How do I respond to wrongful allegations

clownlove · May 29, 2014

I have posted this on the Australia forum as well but thought perhaps there are more people reading the general forum. Sorry in advance for the double post if its considered a faux pas

We have a lady in our nursing home who in the last few weeks has taken to yelling out literally all day and all afternoon. Its been distressing for other residents around her as well as staff and visitors. She had been reviewed by older persons mental health and they reported back to her normal GP that they didnt see anything wrong.

Her regular GP did prescribe risperidone 2.5mg BD PRN

This medication has been un-successful so the other day I was talking with the RN in charge and I stated to her that I thought that we needed to contact this resident's GP to seek alternatives, she very quickly replied that she didnt think we should and also stated that she didnt have confidence in this GP and that she had no buisness prescribing psychotic type medications and that it should be done through OPMH

Yesterday I tried to contact OPMH to no avail and by 1430 aftet this poor lady had been yelling out all day and all afternoon I rang her GP and explained what was happening and simply asked her what she thought we could do as she was the one who prescribed the risp in the first place. Her suggestion was initially serapax but she quickly said no that it wasnt a good idea as we didnt want to knock this resident out so she gave an order of diaz 2.5 - 5mg TDS PRN

Now bear in mind that the said RN was off shift when I called the GP and I didnt give the GP any suggestions as to what to prescribe, the said RN comes on shift this morning and in report hears that this resident had been given 2.5mg of diaz and that she had settled and had been easier to manage and the look I got wasnt nice.

She then proceeded to go to the DON and reported me for acting outside my scope of practice for ringing the GP as she claims my intent was to change the medication regime and that I ignored her directive.

I have been given a few days to respond in writing but I'm so ****** off that I dont even know how to reply to this, that being said this same RN also accused me of bullying another RN the other week and reported same to the DON, I was able to verbally meet the DON and explain the whole story so that was resolved and didnt go any further.

If anyone has some good letter writing skills with this kind of thing any help would be appreciated. Do I not have a duty of care to this resident to try and acheive outcomes that benefit her and her quality of life.

Regards and thanks for any help

ProgressiveActivist, BSN, RN · May 29, 2014

I would describe in factual concise manner and in chronological order the events contacts and orders received.

as well as the pt.s response.

clownlove · May 29, 2014

Thanks Libby, I have drafted a reply so far and I beleive that I acted in the best intrest of this resident to try and acheive a positive outcome for her.

And I think it would stand to reason that if the GP didn’t want to order a particular medication the she wouldn’t regardless of whether she was prompted or not and she is the residents GP after all.

So this poses the question is it not within my role to relay to the GP changes within her patient so she can decide how we are to treat her? My intention was not to change her medication regime as suggested, I was acting out of my duty of care to try and achieve a better outcome for a lady who is suffering a lot of mental anguish.

The afternoon shift nurse clearly documented on our system that she administered 2.5mg of diaz and that within a short time resident was settled and was even able to take a phone call from her sister and still maintain a conversation with her.

Mollytone · May 29, 2014

It is not within the scope of the RN to deem that she feels the GP is not up to the task. You have a duty of care to advocate for your patient at all times, it's one of the reasons you are there. You have shown the initiative that I would expect from an EN and equally as a team member. Well done.

In forming your written response you should give them the definition of both teamwork, empathy and duty of care. You were not seeking to better the RN but trying to resolve a distressing situation for your patient. Just because we have the degree doesn't make you any less important when providing the best possible care.

thenightnurse456 · May 29, 2014

Some facilities have policies that don't allow ENs to call doctors. You should check if your facility has that sort of policy.

It has something to do with assessment/phone orders or something like that.

I think that if the prescribed medication wasn't having any effect, the RN should have informed the GP and requested an alternative.

You had the right idea though.

ausrnurse · May 29, 2014

It may depend on the state you are working in, but I think you may have been toeing the line of practicing outside of your scope by contacting the doctor without an RNs knowledge. Was there another RN on that shift? However, I know things do work a little differently in aged care, and I work in a hospital setting. I don't think this nurse was necessarily right for reporting you to the DON either. She could have spoken to you in person first. I think the best thing for you to do would be to contact your DON and present your side of the story as well.

Unfortunately in the elderly, drugs like diazepam can actually make dementia and psychosis symptoms worse in the long term, so I can understand why the RN would not have wanted the patient started on these drugs and would have preferred to get the mental health team involved - they have more experience in this area than a GP and could have worked towards a better outcome for this patient. Understandably, that isn't helpful when you are the nurse on, listening to a distressed and agitated patient all day. We've all been there :)

clownlove · May 29, 2014

Thanks Mollytone that sums it up nicely as I wasnt trying to undermine the RN at all but I think she feels this way as she wasnt there, and I thought thats what we were supposed to do is show initiative as we all reap the benefits.

thenightnurse456 Thank you as well for your reply and honestly I dont think we have such a policy as I have sent numerous faxes and countless phone calls prior to this most of which have resulted in a positive outcome of some sort even has been to demonstrate that I tried to do something in the eyes of he family, the eca staff but most importantly the resident.

I see it as a form of customer service if you will.

Both or your replies have given me some food for thought, so again I thank you so much.

clownlove · May 29, 2014

Thank you ausrnurse, I can totally see what you re saying and I have spoken to this RN and I did state to her that I was in no way attempting to backdoor her or undermine her and she did explain the ramifications of diaz in the elderly which I took on board. We talked about this at approx 0800 hrs and the DON actually contacted me at 1445 prior to report to ask me to come see her.

I did explain my side and she did ask that I submit a reply in writing and she assured me that this wasnt going to be put on my file, this particular RN tends to be very aggressive and she doesnt like it when she is challenged in any way.

The RN that reported me also tried to implicate me for bullying another RN who is also the same one she constantly runs down and tells everyone how much she hates her so for some reason at the moment she has decided to be this RN's mate and focused on me.

And honestly I have already been polite and showed respect to the RN that reported me the other day. I really need to ensure that I word my reply so that it reflects that I was really just trying to do the best for that resident under the circumstances. Sigh why do we as adults still have to deal with bullies!!!!

jadelpn, LPN, EMT-B · May 29, 2014

If you are an RN, or an LPN with the ability to take telephone orders, then I am not sure what the issue is. The medication that the patient was receiving was not working. It is up to the GP to decide what to do about that, not nursing. You can only report what you are seeing and the effects of the medication.

If the GP came in house and the patient continued with their distress, and the GP then decided to change the medication, that is not your issue, you can only do as ordered by the GP.

There are many nurses who have said "do you think we could try xyz" and either the GP agrees and gives a specific order, or no and gives no orders or an alternate. The ultimate decision lies in the GP and not nursing.

To be a patient advocate is not a bad thing. I would be clear and concise that the patient, regardless of being medicated per MD order with risperidal (dosage) continued to act out in a disruptive manner. That other patients were complaining (if they were). That the patient was yelling until she was hoorifice (if she did). That you called to report this to the MD, as justifying an anti-psychotic medication that was not effective is not in the patient's best interest.

And be sure that other things are attempted, and documented. Music in the room, a family member to sit with the patient. Patient in a wheelchair able to move about in the chair. If you have therapy animals, or other groups and activities that the patient is allowed to participate....because those attempts are just as important to be documented as medicating.

Good luck and let us know how it goes.

Esme12, ASN, BSN, RN · May 29, 2014

threads merged as per the TOS

Ruas61, BSN, RN · May 29, 2014

What is an EN?

How do I respond to wrongful allegations

Are EN's allowed to ring GP's to seek treatment for residents