I recently was in a tough situation, and made a comment I now regret but still feel a bit of fustration! I take care of a 86 year old lady with multiple chronic illnesses, she has some dementia and anxiety issues. The RP is her daughter, who is very sweet and I have established a wonderful repor with over the last year or so that I have taken care of her mother, I have built a relationship of trust and respect, (which is not always easy in LTC). The resident has recently had c/o her ears "not feeling right", they "feel funny", she c/o of not being able to hear from time to time. I reported to MD and requested he check her ears...after more than one request the NP writes an order for a ENT referral, our SW contacts the daughter, who questions why? Daughter fears the out trip and visit would cause her mother alot of duress as her mother doesn't even like to leave the floor for the ice cream parlor! SW calls me and states she called MD to clarify for the daughter and MD requested the nurse look in resident's ears, so SW was asking me to do so!! I felt this was inappropriate. Daughter also asks me why the ENT referral and does she really need to see a ENT? Seems there is no communication going on between MD and RP...I am once again the middle man! I told the daughter I can not make the determination if resident needs ENT, daughter really struggled with decision, she kept putting it back on me..finally I said it....the words I deeply regret but then again I don't. Resident fell x3 in short period, I called the daughter to report, daughter asks me if I think it could be related to ear c/o, again asks if I think she needs to see ENT..I replied that we colud not know until evaluated because it could be anything..she continued to ask questions and ponder decision, I stated her ear c/o could be from nothing or something very serious, I gave example of either wax build up or God forbid, a tumor. The daughter then states, "My mother does have h/o a brain tumor in the base of her brain, didn't you know?" Nowhere is this in the resident's medical record, I even checked with medical records, I called MD, who was furious and scolded me up and down for my comments....he said NEVER should I mention a diagnosis, we can be sued. But I found out my client has a brain tumor..I was asked my opinion and put in the middle of a situation, I said the problem could be anything, trying to get out of makng the decision myself. I am usually very careful about what I say, and I am always asked my opinion and for advice from family members. I was trying to help this daughter make a decision and learned something of my resident past medical history. But I made a huge, "No No" and am feeling very uneasy. Anyone ever done something like this??
Thank you all so much for your comments! I feel 100% better I take criticism very hard. I'm sure you all understand that desire to deliver the most compassionate care :redpinkhe Then to have a physician yell at me..I had not had that happen to me in YEARS and then to insult me and state it's inappropriate and lawsuit worthy, I felt like how could I have been inappropriate when I have such a great repor with this RP. (BTW we lavaged this clients ears in April.) And of course, in this lawsuit society, I wouldn't want to put myself at risk.
Just another person totally agreeing that you are totally in the clear. I am also in LTC in St. Louis and know that the docs here can be very conservative but that doesn't remove our responsibility to advocate for the residents, which is exactly what you did in a completely appropriate way. There was no diagnosing going on, just answering an RPs legitimate questions. Don't second guess yourself!
I don't see what you did wrong. I had a patient recently who had already had one leg amputated and all toes off the other. He had numerous necrotizing spots on the foot with no toes. When the daughter asked me what she should do, I told her to contact his MD and make an appt. She had told me previously that she didn't think our wound care was doing a good job and that was why his foot was necrotic. He's a diabetic who she refuses to let have insulin, just Prandin and already had numerous amputations. I told her that he would probably need more surgery d/t his poor circulation. He had no pedal pulse and zero profusion to the bottom of his foot or in his leg. A week later he was sent out for extreme nerve pain d/t the dying of the tissue and his other leg was amputated. I gave my professional opinion and prognosis of the situation. As a nurse we don't have to stand back and say only what the MD tells us to say, we can offer medically pertinent information that may be a possibility in the patients future care. We are able to put two and two together and offer some information. You did nothing wrong. You were being honest. If you rattled off bad prognosis for every sympton for every resident with every family member, I would be concerned, but due to the symptoms, and the situation you were in, I would of done the same thing. Nursing has so many roles and it's sometime confusing which one to play and in what way, but if your being your patients advocate along with the family, I don't know how ethically you can go wrong. Don't beat yourself up.
Anyone ever done something like this??
nowinsituation
3 Posts
Thank you all so much for your comments! I feel 100% better I take criticism very hard. I'm sure you all understand that desire to deliver the most compassionate care :redpinkhe Then to have a physician yell at me..I had not had that happen to me in YEARS and then to insult me and state it's inappropriate and lawsuit worthy, I felt like how could I have been inappropriate when I have such a great repor with this RP. (BTW we lavaged this clients ears in April.) And of course, in this lawsuit society, I wouldn't want to put myself at risk.