Dad says I have to learn to tune this stuff out

txspadequeenRN, BSN, RN · May 18, 2007

this is probably the biggest no-no i have come across yet..i would never get on the phone with a attorney for any of my patients. anything of this nature belongs to the social worker. nursing is responsible for reporting it but carrying it out would be going way to far....

i have gone as far as helped a pt. find a family law attorney in the yellow pages, dialed and translated for the pt through slurred speech. guess what! that guy won his court case and the family was removed from his house!
the more you handle these situations the better you get at it. you win some you lose some, that is the reality.

jill48, ASN, RN · May 18, 2007

What the hell is going on at this facility. You say she is "there" mentally. Is she really A&O x3? If so, why isn't she the one making her own decisions about going into hospice? This sound like a bunch of crap to me.:angryfire

barbyann · May 18, 2007

this is probably the biggest no-no i have come across yet..i would never get on the phone with a attorney for any of my patients. anything of this nature belongs to the social worker. nursing is responsible for reporting it but carrying it out would be going way to far....

if a pt asks to make a phone call you are obligated to help. as long as the call is reasonable, you, as a nurse advocate, are responsible for helping the patient locate the phone number, dial the phone (if unable to physically) and translate their speech (but add nothing yourself). it should make no difference if they are calling their mother or their lawyer or for chinese food. but yes, i have been accused of going way to far in some situations, but not in this one.

txspadequeenRN, BSN, RN · May 18, 2007

are you kidding me?? if the patient wants to call his mother and he has no restrictions then, you dial the number. but when a patient ask you to make a call to a lawyer and you are the one having to translate ...you get the social worker . if they are able to make the call on their own and speak for them self ...have at it... you are putting yourself in the middle of a bad situation.

if a pt asks to make a phone call you are obligated to help. as long as the call is reasonable, you, as a nurse advocate, are responsible for helping the patient locate the phone number, dial the phone (if unable to physically) and translate their speech (but add nothing yourself). it should make no difference if they are calling their mother or their lawyer or for chinese food. but yes, i have been accused of going way to far in some situations, but not in this one.

AlisonBSN · May 18, 2007

The patient has MS and receives a check. She was alert and oriented, it was her decision. I felt sorry for the granddaughter because her mother has made a living from caring for her mother and has become dependent on that money, instead of developing the necessary job skills to make it in the real world when her mother passes away. It's a lose/lose situation, but our responsibility was the best interest of the patient. Sending her back home doesn't seem like the best thing, but it gets her out of the hospital, which makes the chiefs happy.

AlisonBSN · May 18, 2007

And I wasn't shaking my finger at you, Suesquatch. That was my personal rant about her putting Iodosorb on the sacral wound, and Dakins on the feet even after we told her it's the other way around. I should have been more clear, I apologize.

DusktilDawn · May 18, 2007

The patient has MS and receives a check. She was alert and oriented, it was her decision. I felt sorry for the granddaughter because her mother has made a living from caring for her mother and has become dependent on that money, instead of developing the necessary job skills to make it in the real world when her mother passes away. It's a lose/lose situation, but our responsibility was the best interest of the patient. Sending her back home doesn't seem like the best thing, but it gets her out of the hospital, which makes the chiefs happy.

1) Why is her daughter being a loser ANY of our concern...especially when our obligation is to our patient who would have a much better death in Hospice than on our crappy MedSurg floor...and especially when there's plenty of other government programs who give free housing to broke chicks with kids.

perhaps in a private conversation between the social worker and the patient without the loud-mouthed daughter talking over her mother...

Actually you're being very judgemental regarding this patient's daughter. Judgemental in an extremely negative way and you have brought it down to personal level, it is obvious by the disdain you have towards this patient's daughter. You attitude towards this patient's daughter is unprofessional because you have allowed personal emotions, opinion, and assumption into the situation. How could it not cloud your judgement and your ability to advocate for the best interests of this patient. You refer to this woman as a loud mouth, yet this woman has probably been her mother's advocate for years.

You do not know the interpersonal relationships of this family, their history, nor the motivation behind WHY the daughter put her life on hold to care for her mother, or for that matter why the patient chose to discuss hospice care with you. For all you know, the patient may be very manipulative where her daughter is concerned, or they may have a truly loving mother-daughter relationship where the daughter chose to take care of her mother for truly selfless reasons. The patient may have express her desire for hospice care because perhaps she felt she had been a burden on her daughter, or perhaps to use you as tool of manipulation towards her daughter. YOU DO NOT KNOW what the truth is.

When anybody would ask why this lady was here for so long, the social workers and nurses who had been working with her forever would say that it's because the daughter lives in her mother's house, and if the lady goes to Hospice, then the daughter won't have anywhere to go, or will stop getting goverment money...something like that. But the daughter is grown with a 10 year old kid herself. (I don't completely understand because I don't understand Medicaid or Medicare, and what happens to that when people go into nursing homes or Hospice.)

You state you don't know the financial intricacies regarding Medicaid or Medicare funding, yet that ignorance doesn't prevent you from making biased opinions and having a biased attitude towards this patient's daughter. It seems to me you have judged the daughter as monetarily motivated in her decisions. You also do not know what job skills this daughter also has. You have assumed the daughter is dependant on the patient for her PRIMARY income, YOU DO NOT KNOW THE FINANCIAL SITUATION OF THE DAUGHTER. You carry on about advocacy, but you forgot about providing care in a non-judgemental manner, and yes that includes the family, especially in this instance since the daughter has provided long-term care for her mother.

