Kudos to this doctor

bebbercorn · Apr 25, 2016

Don't know you, doc, but I love ya.

roser13, ASN, RN · Apr 25, 2016

Honk if?

I hate when I see a typo that I missed, but it's too late to edit. It's usually an autocorrect thing.

But I do think your honk is the best I've seen in a while;)

djh123 · Apr 26, 2016

He would get a hand-hurting high-five from me for this part alone:

Family member screams, "It's THEIR job to help him heal!" Dr responds, "If he doesn't want to help himself, they can't help him. They provide excellent nursing care and it's evident where the problem lies."

mkrn32 · Apr 26, 2016

Gotta love docs that stick up for their nurses!! And not cower any time a family member gets loud. We need more like him!!

Susie2310 · Apr 26, 2016

Overheard a conversation the other day between a pt's family member and a doctor. I was sitting at the nurse's station and he was sitting beside me. Family member walked up to him and began yelling that her loved one is not getting the proper nursing care and demanded to know why the pt was not any closer to discharge status. Dr says pt had been educated on post-op plans and had been refusing to take initiative to begin the recovery process (i.e. getting up, ambulating, incentive spirometer, etc.). Per documentation, RNs have been charting (in detail) that pt has been refusing.
Family member screams, "It's THEIR job to help him heal!" Dr responds, "If he doesn't want to help himself, they can't help him. They provide excellent nursing care and it's evident where the problem lies."
Family member continues to yell/scream (literally screaming) about an NA who "got urine all over him while helping him use urinal in bed." Dr says, "I don't understand, why can't he use the urinal without assistance?" She says (through gritted teeth), "if my son, who is sick and in pain and unable to sit up or get out of bed, needs to pee, you better be darn sure someone here is gonna hold his member in a bottle for him...and NOT spill his **** all over him!!" Dr replied, "well ma'am, then I suggest you re-familiarize yourself with your son's anatomy and provide that care yourself."
At this point, I'm picking my jaw up off the floor. On behalf of all RNs and NAs, I wanted to give him a big, fat wet one!!
FYI, pt is twenty-something 3 days s/p lap sleeve gastrectomy.

While you mentioned that the nurses have been educating the patient as to the need to get up, ambulate, and use the incentive spirometer, you didn't mention what efforts the staff have made to discover the reason for the patient's refusal to do these things. Why was the patient refusing to get up? Were staff available to help the patient get out of bed, and to assist with ambulation? Why was the patient refusing to use the incentive spirometer? Was the patient shown how to use the incentive spirometer, and did they do a return demonstration? Were they encouraged to use it regularly? Was the incentive spirometer easily within their reach?

The attitude conveyed by your post to me is that the staff (nurses and doctor) may have taken a rather arrogant, passive-aggressive, negative attitude towards the patient and their family member. I am not suggesting that the patient and/or their family member may not have been difficult to take care of. When the family member approached the physician with a complaint about the care a family member is receiving, whether justified or not, stating that it is the job of the staff to help their family member, it is appropriate to investigate the complaint and to work with the family member/patient towards a solution for the patient/family member.

Has anyone investigated why the patient isn't participating in their healing as expected?

Being a family member, as numerous nurses on this forum have posted, is often a very stressful experience for NURSES when their own family members are hospitalized, and nurses have an understanding of hospitals, patient care, and disease processes. For family members who may have problems of their own and patients, there are even more difficulties and stressors; they don't understand everything that is happening in the hospital as nurses do; it is often difficult for them to articulate their concerns and to understand medical terminology that is used, and they don't have a knowledge of various disease processes, etc.

A softer attitude and being willing to listen and understand why people are behaving the way they are goes a long way.

Also, in my experience, just because something is documented (i.e. patient education) does not necessarily mean it was done.

NurseSpeedy, ADN, LPN, RN · Apr 26, 2016

[quote=

Any guesses as to what 'bad survey reports' will be forthcoming from that family? :banghead:

I think this is something that administration fails to acknowledge when they get on the nursing staff to improve these bogus scores. Any patient that had a rotten experience, even if it is only what their delusional version of rotten is, will write a novel about how crappy their experience was....whereas a patient that for some reason had a positive medical outcome against all odds will probably not be filling out a survey showing how great they thought the hospital staff was during their stay.

