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Discussion

Damned if you do/don't

So I am very new RN (3 mos) and I work in a subacute/LTC facility that is attached to a hospital. I was working my first weekend off orientation and one of my patients has a sacral flap. During the treatment I noticed the sutures were open about 2 cm and there was an area 2x3 cm that was discolored-purple. I called the surgeon and made aware and was told even if it turned black there was nothing more that we could do, that he was already aware of the situation and that the patient was transferred to my facility from the hospital like that.

I couldn't find any documentation but was told by other nurses on my unit that it was in fact true. I documented that i spoke to MD and that he was aware. The next day the family asks me about the flap. I let them know we are monitoring and there was a small area open and that we are doing treatments for it. Yesterday the PCC shouts who told the family the flap was open because they called admin and want to take the patient out.

My understanding was that the family was aware and like I told the PCC what was i supposed to do lie! I am trying my best to do the right thing and being on the other side as a concerned family member I would want to know whats going on. Also I could not find any documentation regarding the matter! Again I chose my words very carefully with the family and thought I was doing the right thing.

Another MD chimed in that I'm new, young (I'm in my 30s but everyone thinks I am 18 because I look young), and gave me a lecture that with time I will learn to speak to families and just defer everything to the MD. He also chimed in that its not always black and white but grey areas and that I will learn not to throw people under the bus! To be perfectly honest I was livid. I am an adult, have 12 years customer service under my belt and have handled people in my previous career. I would never intentionally throw anyone under the bus.

That being said I felt badly about it. I don't understand how me being prudent and wanting to be an advocate would backfire on me. I bit my tongue with doctor because I am new and just want to clock in/clock out and do my job. The permanent nurse for the patient then told me with time comes wisdom ad you won't bother so much with people because it creates more work for us. Any thoughts and advice would be appreciated. I feel embarrassed and they have floated me to the LTC side since then.

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    • Featured Replies

    Unfortunate situation, but you got some candid advice from your colleagues.

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    • Guides

    You don't necessarily have to lie to patients/families, but it isn't your

    job or responsibility to inform them of EVERYTHING that is going on,

    either. It does indeed only create more work and more headache

    for you. I mean, I do understand where you are coming from. As

    a family member, I would want to know what is going on as well.

    Again though, it isn't really the nurse's job to inform the family of

    a patient's condition. You could have just said "well, the wound looks

    good, no infection, we are still treating it daily" and left it at that.

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    • Experts

    I admire your gumption, MVNurse. You took an initiative, and were honest with the family. Your approach was untempered, direct, and forthcoming. Your objective documentation was an excellent maneuver.

    We learn to temper our approaches according to the situation and the institution for whom we work; we become somewhat like politicians. We say what People need to hear and let them know any concern will be addressed by those responsible. The best we can be, in a lot of situations, is a strong link in the chain. We have only so much power, so we learn to dance and put on a good show, never forsaking our principles or integrity.

    All in all, you did a good job, MVNurse. Just learn to play the game a bit.

    The very best to you.

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    If the asked her a direct question regarding the wound what was she supposed to say? I think you were correct. I would not feel comfortable withholding information.

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    • Experts

    Radical honesty IS NOT always the best policy, in my humble opinion. I speak as a nurse, and also as a daughter with a very ill mother in the hospital as I type this.

    Be honest, but general...and leave the painstakingly specific minutiae for the doctor to divulge. "We're doing daily dressing changes." "The wound flap has no signs or symptoms of infection." "Your loved one is in good hands."

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    Since when are patients and POA's not entitled to know the specifics of their, or their loved one's medical condition? If this patient was A&O should she also not be told that the flap was open and why she was getting these treatments?

    If there was no reason for the family to be concerned than the physician should have been more than comfortable explaining to the family that this was a minor complication that could be managed in the SNF and didn't require a higher level of care at this time. If the family wants the patient seen elsewhere, that is their right.

    OP, you did nothing wrong. If the culture at your facility is to hide information from patients and families I would be looking for another job.

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    • Guides
    Radical honesty IS NOT always the best policy, in my humble opinion. I speak as a nurse, and also as a daughter with a very ill mother in the hospital as I type this.

    Be honest, but general...and leave the painstakingly specific minutiae for the doctor to divulge. "We're doing daily dressing changes." "The wound flap has no signs or symptoms of infection." "Your loved one is in good hands."

    Many times, the nurse knows more about the patient than the physician. :cool:

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    • Author
    Many times the nurse knows more about the patient than the physician. :cool:[/quote']

    In my facility, sadly this is the case. The physicians I believe are only required to see them monthly and if it's a specialty MD I believe it may be longer. Thank you everyone for your input. I am back tomorrow and will see where they will put me and keep everyone posted. I am currently looking for other positions but 3 mos experience does not sit well with potential employers. Until then I will ride the waves and hope not to drown.

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    • Author

    Just an update- the flap is more open and necrotic. The patient also scratched a pretty significant amount of tissue from his leg. You know just the sort of talk in the break room. I stand behind the way i responded to the family and my calls to the MD. Unfortunately though they haven't put me back on subacute, but I'll take vent any day :)

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    Nurses are not only allowed to ensure that the patient is kept up-to-date and is well informed about their condition, it's a legal requirement of the license.

    If the story is correct, that the PCC wanted to withhold information in order to keep their business and the patient's nurse is aware of that, I would expect the nurse to report that to the proper oversight agencies.

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    Since when are patients and POA's not entitled to know the specifics of their, or their loved one's medical condition? If this patient was A&O should she also not be told that the flap was open and why she was getting these treatments?

    If there was no reason for the family to be concerned than the physician should have been more than comfortable explaining to the family that this was a minor complication that could be managed in the SNF and didn't require a higher level of care at this time. If the family wants the patient seen elsewhere, that is their right.

    OP, you did nothing wrong. If the culture at your facility is to hide information from patients and families I would be looking for another job.

    They do have the right, and they should be referred to the patient's physician. OP, you're in for a short, painful career if you play things like you have in this situation.

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