I think I just need to talk about this...

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Specializes in Longterm Care.

I am an LPN working in longterm care. I love what I do for a living. I am currently working on my RN (at 42 years of age...lol). Today was one of the most difficult days, emotionally, for me as a nurse.

This morning I admitted an elderly woman to the facility that I work for. Nothing unusual about that except for her reason for admission. I really want to be able to discuss this without it becoming a HIPPA violation so of course, I will not use name, age, or location in this post. She came to us from the hospital having had exploratory surgery done in effort to determine the extent of internal damage caused by a self inflicted gunshot wound to the chest. She had attempted to shoot herself through the heart, however, the bullet ricocheted and traveled around her rib cage and exited through her back.

Now, I am sure ther are a lot of nurses here who see this kind of thing regularly, and perhaps have even become somewhat acclimated to it... but it is not something that comes through longterm care doors often. I have helped, during my career as a nurse, many, many people to leave this world with as much comfort and dignity as I could possibly provide. But never have I seen such anguish in another person as what I saw in this woman today, and frankly I am having a very difficult time dealing with it.

Then to top it off, my MDS coordinator hears about it and knocks on the door while I am doing her admission assessment. I called out that we were occupied but she came in anyway just as I was removing the dressing on my patients chest to measure the wound site. She said OH! OH! OH! I want to see this! If you could have seen the look of sheer humiliation on my patient's face it, I believe you would have been as sickened as I was by that behavior. Her actions took my patient from being a woman in crisis to being a gunshot wound in an instant. I asked her to leave the room and apologized to my new patient. Unfortunately that was all that I could do.

I could use some advice here from anyone willing to offer it. I am usually able to maintain a professional attitude about work, but I must admit that this one had me in tears all of the way home.

Thanks for listening,

Carly

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Specializes in Utilization Management.

You should definitely write that up as an incident. That MDS Coordinator had absolutely no business in there while you were assessing the patient's wound unless she had permission, which she did not.

This patient is rightly assessed by you as needing especially sensitive and caring treatment by the staff, and everyone needs to be on board with that concept.

Kudos to you for trying to provide the best possible caring environment for this patient.

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Specializes in LTC/Rehab, Med Surg, Home Care.

That is so sad! Remember that a suicide attempt is a cry for help, a permanent solution to a temporary situation (usually...you mentioned LTC, perhaps she was try to speed something along). In any case, you have a patient in crisis and the care team should focus on developing her care plan with this in mind. In addition to the long term care you and your facility will provide, her emotional/mental health needs must be adequately addressed.

I'm sure you know and understand all of this, but sometimes it helps to remind yourself or hear it from someone else. Take care of yourself, and let that MDS coordinator know what an insensitive idiot she was to your patient.

I am an LPN working in longterm care. I love what I do for a living. I am currently working on my RN (at 42 years of age...lol). Today was one of the most difficult days, emotionally, for me as a nurse.

This morning I admitted an elderly woman to the facility that I work for. Nothing unusual about that except for her reason for admission. I really want to be able to discuss this without it becoming a HIPPA violation so of course, I will not use name, age, or location in this post. She came to us from the hospital having had exploratory surgery done in effort to determine the extent of internal damage caused by a self inflicted gunshot wound to the chest. She had attempted to shoot herself through the heart, however, the bullet ricocheted and traveled around her rib cage and exited through her back.

Now, I am sure ther are a lot of nurses here who see this kind of thing regularly, and perhaps have even become somewhat acclimated to it... but it is not something that comes through longterm care doors often. I have helped, during my career as a nurse, many, many people to leave this world with as much comfort and dignity as I could possibly provide. But never have I seen such anguish in another person as what I saw in this woman today, and frankly I am having a very difficult time dealing with it.

