treating a visitor of your pt? reprimanded for not doing it....

CoffeeRTC, BSN, RN · Nov 14, 2005

Why didn't the NM go and take her BP?

YOu did the right thing!

HappyJaxRN · Nov 14, 2005

am i right or wrong here? just fyi, i work in a subacute rehab attached to ltc.
during report, had a nurse manager come in, tell me pt "had fainting spell" and to go see her. i get up, go in the pt's room, ready to do VS and assess, etc. four family members in the room with pt, one of whom is lying in bed next to pt. i say "what happened?", pt sitting up, a/o, no c/o. i go to take a BP on her, and another family member says "no, it's not her, it's my sister". sister laying in bed, says she has a "heart problem" and is vague with her symptoms. i say "sorry, i am not allowed to take your VS, but i will call an ambulance for you". rest of the family says, "no thanks, she's been complaining for the last hour, but we don't know why the nurses can't just give her a BP pill and check her VS every so often.":uhoh3: offer again to call ambulance, declined offer. so i go to nurse manager who's supervising building for the weekend, who goes to talk to family, and then writes me up for not taking the woman's vs. :stone
am i completely wrong here?

Nope. Your nurse manager was waaaaaaaaayyyy wrong. I would have written on the write up "persons involved was not patient," or something along those lines.

I can't believe that she wrote you up over this....I would be looking for that policy.

Jolie, BSN · Nov 14, 2005

I once had a physician go nuts on me because I refused to treat a child who was not a patient. Fortunately, my manager had the good sense to back me up. This was in an acute care hospital with an ER and a pediatric unit, both of which would have been perfectly appropriate settings for this child to receive care, unlike the newborn nursery where I was working! Furthermore, he could have simply asked to parents to drive the child a few blocks to his office, where he had access to the child's records.

You did the right thing! You might even want to check with your state BON and review your Nurse Practice Act regarding the treatment of persons with whom you have not established a nurse-patient relationship.

chaosRN, ASN, RN · Nov 14, 2005

I think you did the right thing. I work in a hospital & we have sent many family members to the ED to get treated for fainting, chest pain, etc. WE did not check any v/s. Is there a way you can write up an incident report? On ours, it has a place to specify if it was the patient or not.

Ruby Vee, BSN · Nov 14, 2005

unfortunately, i believe that the nurse manager would write her up. it's happened to me!

years ago, i had an italian patient with a very demonstrative italian family. when he died in our ccu, the daughter who was with him began to shriek. understandably, this startled his roommate, who was sorry that the patient had died but not all that inclined to try to recover from his heart attack in the midst of a ruckus. we tried to guide daughter out of the room, but she flung herself on the body and hanging on for dear life, proceeded to kick, scream, swear, and carry on the likes of which i have rarely seen. (and my husband's family is latin!)

once it was established that the daughter would have nothing to do with any comfort, redirection, etc. that i tried to offer, i called both the social worker and the priest on call, then helped move the roommate down the hall. meanwhile, the shrieking continued at full volume.

the patient's doctor came in to pronounce him, and refused to even go into the room "until you sedate that woman." i told him she wasn't a patient, i couldn't sedate her. "just giver her 10 mg. of valium im, " he said. i refused. i told him that both the priest and the social worker were on the way, or we could have security scrape her off the body and take her to the er for treatment. "just give her the damned valium," he bellowed. "or i'll have your job!" (not sure what he'd want with my job, he who was making enough to afford the mansion on the hill, a few mercedes' and regular safaris in africa -- first class, of course.) at that point, my nurse manager entered the fracus and ordered me to give the valium. again, i refused, stating that she wasn't a patient, i didn't know her history and it wasn't safe.

"wait for me in my office," the nurse manager said. "we'll discuss your employment status. you might want to consider wisely what you'll bring to the discussion. i"ll give the valium."

as i waited in the nurse manager's office reflecting that i'd rather lose my job than my license but preferred not to lose either, i heard a code called in the ccu. i rushed out of the office to find my nurse manager, the attending physician and a few other folks doing cpr on the patient's daughter -- who had respiratory arrested after getting 10 mg. of valium im.

the discussion in my nurse manager's office, when it finally happened, went someone differently than she had anticipated. it was one of the few times a manager has ever apologized to me.

oh and shrieking woman? she recovered, and last i heard, was suing the hospital and the physician.

ceecel.dee, MSN, RN · Nov 14, 2005

the discussion in my nurse manager's office, when it finally happened, went someone differently than she had anticipated. it was one of the few times a manager has ever apologized to me.
oh and shrieking woman? she recovered, and last i heard, was suing the hospital and the physician.

wow, what a mess! you intelligently dodged quite a bullet.

i'm sorry for that woman, who will probably be stuck in the anger stage of her grief for a long time.

