Crossing the Line?

jadednurse · Apr 19, 2003

As I sat down at the computer to read some of the replies today I must admit I was really releived to see so many positive comments. After reading some of the other replies to posts on this boards I was a little nervous at first...

mattsmom81: point taken re: "if you ask yourself if you are 'crossing the line' you probably already have." I certainly knew I was crossing a line, but I think you and are are talking about two different lines. The one I'm talking about is crossing over into actually standing up for what is right, not just watching it happen and ragging about it later over coffee or drinks with my coworkers. I know we've all been there, sitting around after work or on the phone, talking about such and such patient and how crappily (for lack of a better word) they were taken care of and how, if it were me/my loved one I would have done such and such. I think I had finally reached a point where, after nearly 8 years of hearing the suits in administration sell their propoganda about "the patient coming first" or needing to do "what's in the patient's best interest", well, I ACTUALLY expected them to deliver!

HelllllloNurse hit the nail on the head for me...it really does feel like a bunch of lip service from administration. Though this happened many months ago, the frustration and bitterness toward "the system" is still with me.

Canoehead, I am worried that this hypocrisy inherent in the healthcare profession is making me rethink a long career in nursing. Perhaps I just need some time off and need to learn from this experience and heed the wise words of sjoe...next time carry both a sword and a shield. I only wish there were some way to let that particular hospital/system know how badly they let this patient (and this nurse) down.

**canoehead, BSN, RN** · Apr 20, 2003

They know they are letting people down every day, and here's a news flash for you- they don't care. That's why caring devoted nurses like yourself are so precious,and so important to keep in the profession. Otherwise the patient becomes a "market share" and the nurse is no different from a piece of equipment.

jnette, ASN, EMT-I · Apr 20, 2003

Originally posted by Hellllllo Nurse
JadedNurse,

Seriously, you advocated for your pt, plain and simple. Employers love to hear noise from nurses about their pts coming first, but when you actually base your nursing interventions and behaviors on those ideals, mgmt does not like that one bit. Lip service to pt advocasy is as far as they go.

Ditto. Good job !

Tweety, BSN, RN · Apr 20, 2003

I've had to think about this one. Kudos for being a patient advocate.

But I was also thinking two things. One an ICU nurse going to med-surg perhaps doesn't realize the world of med-surg is completely different and they can not provide the same level of care. Two, like certain family members nothing they could have possibly done would have been good enough for your friend.

Now if you've honestly looked at the above, as I'm sure you have because you said they were borderline malpractice. Did you follow the chain of command? Did you do an incident report. Was the battle after you got fired not worth the fight if they are malpracticing? If it were my loved one and I got fired for interfering in care (even if that wasn't the official reason), I would be writing the papers, I would consider getting a lawyer. I know we must choose our battles. But perhaps you were a bit jaded because of your personal involvement. But I'm sure you've looked at these issues carefully.

I'm glad you held them accountable. Para's are often neglected on the floor. I've seen it too. They aren't turned properly and q2h, their bowel routine isn't adhered to, their pt isn't what it should be. When they come to the floor after ICU, I always screamed "get them to rehab FAST!".

karbyr · Apr 20, 2003

Good job jaded. I agree, you may have become 'too involved" but SO WHAT???? Define 'too involved'...........isn't being 'involved' what nursing is all about?? and, agree w/ others who say that advocacy is not generally appreciated by management.........and just bet they, and other nurses encouraged you to feel 'over-involved'............agree, level of care is different from ICU to floor, but why?? That tends to be a management expectation and a convenient way to dismiss negligent care.........furthermore, i think, floor nurses at times expect themselves to provide less comprehensive care because they truly are not able to provide better with their staffing ratios..........how many of the nurses told you they would do things differently but were short staffed during his stay..???? not just an excuse, is the truth, and sometimes needs to be brought to our attention, because think we all learn ways of getting through a shift that isn't meeting all of our patients needs...............because we can't.............doesn't mean the ideal shouldn't be held up for us to re-evaluate where we are failing it.............and management generally doesn't appreciate it, and, neither do the floor nurses at the time, as are so overworked and overwhelmed to start with, that alone tends to make one defensive, when you are trying to do your best, and in your heart you know that care could be better............if you could ever get the time........... see it as a management and systems failure, not the nurses and not yours........way to go, jaded and sorry for such rambling.

Nursie30 · Apr 20, 2003

I'm sure you did all that you could, and were probably wronged, but getting an attorney at this point, since you two are now romantically involved will probably make it look worse. People will say you only "crossed the line" because you were already romantically involved, which may bring more repercussions for you in the long run, or finding another job, if using them as a reference.

Not my opinion, but others may see it that way.

Good luck

jadednurse · Apr 21, 2003

Originally posted by 3rdShiftGuy
I've had to think about this one. Kudos for being a patient advocate.

But I was also thinking two things. One an ICU nurse going to med-surg perhaps doesn't realize the world of med-surg is completely different and they can not provide the same level of care. Two, like certain family members nothing they could have possibly done would have been good enough for your friend.