She's had a Hospice consult but the family refused Hospice...so she stayed in the hospital for way longer than was medically necessary because she had nowhere to go. No nursing home would take her either. But I don't understand how the family can refuse. What does "the family" have to do with the decision...

In this instance, "the family" may have more to do with the situation than you realize. Do you know whether or not the daughter has POA? The daughter has also been this patient's long-standing primary care-giver, which means she has no doubt in the past been part of all health care decisions. Why would you think she shouldn't be involved now?

For instance, we had a patient that was end-stage Multiple Sclerosis. She was very contracted and had a very difficult time speaking, but if you took the time to figure out what she was saying, you'd see that she makes perfect sense when she talks. She never had episodes of confusion, and even made jokes every now and then. So she was completely there, mentally.

This is what you did right as a patient advocate. You took the time to listen to your patient express her wishes. What should have come next was a multidisciplinary meeting of the health care team, Social workers, the patient, AND HER DAUGHTER to discuss a doable solution to meet the best interests of the patient.

Patient Advocacy is not necessarily about giving the patient what they want, it is about the BEST INTEREST of the patient. You wouldn't advocate for something the patinet wanted if it was detrimental to their well being, would you? How do you know that it doesn't serve the better interests of the patient to continue to be cared for by her daughter?

SuesquatchRN, BSN, RN · May 19, 2007

The patient has MS and receives a check. She was alert and oriented, it was her decision. I felt sorry for the granddaughter because her mother has made a living from caring for her mother and has become dependent on that money, instead of developing the necessary job skills to make it in the real world when her mother passes away. It's a lose/lose situation, but our responsibility was the best interest of the patient. Sending her back home doesn't seem like the best thing, but it gets her out of the hospital, which makes the chiefs happy.

Alison, in reality the daughter is the best one to care for her mother, and the one likely to be most consistent and 24/7. She also costs a lot less than home health aides. The whole family depends on that money, to stay in the family home with Mom/Granma.

I have a sister with schizophrenia. Well-meaning but ignorant people are always suggesting that my parents look into group homes. Yeah, like we never thought of that. While I am alive my sister will not be living with strangers in a group home with paid caregivers. She will be with my parents until they die, and then my husband and me. She gets an SSI check and we will use that money towards her support - and it doesn't cover it all.

I think dustildawn was harsh because you are - forgive me for stating the obvious - you are very young, and although we are nurses of the same experience I have the slight advantage of having lost my rose-colored glasses some decades ago. I expect the world and the people in it to be as it is, not as it should be.

Listen to your dad and try to step back and appraise things objectively, without emotion. I know, much easier said than done.

No prob on the emoticon. I just really hate that one and even if it isn't being shaken at me I get offended.

jojotoo, RN · May 19, 2007

Allison - No, you didn't have the whole story. But when do any of us have the "whole" story?

I applaud your attempts to be your patient's advocate, even though it probably wasn't a popular stance among your coworkers. It can be hard to do what you think is right when you don't have peer support. Be prepared for unpleasant consequences.

You are the voice for those who only have a weak one, or none at all.

Never lose your idealism, no matter what your age.

P_RN, ADN, RN · May 19, 2007

I don't remember if you said a state she lives in. Here MS is an automatic qualifier for Medicaid and SS disability usually too. Hospice can be an agency with no walls. It's doesn't have to be a building the patient goes to. The workers come into the home. Or they can go into the nursing home also.You can see I'm not a Hospice nurse. I'm not explaining it as clearly as I'd like.

But the laws usually have the clause "you don't have to give up your home" just to go into ECF. SW and discharge planning seem to have bounced their ball into your court where THEY should have been handling the details.

You did as well as you could under the circumstances. How about arranging an inservice on Hospice for your coworkers? Maybe one on Medicaid and Medicare rules too?

crissrn27, RN · May 19, 2007

Please excuse my oddly placed dancing monkey.

:lol2: :lol2:

I'm sorry, I know this is a serious discussion, but this struck me as sooo funny.

Now on to the serious issue. You are correct, I don't see why they are listening to the family and not the pt. You are doing your job advocating for the pt. Keep asking these questions, and maybe someone will listen. Also, be very blunt (to social worker, etc) and say "this lady is A & O x 3, she needs to make her own decisions". I saw this alot in LTC, they would listen to the family and not the pt, just because the pt was old or sick. Sad. I won't go in to all the other things, such as the daughter, we really don't know that story, and never will. BTW, even if the daughter has POA that is for times mom can't make good decisions, and at this point it sounds like she can.

AlisonBSN · May 19, 2007

I just don't think the whole family story is relevant. Neither is my belief that the daughter is a loser. I will say that the hospital knows this family, she's a frequent flyer and related to some of our staff. I have a pretty clear picture of things, but that's all irrelevant. All I'm saying is that the hospital staff is listening to the daughter and not the patient, because the squeakiest wheel gets the grease...and that is wrong. I see it all the time. He who raises the most hell gets what he wants.

I know I'm young and inexperienced, that's why I started this thread. Don't lecture me on being judgmental. I call them like I see them. I still treated them with respect.

I guess you showed me with your bold typing. I needed a good talkin' to. Really.

:monkeydance: Settle down, ladies. Just enjoy the monkey.