they were afraid to call again...I ask why...am told the doctors bring them business and nurses are not to bother them....WHAT? I bothered him ALOT! Assist with NG tube-no meds ordered for comfort:madface:-Gi Consult to come-GI shows up at 11:30PM surprised to see me! Give him entire hx-don't say I am a nurse-didn't have to tell him. Tell him what I want-warn him he needs restraints or he will pull tubes. FINALLY A DOCTOR WHO IS WORTHWHILE-Listens to a nurse and orders appropriate care, but also adds nurse at St C....are much quieter, and don't normally offer their opinions---no kidding.
Finally leave at 1am, he's comfortable-belly has gone down and he seems peaceful-warn night nurse HE WILL PULL TUBE IF NOT RESTRAINED. Had to work all day yesterday...my place crazy, and unable to call until 4PM break...guess what-TUBE PULLED X2 WITH RESTRAINTS ON (or so they say), and husband tells me that he has no ng tube all day and has been vomiting-no bm and belly distended! Again aspirated-gurgling. I almost had a stroke! Called nursing station-no meds, nothing for pain, no anti nausea meds NOTHING ALL DAY! Pmd stated GI had to order, GI in surgery all day-GI had not ordered so nothing done. WHAT? No comfort, no actions, no advocacy, nothing. What if I werent a nurse? I am sick over this whole thing! Called the doctor again, told him I want him off the case...guess what, hospitalist told me he can't pick up case because PMD brings alot of people into hospital. Can't get transfer to my facility because we are packed! What a crock!
Right now I am so frustrated and had to tell you all. When a hospital is kissing physician butt like this the patients suffer. When a nurse is afraid-a term I heard from every shift, to call for orders or to offer suggestions, or report negative findings. There is something terribly wrong!
Last night a surgeon came to the bedside-10PM. Again, surprised to see someone there-I was in my scrubs and got the hairy eyeball. I watched as I gave this young doctor an account of his history and care while in the hospital, he said "I wouldn't encourage the nurses here to request things they don't know about, if you have a problem-speak with us directly. I am treating the patient and I know what he requires." I told him that was an interesting statement, as his nurse or any other nurse is at bedside for the shift-and that he isn't. His few minutes of observation needed to be augmented by good assessments throughout the day. He asked me where I worked, I told him....oh, no wonder....nurses are aggressive there. :madface::madface: My response, "no the physicians and nurses respect each other's opinions-both are advocates for the patients, something that should be tried here!"
Anyway, when I left at 1am last night-more meds ordered by surgery-restraint order still in place BUT I APPLIED. Today, ng tube was still in nose, but curled up out of stomach. New to be inserted, at least stomach decompressed.
Floor nurses is this the norm at your facilities? Do doctors not call, write orders or take your recommendations? Frankly, I am floored by this!
As far as, assessing patients how often is it done on the floor? If someone came to you with a significant history, and problems like I described would it still be 1x per shift or more. I would assume more. I don't know how to proceed! I am like a fish out of water, and truly feel like kicking this doctor all over town!
So sorry this is long-had to give you the whole picture. I am really disgusted by this facilities policy towards doctors and the handcuffing of nurses and their opinions. Don't know what else to do. Any suggestions?
Maisy:banghead:

I will repeat what I have said a million times- there are too many individuals who go into nursing with the, "martry mary" mentality. Coupled with hospitals who bully nurses and cater to the "physician money makers", and nursing schools who do not provide the tools that nurses that need to survive in the real world.

I would report these nurses to the BON. Maybe when they are called on the carpet to explain their conduct, and are held accountable for it, they will realize that they are obligated to be patient advocates. Perhaps it will shock them into changing their behaviour, and stand up to the hospital. Demand their right to speak up for their patients. This entire scene would have infuriated me, as well.

Lindarn, Rn, BSN, CCRN

Spokane, Washington

UM Review RN, ASN, RN · Apr 19, 2008

Your facility sounds more like my facility. Thank god.

