This is the one thing I do NOT like about Hospice. Tonight, had a patient transferred in from an area hospital. The woman has end stage cancer. She is absolutely Hospice appropriate. However, the family is in NO WAY shape or form ready for her to be in hospice. She is still a full code, they want all her meds to stay the same and asked when her AM labs would be drawn. I asked them exactly what it was they wanted. They really would like more treatment, but the doctors told them nothing more could or would be done for her. We discussed hospital and acute care vrs. hospice and comfort care. She was admitted respite care so that the family could have time to decide whether or not to place her or to take her home. They thought she was coming in as an inpatient for symptom management. I reviewed the two types of services with them as well. The decision was made to have her admitted, then discuss all options with the medical director and social worker on Monday. (Did I mention the great planning that had this woman transferred at 6pm on a Friday night? They KNEW this was going to be a problem:banghead:) So in comes patient's sister after I finally got through to the spouse and children. "What do you MEAN she can't stay past 5 days? We cleared all this with "Mrs. Big whig" at your main office. Don't you understand who I am? I have donated a lot of money to this place and I demand that you take care of my sister:rolleyes:" My reply? Ma'am, "Mrs. Big whig" doesn't have the authority to make those kinds of decisions, her title is in marketing. The doctor and social worker will be in Monday to help straighten everything out. Futhermore, while our organization does appreciate all donations that will not encourage us to make fraudulant claims to insurance companies. If we did that then they would shut us down and we could help nobody. ALSO, I have cared for a US Senator's father and I have cared for the homeless, they all get treated with the same respect.
She was not happy with me, her hand was on her hip and she was jabbing her finger in my face. Finally the patient's spouse had to tell her to stop it. She then left the building and promptly called "Mrs. Big Whig" and left a message on her cell phone. I got a call at 11:30 at night. How dare I say she has No Authority, she IS a director. I replied, I wasn't being disrespectful, I was being honest. You do NOT have the authority to decide if someone is admitted GIP or repite care. Further, I hope the money she gave was worth all the energy and time I have spent admitting this patient tonight while the rest of my patients got neglected. I was informed in no uncertain terms it wasn't about the money it was about the patient. Blahhhh, sometimes I just want to tell them all where to go. I just want to take care of my patients and make them as comfortable as I can.
Well, I guess she started in on the Assoc. Med Director yesterday. His response? Hmmm, I thought the decision was made to wait until Monday. We will just leave her respite for now, as nothing I see here would qualify her for GIP.
unfortunately people with money and connections will always think that they deserve preferential treatment. that will never change. we deal with this alot where i work and i am very laid back about these type of confrontations. i tell them i am the nurse and i am here to care for your family member, i cannot and will not put my job at risk for doing something outside of policy, if you would like to call someone else with more power then you can let them deal with it. nurses have enough to worry about than deal with people like this.
Do you all remember the thread I had a week or so ago, about the woman who donated a lot of money and shoved it down my throat? Well the head of Marketing (the woman who is in charge of collecting donations) went to the top administrator with complaints about MY attitude and the way I dealt with the woman that night. Nobody has read my documentation, I asked, and I had an hour long meeting with the "top dog" last night. It ended with me leaving work sobbing and questioning whether or not this is the company I want to work for every day. Ofcourse, my clueless boss didn't do anything to support me, but then he never has so that isn't a surprise. I really, really love Hospice nursing. This is the only inpatient facility in our area and I don't want to do in home visits. I am sad, angry and scared. I do have other alternatives, however. Every time I pick up on my old unit I get offered my job back. I also do agency on the side and wherever I go, they tell me to come back any time. I just don't want to leave what I love. HELP!
I am so sorry this is happening to you. I would set up a meeting with the 'top dog' or whoever and have a non-emotional discussion with them. You, of course, will have questions and ideas that you would like to talk about (write them down so you won't get sidetracked by others or your emotions) and also insist that your documentation can basically speak for itself.
Have they talked about possible firing because of this issue?
Do you feel you need legal representation to protect yourself?
Specializes in Med/Surge, Psych, LTC, Home Health.
I had to go back and read your original post. =) I admire you for the way that you handled the whole thing. I unfortunately have no advice. I wish I did.
Did the family complain to the top dog or just the marketing woman?! It could be she is trying to throw some blame you're way out of embarassment as she overstepped her boundaries with the family from what I remember.
Are they threatening to suspend of fire you?! On what grounds?! How long have you been with this company?! If they are just making you miserable and aren't threatening any action again you that effects your job description, title, money, etc. I would just let it play out. Perhaps it just ends here for them and I would sign NOTHING as you did nothing wrong.
If you decide you want to leave do so after clearing your head a bit. If you love it there and this is an isolated event just let it go. If you can't deal then look for something new you that you love.
Didn't the marketing director make promises to the patient's sister that if delivered could have led to fraudulent claims being made to insurance companies?
Didn't you discuss with the patient's spouse (who would be the next of kin, not the sister) the options available and it was agreed that they would discuss with the medical director and social worker to also discuss the options available and a decision would be made then?
This marketing director made decisions with the patient's sister, not the patient's next of kin, nor the patient. A director of marketing certainly isn't qualified to make promises much less decisions regarding the care of that patient.
I think you should write exactly what happened in the most objective terms possible, speak/discuss what happened with the facilities risk management. I have a feeling the top administrator you spoke with may not be well versed on the possible consequences that could have been caused had you simply went along with what the marketing director promised the patient's sister. Arrange another meeting with this administrator and risk management.
I think risk management will have some real problems with the marketing director's behavior and actions. If that's the case, they may convice the top administrator to view the situation differently.
No matter what they say it's always more about money than anything else! If it wasn't, this wouldn't even be an issue. What did they suggest you do instead of being a patient advocate? In your original post it sounded like the spouse was the more rational one- is he the POA & has admin. even talked to him??
This incident illustrates why we need single payer. Hospitals and clinics need to be competing for patients not insurance contracts. Greed is the downfall of health care. We need to get back in the business of caring for patients according to their needs not for how to maximize reimbursements.
RN1982
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