MsPebbles · Apr 26, 2016

While you mentioned that the nurses have been educating the patient as to the need to get up, ambulate, and use the incentive spirometer, you didn't mention what efforts the staff have made to discover the reason for the patient's refusal to do these things. Why was the patient refusing to get up? Were staff available to help the patient get out of bed, and to assist with ambulation? Why was the patient refusing to use the incentive spirometer? Was the patient shown how to use the incentive spirometer, and did they do a return demonstration? Were they encouraged to use it regularly? Was the incentive spirometer easily within their reach?
The attitude conveyed by your post to me is that the staff (nurses and doctor) may have taken a rather arrogant, passive-aggressive, negative attitude towards the patient and their family member. I am not suggesting that the patient and/or their family member may not have been difficult to take care of. When the family member approached the physician with a complaint about the care a family member is receiving, whether justified or not, stating that it is the job of the staff to help their family member, it is appropriate to investigate the complaint and to work with the family member/patient towards a solution for the patient/family member.
Has anyone investigated why the patient isn't participating in their healing as expected?
Being a family member, as numerous nurses on this forum have posted, is often a very stressful experience for NURSES when their own family members are hospitalized, and nurses have an understanding of hospitals, patient care, and disease processes. For family members who may have problems of their own and patients, there are even more difficulties and stressors; they don't understand everything that is happening in the hospital as nurses do; it is often difficult for them to articulate their concerns and to understand medical terminology that is used, and they don't have a knowledge of various disease processes, etc.
A softer attitude and being willing to listen and understand why people are behaving the way they are goes a long way.
Also, in my experience, just because something is documented (i.e. patient education) does not necessarily mean it was done.

Susie, you make very valid points. It was never my intention with my original post to convey an arrogant or snarky approach to a family member or patient; however, based on the limited info I've gathered about this pt and his mother from staff who had participated in his care, their behavior and his lack of participation in his own care/healing process, the response by the physician seemed warranted.

His mother refused to leave (spending all 3 nights there), and flat-out refused for him to be weaned off his Dilaudid PCA on post op day 2, as is customary with this type of procedure. Our staff is known to provide excellent post-op care and we provide excellent teaching (incentive spirometer use, ambulating within a few hours of surgery to minimize risk of pneumonia, etc). At one point, staff had gotten pt to dangle, with the intention of at least attempting to stand up, and pt's mother screamed at them that he appeared pale & that their actions were "bringing him to the brink of death" (per my coworker who was assigned to pt a couple days prior). As I understood it, pt had demanded his mother seek out "anyone with a white coat" numerous times to increase his Dilaudid dosage as he wasn't going to do anything until his pain was "completely gone." Attempts by staff to educate him on alternative pain therapy and the reasons why ambulation, while initially painful and difficult, can lend to a quicker recover were met with absolute refusals and threats of complaints to management.

As a nurse whose parent has been battling a chronic, difficult illness with multiple recent hospitalizations, I can completely empathize with family members of my patients. Truly, I do. But sometimes there are just those people who expect us to be their miracle workers and cater to their every irrational whim. Some people will stop at nothing just to have their way, even when every attempt is made to educate and reinforce those reasons why they must remain compliant during recovery, which, knowing my colleagues, had been continuously addressed.

So, in this particular instance, knowing what I know and having witnessed the mother's behavior on that day, I find that the doctor's response was appropriate and very much appreciated.

MJB2010 · Apr 26, 2016

This is going to sound cold, and I apologize. I worked on a bariatric floor for a short time when they were short staffed and quickly realized why they were short staffed. Very difficult floor with a lot of lifting. This is not an unusual case, but seems an extreme one. Sounds as if mother needs an intervention, and some counseling and education. Doesn't sound like she is ready to listen. A lot of times the extremely obese have an enabler that helps them get there. This sounds like a classic case of codependence. Very common. The family dynamic is going to change or this man ( at 23 he is a man) is going to have a difficult recovery. The patient is normally sent for a psychiatric check up before getting approved for the surgery, but they enabler is not.

