Terrible clinical day, nurses don't seem to care. - page 11

I may get a lot of flack for this from the more experienced nurses, but I would like some help in understanding this situation. Today, I walked by a patient's room in the hallway. Keep in mind... Read More

  1. by   nursemike
    Early in my med-surg clinicals, I had a patient who was probably terminal and very anxious to talk to someone. I think my tasks for the day were assessment and ADLs. I'm not sure we were even passing meds, yet. He had a number of concerns, and told me about them at such length that it was almost all I could do to get him assessed. As my clinical time was nearing an end, his staff nurse came in, and she asked, rather pointedly, rather giving a bath wasn't part of my duties for the day. By then, of course, I was out of time, but I took the point that I was going to need to learn how to get my work done while I listened.

    Later, after post-conference, I was kneeling at the nurses' station, gathering info for my careplan, when the same nurse noticed me kneeling next to her and asked if I was about to propose to her. I told her I was begging forgiveness for not getting my bath done, then told her how he'd kept saying that I was the only one who cared enough to listen to him and yada,yada,yada, and she said, "Yeah, he's right about that." I didn't interpret her to mean that she really didn't care. I believe she meant that she'd already heard it several times and couldn't spend a couple of hours a day listening again. Then both she and another nurse who was nearby agreed that there were times when there were more important things than smelling bad for a day. Next time I had him, he got his bath.
    It was embarrassing, at the time, but I learned some good things, that day. As a working nurse, I have more than one patient, and lots of tasks that have to be done, more than a few of which may be life-sustaining. On the other hand, there are still times when the most important intervention I can do is to pull up a chair and just listen. Balancing all my patients' various needs is a continuous challenge, and I still end up charting an hour past my shift once in awhile because of that, but I'm learning every day how to prioritize my care. Part of that, I have to admit, is setting firmer limits than I did as a student, even though that can feel a little hard-hearted, at times. Real-life nursing isn't all flowers and rainbows. On the other hand, it can be very satisfying when you can look back on a shift where you've saved a life, kept someone else's pain under reasonable control, cheered some else up a little, and fluffed a couple of pillows, and you're only twenty minutes late getting out. It isn't how I imagined it would be when I was a first-year student, but in some ways, it can be much better. I wish the OP much success in finding that balance. For me, after almost four years as a nurse, it remains a work in progress, but I see the best nurses I know dealing with some of the same challenges, and I tell myself that when I've been a nurse for twenty years, I'll be as good at it as they are. Of course, I'll be 68, by then. I fear that may slow me down, a little...
  2. by   nerdtonurse?
    I look at it this way -- if I'm going to touch you, I'm going to look at your chart (who knows if the person who had them before had put up the NPO sign, or if the pt took off their DNR bracelet). Moreover, at night, I make sure I know the DNR status of everyone on my hall, whether they are my pt or not. I hear the telemetry tech yell, "Asystole 238!" That's not the time to go find a chart. And providing patient care IS allowable under HIPAA. That's my hospital, that's my hall, and anybody on that floor can become my patient in an emergency.

    Yes, HIPAA is the 800 pound gorilla in the room. However, a lot of bosses beat folks over the head with things the law doesn't actually cover. if you read the actual law http://www.hhs.gov/ocr/privacy/hipaa...impregtext.pdf


    164.514 states that health information is not covered as protected information IF the following data is not released:
    No names of pt or family members
    No address
    No employer
    Any geographic information smaller than the state
    Location of treatment
    Type of treatment or disease
    Any date -- birthday, admission, etc., -- EXCEPT IF THE PT'S OVER 90 - then you can say how old they are.
    Picture, fingerprint "biometric identifiers"
    SS#, any insurance number, license number including professional licenses, driver's licensing, etc., IP addresses
    AND -- here's the kicker -- that data must be released in such a way that identification of a specific individual is possible to an outside entitiy.

