Conflict of intrest issue

Dixielee, BSN, RN · Jan 18, 2005

I don't really think this is a conflict of interest. I took care of my grandmother when she came thru the ER and escorted her to the stroke unit and went back to work. Obviously, you are probably going to be more attentive to your family member, but in the ER it is for a limited time. Maybe if it were in ICU or a general floor it might be different if you could not break yourself away from your family to the detriment of all other patients. If that is the case, you need to call in sick and just be with them. A lot depends on their degree of illness. If it is routine, and not life threatening, you can probably divide your time effectively. If it is life threatening situation, then you probably are not emotionally able to do the best job for your family member. I know if my husband, child, or other loved one came into the ER where I work, nobody better try to keep me out of there!

Nurse Ratched, RN · Jan 18, 2005

As a psych nurse, I have a very clear duty to report any pre-existing relationship with a patient, so it can be determined whether or not I should even be present on the unit while that patient is.

I would not care for a family member unless for some other reason there was absolutely no other alternative. Too much chance of your judgement being clouded because of the relationship.

As far as how you approach it, good luck with that one. To answer your question, no I don't think ED nurses are subject to any diffferent ethical standards than the rest of us.

rjflyn, ASN, RN · Jan 18, 2005

Being an ED nurse i would have to say I would care for a family member for something reletively minor ie a small superficial laceration, a cold or a sprained ankle. Beyond that I would probably have to totally excuse myself from working alltogether if it were anything more. I personally dont think anyone is doing anything in their patients best intrest family or otherwisw if their mind is on the health of a seriously ill or injured family member. I personally dont think I could keep my mind on my patients if mom were in a room with a possible MI or grandma down the hall with a fx hip.

rj:rolleyes:

ageless · Jan 18, 2005

This nurse also said these words to me in a hostile (or frantic it was difficult to tell) manner "I'll be up to check on him tonight. take good care of him" Her report was detailed yet she sounded stressed out/hurried on the phone and was very curt towards me

.

She loves her Grandfather. I would have responded with compassion and said the words that I would have wanted to hear had I been in her situation; "I will do my best"

I took report but was at a loss for words about what to say to this nurse about the concern I had for the others she was looking after while he was there.

What in her report made you believe that the other patients in the ER were not getting the best of care?

What would you do/say in that situation? I don't have the policy/procedure manual of my hospital here. Do ER nurses have different policies in this situation? (figuring that they all rotate the triage, walk-in, Trauma areas, they'd eventually HAVE? to take care of the loved one?)

This would not have been the time or the place to say anything. I would not have know what the circumstances were in the ER and I am not her supervisor nor her judge. With such little information other than what was given in report, I would have minded my own business and focused my energy on providing for my patients. Then later, after reflecting on the days events, make a decision on how I will handle the day when I may be required, by circumstance, to care for my loved one.

peeps79 · Jan 18, 2005

She loves her Grandfather. I would have responded with compassion and said the words that I would have wanted to hear had I been in her situation; "I will do my best"

Which I said. But that's the point entirely. Aren't we NOT supposed to be in that situation? I clearly remember a professor telling me that when we as nurses have any connection to a patient while we are on duty, we are to make arrangements to have another nurse care for them, lest our emotional feelings for the patient interfere with our rationality. Turns out he was waaaay more ill than she told us. He had an unstable AA and on the ekg, showed A-flutter (she had made the statement that he had a tremor from a previous stroke which altered his ekg readings, but when up on our unit no evidence of tremor was there).

He ended up needing another unit all together.

What in her report made you believe that the other patients in the ER were not getting the best of care?

My concern was the manner in which she spoke with both me and the secretary. She yelled at the secretary, refusing to wait to give report (I was involved in a blood transfusion at the time) and then while I was on the phone, she was speaking in a hurried, scattered (but detailed) report, curtly telling me that she'll be up there later to check on us and I'd better take care of him. I did end up asking her if she would be ok working for the rest of the shift, and she replied with a sigh "I'll have to be". And I know for a fact I would behave like that if my grandparents came through the door. The way she was presenting herself led me to think she was very concerned for her Grandpa (as she should be) but to the point where she wasn't functioning at her best as a nurse.

This would not have been the time or the place to say anything. I would not have know what the circumstances were in the ER and I am not her supervisor nor her judge. With such little information other than what was given in report, I would have minded my own business and focused my energy on providing for my patients. Then later, after reflecting on the days events, make a decision on how I will handle the day when I may be required, by circumstance, to care for my loved one.

But that's the point again. I was taught that it is very unprofessional to take care of family members while working. I am aware that I am not her supervisor and judge but it doesn't mean that we as nurses are not ethically accountable to eachother for professional practice. I know there is an appropriate way to handle this. Saying nothing when I AM concerned doesn't seem right. I'm sure that other nurses have used a compassionate yet firm approach to express concern about this before. I'm seeking the most effective way to approach this. I was focusing my energy on my patients (he was one of them!) and when he arrived for me to take care of, his care was compromised by being on the wrong unit.

What's done is done. but I'd still like more input.

