Our Administration recently reprimanded several ER Doctors and Nurses. The reason- several patients with very very minor problems (ie: Very minor Contusions, Acute Rhinitis, Bumped Acrylic Fingernail, Superficial Paper Cut) had requested "Strong Pain Medicines" (ie: Morphine, Fentanyl, Dilaudid IM/IV and presciptions for Oxycodone, Hydrocodone to go) and didn't get them. While they didn't receive these medications due to the ER doctors didn't feel it was Clinically Indicated, the patients did receive appropriate interventions, such as X-Rays, CT scans, crutches, ice packs, elaborate wound care, Motrin, Tylenol, wheelchair service, etc.
The Reprimand/Verbal Policy by our Managment: All patients who ask for Strong Pain Medicines should get as much as they want, without knocking out their Respiratory Drive- even if it's not Clinically Indicated. Rationale? "Customer Service"..."Happy Customers are less likely to complain and less likely to Sue." "Give them all that they want." Might sound unbelieveable to some of you, to others maybe I sound callous, but for me it brings up Ethical Questions, the Hippocratic Oath & the Ethics of Business Practice.
The Question: Is this Legal or Ethical? What about the Hippocratic Oath? "Do No Harm"? Are we harming these people by giving them Medications that aren't clinically indicated, or are we harming them by allowing them to "Suffer" from Contusions, Sinusitis, Broken Fingernail, etc without the benefit of Opiates? Should we do interventions (medication and non medication) that aren't Clinically Indicated just because patients ask for them, just to make them happy? Are we monopolizing business from other Hospitals by doing this?
To note, our ER already has the unspoken policy of "give the customer whatever he or she wants", even if not Clinically Indicated, in terms of everything else, and our Community knows and expects this. For example, a young and very healthy patient had a superficial paper cut that we couldn't even see, but we did all she requested, wheelchair service, Irrijet Wound Care, Bulky Dressing, Vicodin Orally and Presciption, Meal, Refreshments to friends in Waiting Room, Personal Phone calls to concerned friends and family. No kidding, this is typical AND EXPECTED BY MANAGMENT at our facility.
Also what I see that is detrimental with this practice is that our ER staff is overloaded with the Customer Service Demands of the not-sick patients, and hence Critical Care patients don't get the care they need. Critical Care patients can't complain, while not sick patients can complain and ask for unlimited things. And our management, not being Clinical Practitioners, don't see the reasoning of this.
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
Okay, I've read and re-read this post and quite frankly, with the way it is written, I do not believe this.
You do realize, that if what you say is TRUE and you haven't reported your chief nursing officer to the board of nursing (as they are an administrator), and your nurse manager and director then YOU are guilty of allowing this to happen, AND facilitating as well.
Specifics I would like to have you clarify...
1) "several" patients with very minor problems...had requested strong medicines... How many is several?
2) reprimanded "several" ER doctors and nurses...HOw many?
3) why were they reprimanding the nurses? The nurses can't prescribe or order meds?
4) What reprimand? A written report that goes in their employee file?
5) There is NO DEFENSIBLE policy that could be written with the words "should get as much as they want"....this is not legally defensible and subjective in nature. A solid policy is objective.
Why don't you go ahead and publicly state some specifics like name of facility, administrators involved etc. If this stuff is all true as you say, YOU have a legal and ethical responsibility to whistle-blow.
If you DON'T go public, you are part of the problem and just as guilty. Even if you quit that job and you know that it was not resolved when you left - you had knowledge of it and did nothing (at least you've not posted here that you did anything so one can only assume you haven't)
-MB
Our Administration recently reprimanded several ER Doctors and Nurses. The reason- several patients with very very minor problems (ie: Very minor Contusions, Acute Rhinitis, Bumped Acrylic Fingernail, Superficial Paper Cut) had requested "Strong Pain Medicines" (ie: Morphine, Fentanyl, Dilaudid IM/IV and presciptions for Oxycodone, Hydrocodone to go) and didn't get them. While they didn't receive these medications due to the ER doctors didn't feel it was Clinically Indicated, the patients did receive appropriate interventions, such as X-Rays, CT scans, crutches, ice packs, elaborate wound care, Motrin, Tylenol, wheelchair service, etc.