    So, according it HIPAA, it's completely legal to come home and tell your hubby, "If that CHF jerk tells me he's going to report me for not bringing him a 2 liter Pepsi one more time, I'm going to scream." There's no way he could pick up the telephone and call the CHF jerk in question. If I come home and tell him, "Mr. Smith in East 324 is a pain in the TAIL." he could pick up the phone, call the hospital, and ask to speak to Mr. Smith in East 324 -- I've identified the specific individual, and I've violated HIPAA.

    So, if a health professional writes a book, and writes about Mr. Smith but calls him Mr. Jones, and changes the age by a year, turns a plumber into an electrician, doesn't mention where the person was other than saying they were in Nevada or California, then you're not blowing up HIPAA. Believe me, before I EVER started posting, I learned what I could say, and what I couldn't.

    And for Pete's sake, don't read the law and attempt to operate heavy machinery, it will put you to sleep....
  3. by   VivaLasViejas
    Moderator's Note:

    This thread has gone off-track in several places due to unnecessary input and inflammatory remarks. Please remember when posting to stay on-topic and avoid personal attacks per the Terms of Service you agreed to when you signed on as a member here at allnurses. Thank you.

    Carry on!
  4. by   lamazeteacher
    By signing HIPAA, patients have given permission for anyone who is remotely interested in acquiring information about their condition, to have it. The records according to HIPAA may be accessed by any doctor, nurse or auxilliary personnel, government agency, police, court, or insurance company!

    Read the small print. This law was changed from its original form, through the efforts of insurance company lobbyists. Originally, it was HIPPA, Health Information Privacy Protection Act. When it became HIPAA, Health Information Portability Protection Act, it changed to accommodate information becoming available for all insurance companies, government agencies, including courts, police, Public Health and any entity requesting the information. Also, all doctors, nurses and auxilliary personnel having an interest in the case have access to the poatients' records.

    So it originated as the illogical permission that allowed healthcare providers to keep confidentiality, by another person (the patient) signing that. Since when does another person (the patient) signing a document asserting what others may not do with their information, assume credibility? It is insulting to professionals who have already taken oaths protecting their patients' confidentiality!

    By maintaining portability of confidential records, insurance companies can sue patients for witholding information when applying for coverage, allows doctors to give each other patients' confidential records, and pharmacists to realease information about any medication ordered and/or received by patients, and of course the lawyers representing the insurance companies and collection agencies may get it too.

    The scourge of HIPAA will go down in the annals of history as the greatest act of fraud against patients, by misinforming them regarding the meaning of their signature on a form that simply states they were given information about it. Shame on lawmakers who allowed this travesty to pass, becoming law.

    As far as a student nurse who finds a patient in need of care, having access to their record, of course is fine, as it allows nursing care to be given, when another nurse may be on his/her break by informing the student nurse of orders that have been given, whether medication has already been given, and the opportunity to record its effect, while specifying what care is possible through the care plan. The student nurse is already obligated to maintain confidentiality, HIPAA or no HIPAA!

    It would behoove all healthcare providers to thoroughly read this stupid act, so they will not misrepresent its intention!
    Last edit by lamazeteacher on Apr 28, '09 : Reason: typo
  5. by   darrell
    I did work in a psych ward - an inpatient crisis unit - and I participated in and initiated restraints, seclusions and medicating over objection. In many cases, it was the only way to keep everyone safe and it was enacted only after less restrictive measures failed.

    All that being said, it was also my least favorite part of the job and I was willing to spend a good part of my shift babysitting and catering to avoid having things get to that point. I happen to have some talent for deescalation and not everyone shares the same amount of this, so different nurses may order restraints at different levels of escalation.

    (My own thought is that a talented and trained deescalation expert would be a beneficial addition to the chain of events, but this means more money and sometimes in psych the sequence is so fast that the whole thing is done before security even shows up!)