Thank you, for your reply.

fergus51 · Jan 18, 2005

I don't think it's ever appropriate. Ever. The fact that she would even tell you that you had to take good care of him because she would check up on him later is a sign to me. It isn't in the nurse's best interest and I don't think it's in the patient's best interest either.

UM Review RN, ASN, RN · Jan 18, 2005

Wow, you guys are tight!

We take care of each other's relatives, friends, and neighbors all the time. We give our best to each of them. It's the same if we get some famous/notorious person at our hospital--which has also happened more times than I care to count. We are in a touristy area of Florida, after all.

Of course, we like some folks better'n others, not because of who they know but because of who they are.

It's more a matter of necessity than conflict of interest. Do you think I'm going to send a relative to a faraway hospital where we don't know anyone to get properly treated? Not! Then why would I expect another nurse to do that?

I couldn't think of a better compliment than to say, "Here, I trust you to care for my family member. I trust you to do your best."

That's what all of our patients' relatives are saying, is it not?

ageless · Jan 18, 2005

You are using words like unprofessional and ethically accountable... I think that you are coming on too strong here.

Let us suppose that she is not the only nurse in the ER (which would make the whole dilemma a moot point) I would guess the whole department knows about this nurse's limited dual relationship with her patient/grandfather. I would also guess that this is not the first situation of its kind in the ER. Let the people who have first-hand knowledge give her counsel. How well do you think that a "monday morning quarterback" opinion will be received? Is it our place to request that this nurse be ethically responsible to you, me or any other RN. when we have one snapshot of the whole progression of events?

Another comment...this nurse/ grand daughter did not originate the patient's diagnosis nor admit this patient to your floor, the physician ordered your department's care and sometimes patients are later moved to other units more appropriate.

this does make for an interesting discussion.............

fergus51 · Jan 18, 2005

Angie I wouldn't suggest sending them out of town, but asking another nurse in the unit to take the assignment if available would make a lot more sense to me. What if things went wrong and this nurse has to deal with being the one to lose the patient? I just don't think it's a good idea and I don't think most nurses can keep their cool when it's someone they love that's sick. I don't think anyone needs to chastise this nurse, but it might be a good idea if the department managers consider the policy in regards to situations like these. If they are ok with it and the state BON has no restrictions, then bully for them. If they aren't, then they need to look at different ways to handle it.

UM Review RN, ASN, RN · Jan 18, 2005

Angie I wouldn't suggest sending them out of town, but asking another nurse in the unit to take the assignment if available would make a lot more sense to me. What if things went wrong and this nurse has to deal with being the one to lose the patient? I just don't think it's a good idea and I don't think most nurses can keep their cool when it's someone they love that's sick. I don't think anyone needs to chastise this nurse, but it might be a good idea if the department managers consider the policy in regards to situations like these. If they are ok with it and the state BON has no restrictions, then bully for them. If they aren't, then they need to look at different ways to handle it.

Oops, my bad, I read the whole thing wrong. :imbar Forgive me.

We don't actually care for our own relatives in a professional capacity, but we will be the "family member in the room" with the patient.

I'd have to agree that for the ED nurse who actually cared for her grandpa--he might've been better assigned to someone else.

Antikigirl, ASN, RN · Jan 18, 2005

If it was my family member that came into the ED where I worked, I would have to guage the situation well. I am held accountable first for my patient, and not tending to their needs is considered neglect...and can endanger my loved one! I would try to get another nurse to take over the case, and try as I might to be relieved of duty so that I can be there as a relative not a nurse! I mean, if a loved one of mine is in the ED, okay...not going to be a great nurse because I am going to be worried sick, so best I clock out and help fix the situation (maybe by calling other relatives, relay info to the MD about their meds, hx, dx and so on, and standing by them so they don't feel alone and terrified!) so I can get back to duty perhaps the next day or so...

Personally if my loved ones were hospialized I consider that a family emergency and would request to transfer duties so I may assist my family.

I have had to do this before and I have never gone over the line of 'nurse vs concerned family member'. I am able to leave the nurse for only reference in the back of my head for medical choices...and not get in the way of what is being done by the medical team! I may be a nurse, but I am not their nurse once I transfer duties to another! And I don't have any probelms letting my loved ones know this..."sweety I am not your nurse, I do that at work...I am me now, and I need to let the ME help you...you have a nurse for the nursing part!"

It seems to me that the nurse mentioned in the post will be off duty as an RN when she comes in to check on the patient. So I don't see the probelm with that...even if she is on lunch break it can be considered off floor/off duty and still..what would be the probelm!

I mean, twist the situation around a bit...what if the patient went to another hospital? Would she be a conflict of interest if she was to leave and go to that hospital to care for her loved one? No..it wouldn't, so she needs to transfer care of her patients...clock off..and go take care of them...and it doesn't matter what building that happens in! The deal is she should clock out completely and be relieved of all nurses duties before stepping in as the concerned loved one! (and she may have been in the midst of doing this when she reported off to you..trying to get another nurse in for her...you never know...).