High five to the Dr for standing up for his staff. A lot are quick to blame nurses, but there are some that appreciate us.

Susie2310 · Apr 26, 2016

Susie, you make very valid points. It was never my intention with my original post to convey an arrogant or snarky approach to a family member or patient; however, based on the limited info I've gathered about this pt and his mother from staff who had participated in his care, their behavior and his lack of participation in his own care/healing process, the response by the physician seemed warranted.
His mother refused to leave (spending all 3 nights there), and flat-out refused for him to be weaned off his Dilaudid PCA on post op day 2, as is customary with this type of procedure. Our staff is known to provide excellent post-op care and we provide excellent teaching (incentive spirometer use, ambulating within a few hours of surgery to minimize risk of pneumonia, etc). At one point, staff had gotten pt to dangle, with the intention of at least attempting to stand up, and pt's mother screamed at them that he appeared pale & that their actions were "bringing him to the brink of death" (per my coworker who was assigned to pt a couple days prior). As I understood it, pt had demanded his mother seek out "anyone with a white coat" numerous times to increase his Dilaudid dosage as he wasn't going to do anything until his pain was "completely gone." Attempts by staff to educate him on alternative pain therapy and the reasons why ambulation, while initially painful and difficult, can lend to a quicker recover were met with absolute refusals and threats of complaints to management.
As a nurse whose parent has been battling a chronic, difficult illness with multiple recent hospitalizations, I can completely empathize with family members of my patients. Truly, I do. But sometimes there are just those people who expect us to be their miracle workers and cater to their every irrational whim. Some people will stop at nothing just to have their way, even when every attempt is made to educate and reinforce those reasons why they must remain compliant during recovery, which, knowing my colleagues, had been continuously addressed.
So, in this particular instance, knowing what I know and having witnessed the mother's behavior on that day, I find that the doctor's response was appropriate and very much appreciated.

In your OP you "overheard" a conversation at the nurses' station, and in your post above you have been gathering information from staff who provided care to the patient and their mother. If you were not taking care of the patient or were not involved in their care, why are you making it your business to know this much about this patient or their family member? HIPAA?

You are making judgements about a patient (and their family member) who is not even your patient.

MsPebbles · Apr 27, 2016

In your OP you "overheard" a conversation at the nurses' station, and in your post above you have been gathering information from staff who provided care to the patient and their mother. If you were not taking care of the patient or were not involved in their care, why are you making it your business to know this much about this patient or their family member? HIPAA?
You are making judgements about a patient (and their family member) who is not even your patient.

I never looked at the patient's chart, I don't know his name or his medical hx, and I couldn't even tell you what he looks like. We are a large, but close, surgical unit. I didn't seek out any additional information. Yes, the limited details I know were shared with me by colleagues. We will share our frustrations, successes, experiences with difficult and wonderful patients, and seek out advice and support from one another. Just as we all do here on AllNurses (as I'm sure you have with your 1000+ posts).

My initial post was meant to show gratitude to the doctor who appreciates and respects what we, as nurses, do. Nothing more. But you are free to interpret my posts however you choose.

ComeTogether, LPN · Apr 27, 2016

In your OP you "overheard" a conversation at the nurses' station, and in your post above you have been gathering information from staff who provided care to the patient and their mother. If you were not taking care of the patient or were not involved in their care, why are you making it your business to know this much about this patient or their family member? HIPAA?
You are making judgements about a patient (and their family member) who is not even your patient.

Seems like you're picking on the OP and I don't know why. OP was sharing a rare moment of a doc sticking up for nursing staff, it is safe to assume the situation warranted it. We all know the type of pt. OP is talking about and those who don't probably don't work in direct patient care.

OP - I don't think you need to keep explaining yourself, and I appreciate you sharing.

Libby1987 · Apr 27, 2016

In your OP you "overheard" a conversation at the nurses' station, and in your post above you have been gathering information from staff who provided care to the patient and their mother. If you were not taking care of the patient or were not involved in their care, why are you making it your business to know this much about this patient or their family member? HIPAA?
You are making judgements about a patient (and their family member) who is not even your patient.

I'm missing the motivation to analyze OP to this degree.

We have abundant negative threads and posts, can we simply take this positive thread at face value?