    I also have been told by peers that I have an unusual amount of patience. This may help explain why I am willing to go further than many around me to avoid restrictive measures. I just don't get ruffled.

    In any case, I am no longer working inpatient and part of the reason is that I would rather spend the rest of my shift sitting down with someone in emotional pain than locking them away and getting on with business. This fits my personal ideology well, but it can be problematic when the patient in question needs constant attention or supervision and the rest of my assignment is feeling neglected because of it. Perhaps something like this affected the decision in your case, too?

    Deescalation or managing dementia are skills that don't come easy for many. I don't mind being within arm's reach of violence and I rarely feel much fear from such threats, so that isn't a big factor for me. On the other hand, I'm not much for imposing my will on others and so I'd make a terrible cop or guard. I guess we all have our weaknesses - there isn't a body fluid yet that has had much impact on me, but aggressively setting boundaries just isn't something I've been able to get a good feel for!

    The bottom line is that I applaud your compassion and I want you to know that it doesn't necessarily get any easier even when it's a common occurrence.

    D
  6. by   roshell1963
    you were not wrong in trying to help this patient. there are national protocols in place per jcaho that require patients in 2 or 4 point restraints to be monitored very closely. if it is not a psych floor situation (where the intervals are even more frequent) the patient is to be checked every hour at the very least, the restraints are to be removed 1 at a time to allow for circulation to the restrained area and charted accordingly. elderly confused/mentally confused individuals should be placed in the rooms closet to the nurses station where there is the likelihood of someone noticing patient safety issues sooner. elderly individuals do not adapt to new surroundings well, they often need consistent orientation reinforcement to alleviate anxiety. many hospitals have volunteer sitters available through the case management staff, or perhaps someone from the patient's own family or church could come and sit in shared shifts. it is never a bad thing to care enough to go the extra mile for one of your patients. often the staff gets jaded after too large of a workload for too long (years) and personal stress burnout as well. when we no longer can put the patient's welfare first on the job, it is time to find another career. perhaps these are the nurses that need a new work environment, possibly by teaching our new nurses and helping to alleviate the current nursing professor shortage. remember back on the first day of fundamentals when they reminded us we should be treating our patients like they were our own loved ones. just my follow your own conscience, you seem to have a good one.
  7. by   klg315
    I wonder what pretending to care would like for you. Just because someone wasn't holding her hand and sitting with her doesn't mean that no one cares! I work in neurosciences where many patients require restraints for a variety of reasons. Some insist on pulling out their IV's, NG's, foley catheters and central lines. Some are aggressive and would punch you in the face as soon as they got their hand free after nicely asking if you could please loosen the restraint. Brain injury or pathology is hard to understand but we have to keep the patients best interest in mind. If she is threat to herself and can't understand why she needs to cooperate, restraints may temporarily be the only viable answer if she has no family to be with her. Ideally it would be nice to have a staff member assigned to her but I know in our facility there is not adequate staffing to do such things.

    Chemical restraints are not always a good idea particularly when LOC needs to be regularly assessed.

    I hope you are able to come to terms with this experience and I think it is great that you are empathizing with the patient. I'm sure you will be a wonderful nurse for it!
  8. by   nursemike
    Quote from klg315
    I wonder what pretending to care would like for you. Just because someone wasn't holding her hand and sitting with her doesn't mean that no one cares! I work in neurosciences where many patients require restraints for a variety of reasons. Some insist on pulling out their IV's, NG's, foley catheters and central lines. Some are aggressive and would punch you in the face as soon as they got their hand free after nicely asking if you could please loosen the restraint. Brain injury or pathology is hard to understand but we have to keep the patients best interest in mind. If she is threat to herself and can't understand why she needs to cooperate, restraints may temporarily be the only viable answer if she has no family to be with her. Ideally it would be nice to have a staff member assigned to her but I know in our facility there is not adequate staffing to do such things.

    Chemical restraints are not always a good idea particularly when LOC needs to be regularly assessed.