Haven't those nurses heard of SBAR yet? I thought that was a JCAHO initiative. Geez. :stone

MAISY, RN-ER, BSN, RN · Apr 19, 2008

After writing today, I spoke with a classmate who is a sub acute nurse-told her the whole story. She had come to pick me up for school on Tuesday and walked into a 911 emergency. I had stabilized him at that point and he was on oxygen. But she knew how he was sent to the hospital-she couldn't believe the rest of the tale. She thinks lack of bm, ng tube and gi tx is a sentinal event....I am not so sure. What do you guys think? If so, what category would it lie? Thank God, have not been involved in any, other than a patient unobserved death(not my patient).

Thanks,

Maisy

pagandeva2000, LPN · Apr 19, 2008

I am sorry to hear that this has happened. He is fortunate to have a knowledgable nurse in the family.

casi, ASN, RN · Apr 19, 2008

*hugs*

Not much I can say as I'm a nursing student and don't have the real world experience to answer your questions.

I just wanted to say that your father-in-law is blessed to have a daughter who is so willing to advocate for him.

Altra, BSN, RN · Apr 20, 2008

she couldn't believe the rest of the tale. She thinks lack of bm, ng tube and gi tx is a sentinal event....I am not so sure. What do you guys think? If so, what category would it lie?

After reading this through twice, I'm inclined to agree that the second time a patient aspirates d/t no NG tube is indeed a sentinel event. Is there no protocol for aspiration precautions at this facility? :stone

(((Hugs))) Maisy, my heart goes out to you & your family.

MAISY, RN-ER, BSN, RN · Apr 20, 2008

This is a community hospital setup like any other I've seen. URGENCY, is the thing that seems to be lacking. Also direction, people seem to be unsure in an emergency how to behave and look to each other for support.

I am sure at this point I am the dreaded daughter in law, but everytime I walk through the door I fear he will be worse than the last time.

Found out from his roommate this evening that he was placed in the hallway to be watched last night-nurses deny it. If so, where was the intermittant suction?

I just don't know what to do....I am worn out! My patience is at an all time low. I am at a point I can't be civil to the doctor, or some of the staff-yet, if I lash out-I'll be banned then who will be his advocate?

The saddest thing I ever heard was my sister-in-law saying that drowning in his vomit would've been preferable to the continous torture of living. OMG! If the staff at the hospital only saw the situation through our eyes, ESPECIALLY HIS PMD, they'd be ashamed. the worst is looking into his eyes, I am helpless to help him.

Thanks for your concern and comments-I really appreciate your support. Hoping a bed opens in my facility tomorrow.

Maisy:stone

P_RN, ADN, RN · Apr 20, 2008

I could have written your post when my dear MIL was still living-if you could call her last years living. I became the DREADED one. At that time it was her own daughter who didn't want her to be given MS because then Mama couldn't talk with her.....uh MAMA hadn't been able to speak in years. But that's irrelevant here.

You go on BEING the LOVING daughter in law and get your dad in law transferred and/or get him a different doc or something. You show THEM the eyeball.

noc4senuf · Apr 20, 2008

By now I would have went to the top of the chain at the hospital with the medical director and CEO. Reporting to JACHO the events as you described them would also be a step in the right direction. I may work in LTC but, when a doctor does not respond to our calls, I have directed our nurses to contact our medical director for orders and to intervene with the attending doctor. As nurses, we ALL need to be the patient/resident adocates.

My thoughts are with you and your family during this crisis.

NurseCherlove · Apr 20, 2008

I will repeat what I have said a million times- there are too many individuals who go into nursing with the, "martry mary" mentality. Coupled with hospitals who bully nurses and cater to the "physician money makers", and nursing schools who do not provide the tools that nurses that need to survive in the real world.
I would report these nurses to the BON. Maybe when they are called on the carpet to explain their conduct, and are held accountable for it, they will realize that they are obligated to be patient advocates. Perhaps it will shock them into changing their behaviour, and stand up to the hospital. Demand their right to speak up for their patients. This entire scene would have infuriated me, as well.
Lindarn, Rn, BSN, CCRN
Spokane, Washington

Perhaps they could also be reminded that they can be sued for neglect and that their licenses can be lost!