MarySunshine · Nov 14, 2005

Wow Ruby, what a story! Good for you for sticking to your guns -- it's so rare that we're actually validated in our convictions, that it's refreshing to hear a story where you were (not that I'm happy the girl arrested!). I have never given valium before and I wonder what piece of PMH would cue someone to not give it -- asthma? Or just bad reactions in the past to sedatives/antianxieties? You just got me thinking....

To the OP, I agree with others that you did the right thing and I would fight it too, not only for the sake of justice in this write up, but also for the NEXT time this happens in your facility. A policy needs to be drafted if it hasn't been already. Best wishes to you!

TypicalFish · Nov 14, 2005

am i right or wrong here? just fyi, i work in a subacute rehab attached to ltc.
during report, had a nurse manager come in, tell me pt "had fainting spell" and to go see her. i get up, go in the pt's room, ready to do VS and assess, etc. four family members in the room with pt, one of whom is lying in bed next to pt. i say "what happened?", pt sitting up, a/o, no c/o. i go to take a BP on her, and another family member says "no, it's not her, it's my sister". sister laying in bed, says she has a "heart problem" and is vague with her symptoms. i say "sorry, i am not allowed to take your VS, but i will call an ambulance for you". rest of the family says, "no thanks, she's been complaining for the last hour, but we don't know why the nurses can't just give her a BP pill and check her VS every so often.":uhoh3: offer again to call ambulance, declined offer. so i go to nurse manager who's supervising building for the weekend, who goes to talk to family, and then writes me up for not taking the woman's vs. :stone
am i completely wrong here?

You were completely right. Think about it, with your patient, you can't initially take vital signs on them and medicate without somekind of admitting order from an MD. Legally, you can't "just take her vital signs"-it's one thing to come across someone passed out in a mall, for example; there you would be covered by the good samaritan act; but in your place of work, it's a different story. At my hospital, the family member would not of even been allowed to lay on the empty bed; anyone with any medical complaints are promptly sent down to the ED. Period. If your supervisor had forced you to care for this family member, she would of opened up an entire can of worms, legally speaking. You need to find out what kind of protocols you have for that type of situation. You did the right thing.

meownsmile, BSN, RN · Nov 14, 2005

i definiately think a trip to the ER would have been effective. No discussions,, if the family member was ill enough they needed to lay in the bed with the patient, they needed to be seen. I would have just gone to the phone and called ER had them come up with the stretcher and take them down. End of discussion. It is not only inappropriate for family members to think you should take care of their ills, but to give them medications? Dont think sooo!

If they arrest, then i treat,, otherwise they are going to the ER and let the doctor decide if they need anything, including blood pressure monitoring.

babynurselsa, RN · Nov 14, 2005

I would refuse to sign the write up until my manager could show me a policy that stated I WAS to tx the individual.

How did she word the write up?

I would request a meeting with the DON.

talaxandra · Nov 14, 2005

ruby, i remember you posting this story in another thread, and i thought it was brilliant then, too. but i particularly like:

"just give her the damned valium," he bellowed. "or i'll have your job!" (not sure what he'd want with my job, he who was making enough to afford the mansion on the hill, a few mercedes' and regular safaris in africa -- first class, of course.)

that? awesome!

rehab nurse · Nov 14, 2005

wow, everyone~there sure are some stories here. glad i'm not the only one this has happened to!

couple people asked why i didn't just call er to take her....i work in subacute in a ltc, our sister hospital is around the corner about a mile away. so, my only option is to call ambulance, since the family didn't want to drive her.

this pt and family have a lot of psych issues. family routinely lays in the bed from what i gather in the nurses notes, and not anything was done about it.

thank you to the person who said "tell them to show the policy stating you're to treat the family". i didn't think about it. i'm too worried about how to defend myself, instead of putting the ball in their court so to speak and asking them to show me their policy. i will say this, my facility is on a firing streak lately, using anything they can construe to get you out the door, esp to those who are top of the tier pay wise. and i have been for two years. i am four classes away from my RN, so i will be leaving shortly anyway, i already have a job waiting for me. i love the pts where i work, and the setting, but the new management has to go.

i don't think i'll get far with the DON. she will back managers over staff any day of the week. my co-worker not too long ago, had a new pt come in needing tube feeding. the order was incorrect, the nurse could not get a hold of dietician, who physician had wanted called to fix order. she went to DON for help, and was told "oh, just give her some water, she'll be fine till the morning". :stone scary, scary, scary is all is say.

thanks so much everyone for your help and replies! glad i'm not the only one who thought the way i did about not treating the family!

oh, and the write up said partly "LPN incorrectly assessed situation, and did not render care as appropriate."