    I hope you are able to come to terms with this experience and I think it is great that you are empathizing with the patient. I'm sure you will be a wonderful nurse for it!
    I also work in neurosciences. It often seems like a cross between LTC and psych. So many patients needing total care. So many with mental status changes. More than a few with both. Not long ago, someone on our unit was looking for logos for t-shirts and hoodies for our unit. I favored one about "Rodeo Nursing" which had a stick-figure patient in 4 point restraints and a stick-figure nurse with a big syringe (more of that dark humor discussed earlier in the thread). Needless to say, it was not the one chosen, but some nights it sure fits.

    I guess I have nothing else to add, at this point. Just wanted to say hi to another head case.
  9. by   Cobweb
    Cops and nurses have a lot of the same issues. Long, long ago, this episode was on Hill Street Blues. I had an episode somewhat like this young student and this episode was like an epiphany to me about the "uncaring nurses". What happened is that a guy was in a car wreck and lost his arm. There was soooo much garbage in the streets, and the cops frantically searched through the garbage looking for his arm. One cop finally finds the arm, after crawling through the garbage looking for the arm, and says something like, "Hey his watch is still on here. Takes a licking and keeps on ticking!" The citizens who stood and watched them forever digging through garbage in the gutters filed a complaint on them for their "disrespectful and uncaring" behavior.

    http://www.youtube.com/watch?v=No0H2TpuGT4
  10. by   survivor08
    Having just come out of ICU as a pt, a restrained one at that. Chemical restraints not good choice if q hr neuro checks are needed and remember how many "regular meds" adversly effect elderly population. I am only 49 and between my pain/nausea meds I saw bugs and tried ripping off bandages and pulling out my PICC. Restraints were not fun but I was safe. Today it is hard for family to be caretaker in hospital and ICU has strict hours. Even though I was an RN in this hospital and had probably 50 people that would have sat with me this is not protocol. Perhaps you did not have entire story and "When you finish school and walk the walk for a while you will see the other side. Please do not judge. Your new co workers will surely not like you and then you will be one of those newbies, complaining how mean everyone is to "new grads". Just trying to give bigger picture. Just graduated last May and had been there and done that. Best of luck to you.
  11. by   WalkieTalkie
    Quote from survivor08
    Having just come out of ICU as a pt, a restrained one at that.

    Thanks for sharing your personal experience with restraints. It makes me feel a little better about having to use restraints in certain situations.
  12. by   Karen05
    I work in an MICU unit where we frequently have to use restraints for various reasons, including protecting the patient from removing his/her IV; and most, if not all patients are not happy about this (who can blame them?)
    In your situation, given the woman's age, chemical restraint may not have been the most optimal choice, as the elderly are no longer as efficient in metabolizing drugs in their system. She was NPO, so obviously you could not give in to her request for water, although you might have swabbed her mouth or asked the MD about providing a small amount of ice chips. Further, the patient may have indeed been given an explanation as to where she was and why she was being restrained but either forgot or was not able to comprehend the situation due dementia. As to the attitude of the nurse, unfortunately I see that a lot; frustration, excessive work load, stress, exhaustion or lack of empathy can cause one to be so callus and careless in one's attitude and behavior.
    My advice (if I may) would be to learn from the short-comings of others, remembering to provide care to your patients as you would have provided to your loved ones and go into your shift each day being the best nurse YOU can be, regardless of those around you.
  13. by   ctconn35
    how sad is that. we are talking about a 80 year old woman. Are you telling me that the chemical restraint wouldn't of helped her settle down. Ridiculous!! It was a easy way out for lazy nurses so they don't have to be bothered. That is against the law. I hope and pray to God I never become a nurse like that or I am done. Unacceptable. I feel bad you had to deal with something like that. Nurses let's not forget they are human beings. Treat them with respect. I would of turned them in.... sad and angry.

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