What to do, who to call

[Thornbird]

My situation is this: I am an LPN working in a SNF through an agency. I have seen such gross mismanagement of patients and callous attitudes about it that it shocks me. I have written letters to the DON of the facility but she appears to not care. My agency is strictly staffing and has no nurse manager to advise. These are some of the things that bother me: 1. An MD wrote an order for Coumadin with PT/INR on the chart of a post CVA pt. The supervisor who noted the order booked the labwork but didn't order the Coumadin or put it on the med kardex. It was discovered the next week when the PT/INR was done. I overheard 2 supervisors laughing about it "what difference does it make, she already had a CVA". BTW, minimal residual dysfunction from the original CVA. 2. An MD was faxed re: a patient with sudden lady partsl bleeding. First the supervisor hid the return fax and the RN who sent it looked for it for 3 days. The fax order was to obtain pelvic U/S. That was 3 weeks ago. when the orginal RN (who works 11-7 and couldn't schedule it himself) asked about it, the supervisor's response was along the lines of "why bother, what are they going to do about it anyways". 3. The dtr of a pt with metastic CA who is in denial (the dtr not the pt) requested that pain meds be d/c'd because they might be making her mother confused. Instead of either the nurse or MD educating the dtr about need for meds, they were d/c'd. Now the pt screams and cries all night in pain. 4. Abnormal test results are not phoned to the MD but are faxed even after office hours. A noteable example was a pt with a crtitcal potassium of 1.9. Rationale : pt is DNR. 5. Meds are given at inappropriate times. Examples regular and rapid-acting insulins (Novolin, Novolog) are given up to 2 hrs before meals. Once a day AC meds are scheduled for 6:30 AM, breakfast is at 8. Since the med pass is heavy and scheduled at the end of shift, these meds are given starting at 4:30 AM. I was taught that AC means 30 mins before the meal, not 1 1/2 to 3 1/2 hrs. The response to this concern is that night shift needs to "do their share".

I could continue to go on, but you get the idea. Any suggestions? I know that I personally can just move on to the next contract, but this really bothers me.

Catherine

[cursenurse]

I would make a detailed complaint to "the State." The attitude of the nursing supervisor frightens me, this person is not someone who should be working. Just because a person is elderly, or DNR, doesn't mean that you don't give care. The ignorance of the staff as far as the patient needing coumadin to prevent another cva- perhaps with severe deficits is unbelievable. As far as the CA patient is concerned, I would call the doctor and request pain meds every time I worked with the patient, if they came along after me and d/c'd them, I would keep getting orders. I think the "care" that these nurses are giving is appalling. I hope that you have copies of all of the letters that you have sent to the DON. You absolutely must call the state- whatever body/board inspects nursing homes- what is going on in that facility is criminal.

[RN1982]

I agree. I would file a formal complaint with the state. This SNF needs to be shut down. I can not believe some of the attitudes of those nurses. Playing russian roulette with their licenses. I would also suggest not going back to that facility if you can help it.

[infectionRN]

This is neglect as well as a delay in the patients treatment. I'm sure if you re-approached the DON of this facility and used the word "neglect" a few times the situation would then be investigated.

[shelly304]

I worked as a CNA for a very short time in a LTC facility. I could have written your post. Most of the nursing staff had been there for years-the DON for 20+. I quit and did inform the state of all the abuse/neglect. Within 3 months the facility closed. The detailed news report that appeared in the local paper made me sick. It wasn't just my call that helped shut the doors, many family members also were calling at the same time. Do what you know is right. You will have a clear conscience and be able to sleep at night.