I appreciate your comments and there are some points I want to clarify:

First, he wasn't in med-surg, he was in a 6 bed step-down unit staffed by 2 RNs and a care tech. Each RN was responsible for only 3 patients because of the acuity. You stated that "like certain family memebers nothing they could have possibly done would have been good enough for your friend." I am not talkning about fluffing his pillow or bending his straw for him, I'm talking about basic vital nursing care. The patient's respiratory status was compromised. He had bilateral chest tubes (had multiple, recurring pneumothorax/multiple fractured ribs/flail chest etc. after his injury), had been intubated for 18 days, had a poor cough effort (T6 complete SCI thus affecting the innervation his muscles in his thorax/abdomen), was on PCA morphine...monitoring his respiratory status was A PRIORITY! When they admitted him from the SICU their pulse ox on his monitor was not working (this is a monitored unit). The nurse and the tech didn't even bother to replace the pulse ox with a working module! When I came in to see him later that morning (some 6 hours after he had been transferred to that floor) they still didn't have one on him (he ws supposed to be having it monitored continuously). The patient said he asked about it but they never got around to finding a working one. I basically had to RAISE HELL for them to even get that goinjg. When they finally did, he was tachyppneic, and hypoxic. Yet, incredibly, the nurse had the gumption to tell me that he was "fine" all morning. They even documented hourly sats on him (I saw the charting) even though the patient (who was A/Ox4) states they never tried to check it again!

This is just one example of the ridiculous things that went on. When the physician ordered one of his chest tubes put to water seal, the nurse disconnected it from wall suction but also clamped the vent port. He ended up with another pneumo. You didn't need a stethescope to even hear how crappy his breathing was. Their answer to his sats being low was to turn down the alarm limit on the sat monitor (once they finally managed to get a working one on him). While his respiratory status was declining he had a series of chest xrays...one showed a worsening pneumo and the resident never signed that out to the on call resident. She nver followed up and the next morning I walk in and their putting another chest tube in him. I could go on, but I hope you get the picture...

While I am an ICU nurse I too have worked the floors, it's where I started. So don't asssume I don't know what it's like. We weren't being "demanding" for silly reasons...these things were basic and if a nurse can't recognize a worsening respiratory status there is no excuse... I don't care HOW busy you are!

Second, I did discuss my concerns, first with the nurses/techs that were providing the care, next with the managers, etc. However, issues like these just kept happening and management and administration, instead of addressing them, decided to focus on my involvement in his care versus addressing these issues. When I asked what would be done, they simply said they couldn't address it with me b/c it would violate the rights of the nurses they would discuss the issues with.

Someone in an earlier post suggested that the patient should have talked to management himself. As most patients, he was acutely ill/injured and had a lot on his mind and lacked the familiarity of the "system" to address his concerns properly. Oh, not to mention he was having trouble even breathing at that point. He ended up crashing, getting intubated again, was paralyzed and sedated for a week and then got trached. The struggles continued after he was off the vent, but still trached, and had difficulty communicating. I made phonecalls on his behalf, but even when he could get a manager/administrator to come to his room to address some of these issues, none of them took the time to sit there while he laboriously wrote on a clipboard to communicate. Not to mention they were rude and defensive.

Sorry for the rambling 3rdShiftGuy, but I just wanted to clarify those things and again, appreciate all of your comments.

susanmary · Apr 21, 2003

Originally posted by mattsmom81
It is important to support excellent care and support our patients and I have no problem doing that. How do we draw the line when our 'concern' for patient care disrupts another unit? IMO the best way to problem solve poor care issues is through appropriate chain of command, not direct personal involvement.

It's important for nurses to recognize when we may be crossing professional boundaries with patients and coworkers....and take a moment to step back and analyze actions and feelings.

Looks like I will be the lone dissenter here, because I feel the OP MAY have crossed that line, and from her post, she may recognize this too. It seems to be a risk she was willing to take.

One of my wise ol' instructors waaay back told me "If you ask yourself if you are 'crossing the line', you probably already have. "

We can't possibly know the whole story, and I always try hard not to judge another nurse harshly until I've walked in his/her shoes. This goes for the OP AND the staff she reported.

Excellent post mattsmom. jaded nurse, I'm confident that I would have been fired if I did exactly the same things you did. Were you a patient advocate -- absolutely. Did you cross the line -- I believe you did. My hope is that "he" (don't know what to call him) continues to rehab to his best possible health ... and you both enjoy your lives.

jadednurse · Apr 21, 2003

Originally posted by susanmary
Excellent post mattsmom. jaded nurse, I'm confident that I would have been fired if I did exactly the same things you did. Were you a patient advocate -- absolutely. Did you cross the line -- I believe you did. My hope is that "he" (don't know what to call him) continues to rehab to his best possible health ... and you both enjoy your lives.

Thanks for your input. I'm sure others feel the same way you do. I don't regret doing it though, maybe just wish I had done it better though. Hard to explain unless you were actually there going through it. While some may think I crossed the line, I'm comforted by knowing that 'he" (I'm not using his name to protect his privacy) is sure glad someone did!

MelRN13 · Apr 21, 2003

I applaud you for your bravery! If you believe that you made the right choices, then you did.

Read my signature line!

susanmary · Apr 21, 2003

jadednurse, are you working now? Did you find support from any of your coworkers on your former unit?

jadednurse · Apr 21, 2003

Susanmary, no, I am not working right now. I suppose that's why I have all this time to rattle away at the computer LOL.

Yes, I have a few trusted colleages that were supportive during all of this, though since they never witnessed any of this I wouldn't expect any of them to get involved. It was nice to have people to discuss this with though. Only wish I knew about this BB back then...I might have gotten some better input.