Then to top it off, my MDS coordinator hears about it and knocks on the door while I am doing her admission assessment. I called out that we were occupied but she came in anyway just as I was removing the dressing on my patients chest to measure the wound site. She said OH! OH! OH! I want to see this! If you could have seen the look of sheer humiliation on my patient's face it, I believe you would have been as sickened as I was by that behavior. Her actions took my patient from being a woman in crisis to being a gunshot wound in an instant. I asked her to leave the room and apologized to my new patient. Unfortunately that was all that I could do.

I could use some advice here from anyone willing to offer it. I am usually able to maintain a professional attitude about work, but I must admit that this one had me in tears all of the way home.

Thanks for listening,

Carly

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Specializes in Cardiac Telemetry, ED.

No advice here, just I'm so sorry. What a hard situation.

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You should definitely write that up as an incident. That MDS Coordinator had absolutely no business in there while you were assessing the patient's wound unless she had permission, which she did not.

This patient is rightly assessed by you as needing especially sensitive and caring treatment by the staff, and everyone needs to be on board with that concept.

Kudos to you for trying to provide the best possible caring environment for this patient.

I would write it up as well as soon as you get to work today. I'm sorry you are so distressed but you did right by your patient and will do right by more taking action here.

And I agree kudos to you for being a wonderful and caring nurse.

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Specializes in IM/Critical Care/Cardiology.

Writning it up hopefully will help heal your emotions. What a difficult situation. Best of luck.

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The MDS coordinator needs to see the wounds and examine the pt. The way that she went about this was not appropriate though. She should have calmly walked in stating that she needed to see the wounds as part of the assessment process. She is only guilty of being insensitive. This is not something that needs a "writeup" but I would go to her privately and discuss your concerns that she was too eager and made this pt feel like a circus sideshow instead of a pt needing a full assessment to plan care and satisfy government requirements.

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Maybe the MSDS person did need to assess the wound, but an insensitive remark to a patient is way out of line. That type of behavior needs to be addressed. Bad behavior is like rotten apples- it spreads from one to the next until the whole bag stinks.

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The MDS coordinator needs to see the wounds and examine the pt.

really?

since when?

any mds coordinators i've seen, refer to admission notes.

either way, i'm still not sure if i'd write her up or not, recognizing i'm feeling pretty ticked off at her now.

but w/o a doubt, she needs to be called on it to ensure it never happens again.

i hope this poor lady has gotten a stat psych eval?

leslie

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Specializes in Day program consultant DD/MR.

If there is not a write up about the situtation at the very least report it to the unit manager or the DON. The MDS coordinator needs a a refresher in ethics 101 ASAP........ The pt is a human being, she deseverse respect she is not a circus show.......

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really?

since when?

any mds coordinators i've seen, refer to admission notes.

Now that is just scary to me. If you do not examine patients wounds, speak to them, assess how they complete ADLs, etc. you cannot accurately fill out the MDS. I never relied on what was in the chart without verifying things for myself. And when I found that things were not even charted, as can happen when a nurse has 30+ pts, I documented in the chart for verification when I completed the MDS.

Being stupid and insensitive is not a violation of nursing practice acts and probably is not against any facility policy was well. So writing her up for this probably isn't going to get anywhere. I would speak with her if I were there. And I'd make a note in my CYA book for future reference. If she has a history of things like this, the DON may do something. If not, writing her up without speaking to her about it is a sure fire way to alienate her and cause even more problems instead of heading them off at the pass.

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Now that is just scary to me. If you do not examine patients wounds, speak to them, assess how they complete ADLs, etc. you cannot accurately fill out the MDS. I never relied on what was in the chart without verifying things for myself. And when I found that things were not even charted, as can happen when a nurse has 30+ pts, I documented in the chart for verification when I completed the MDS.

i know little about the role of mds nurses.

i only worked in ltc for less than a yr and remember the turnover being high.

we had 3 different mds nurses in 10 mos.

and none of them had contact w/the pts.

they would either refer to the charts or hunt down the nurses.

i'm glad to hear you had actual contact w/residents.

leslie

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