Clinical managers opinion formed on the sole basis of seeing said patient for 30 seconds in the patient lounge
(alot of this is a rant because I'm really really angry) ?
Back story: Mrs Smith (not her real name) has aortic stenosis and over the last couple of days has been showing marked increase in the CHF symptoms breathless at rest, pitting oedema at the midshin. This patient has been in the facility for over 9 years and if she is going into end of life, we'd like to manage her within the facility. She is being mobilised via wheelchair because she gets so SOB on mobilising
I had her reviewed by the GP yesterday and our plan of action going forward was a short course of furosemide to see if we could improve her symptoms and given her imminent risk for dropping dead, got some palliative medications in oral and subcut form because you all know if we dont have it charted we will need it. Advised clinical manager re same and advised her that I would do call this weekend because I'm keen to help manage her in residence and avoid sending her out if at all possible.
Got a call from my staff member in charge today to advise that the clinical manager (she works over two facilities and doesnt know the residents in my facility at all)had been in and seen the patient in the lounge and announced she wasnt short of breath, there was no oedema of the lower legs and we didnt need any palliative medications charted and made by staff member send a fax to the provider to cancel the previous request for subcut meds and get oral meds charted instead (bear in mind I had told the clinical manager I was doing this the day before)
I'm not pissed because my senior overruled me. I'm pissed because she is so risk adverse she would rather have us going into the weekend unprepared for the very real possibility that this patient will decompensate and enter into the end of life stage. I'm pissed off because she has provided absolutely no clinical rational for her actions beyond a 30 second inspection in the lounge, and ignoring the staff who were telling her "we are having to move this lady in a wheelchair because she gets so short of breath on even the most mild of exertion and looking at her for more than 15 seconds we see marked increase in work of breathing"
If you have got this far, thanks for listening to my rant.
How do you deal with co workers who undermine when it puts patients welfare and wellbeing at risk?
Tenebrae, BSN, RN
2,021 Posts
My lady passed away very peacefully this afternoon in her home of nine years. We didnt have to move her out.
I am very happy