The Reprimand/Verbal Policy by our Managment: All patients who ask for Strong Pain Medicines should get as much as they want, without knocking out their Respiratory Drive- even if it's not Clinically Indicated. Rationale? "Customer Service"..."Happy Customers are less likely to complain and less likely to Sue." "Give them all that they want." Might sound unbelieveable to some of you, to others maybe I sound callous, but for me it brings up Ethical Questions, the Hippocratic Oath & the Ethics of Business Practice.
The Question: Is this Legal or Ethical? What about the Hippocratic Oath? "Do No Harm"? Are we harming these people by giving them Medications that aren't clinically indicated, or are we harming them by allowing them to "Suffer" from Contusions, Sinusitis, Broken Fingernail, etc without the benefit of Opiates? Should we do interventions (medication and non medication) that aren't Clinically Indicated just because patients ask for them, just to make them happy? Are we monopolizing business from other Hospitals by doing this?
To note, our ER already has the unspoken policy of "give the customer whatever he or she wants", even if not Clinically Indicated, in terms of everything else, and our Community knows and expects this. For example, a young and very healthy patient had a superficial paper cut that we couldn't even see, but we did all she requested, wheelchair service, Irrijet Wound Care, Bulky Dressing, Vicodin Orally and Presciption, Meal, Refreshments to friends in Waiting Room, Personal Phone calls to concerned friends and family. No kidding, this is typical AND EXPECTED BY MANAGMENT at our facility.
Also what I see that is detrimental with this practice is that our ER staff is overloaded with the Customer Service Demands of the not-sick patients, and hence Critical Care patients don't get the care they need. Critical Care patients can't complain, while not sick patients can complain and ask for unlimited things. And our management, not being Clinical Practitioners, don't see the reasoning of this.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I couldn't do it. I guess you must work in a place where most of the patients have really good insurance. But I'd be seething inside. If I were that Doctor, I'd be saying hasta la vista before the day was out.
Our Administration recently reprimanded several ER Doctors and Nurses. The reason- several patients with very very minor problems (ie: Very minor Contusions, Acute Rhinitis, Bumped Acrylic Fingernail, Superficial Paper Cut) had requested "Strong Pain Medicines" (ie: Morphine, Fentanyl, Dilaudid IM/IV and presciptions for Oxycodone, Hydrocodone to go) and didn't get them. While they didn't receive these medications due to the ER doctors didn't feel it was Clinically Indicated, the patients did receive appropriate interventions, such as X-Rays, CT scans, crutches, ice packs, elaborate wound care, Motrin, Tylenol, wheelchair service, etc.
mwboswell
561 Posts
Okay, I've read and re-read this post and quite frankly, with the way it is written, I do not believe this.
You do realize, that if what you say is TRUE and you haven't reported your chief nursing officer to the board of nursing (as they are an administrator), and your nurse manager and director then YOU are guilty of allowing this to happen, AND facilitating as well.
Specifics I would like to have you clarify...
1) "several" patients with very minor problems...had requested strong medicines... How many is several?
2) reprimanded "several" ER doctors and nurses...HOw many?
3) why were they reprimanding the nurses? The nurses can't prescribe or order meds?
4) What reprimand? A written report that goes in their employee file?
5) There is NO DEFENSIBLE policy that could be written with the words "should get as much as they want"....this is not legally defensible and subjective in nature. A solid policy is objective.
Why don't you go ahead and publicly state some specifics like name of facility, administrators involved etc. If this stuff is all true as you say, YOU have a legal and ethical responsibility to whistle-blow.
If you DON'T go public, you are part of the problem and just as guilty. Even if you quit that job and you know that it was not resolved when you left - you had knowledge of it and did nothing (at least you've not posted here that you did anything so one can only assume you haven't)
-MB