Making the right decision, no matter who gets mad.

[nurseT]

Early the other am, approx. 0430, I get a call from the jail. A 47 yr old black male is brought up to holding due to difficulty breathing. The officer says, his HR is 149 and his O2sats are 90%. I have a very sensitive BP/HR/pulse oximeter machine that the officers can use. It is real simple. hook up the patient and push the power button. However, it takes goofy readings if the patient is moving around or talking. So I tell them to let the inmate relax for 30 minutes and get me a full set of vitals and call me back. So they call me back with, BP- 98/66, HR- 149, O2sats 90%, T- 101.7, visible, audible difficulty breathing and a harsh cough. I order the officers to send inmate to ER for eval. The ER decides to admit this fella due to severe Pnuemonia, rt lung appears to be full. So later that am the jail commander calls me and says, "You need to intervene, call the hospital and tell them they need to send him back to the jail, tell them we can't pay for it, I went to see him and all he's gettin is oxygen and eating and watching TV, he wasn't that sick". I said "absolutley not", he'll die and I'm not going to be responsible for his death". We argued back and forth for what seemed like and hour of him hammering me, threatening that this would eat the entire medical budget, that he had pneuminia once and he didn't have to go to the hospital. I ended up getting very angry and said " Well, you're not a doctor, and if it was that easy, we could all be doctors, and if your pneumonia was so mild that you didn't need hospitalization, then lucky you, good for you". He ended up accusing me of "getting excited and hollering". I really wasn't, but I did match his ferocity. The inmate was declining and not responding to TX, so they took more pictures, he had a pleural effusion and they were going to put in a chest tube the last I heard. The judge OR'd the guy that day. Any way, All the officers at the jail that were my buddies before the inmate hospitalization, wouldn't get caught dead even looking at me much less talking to me. They were afraid of getting on the commander's sh*t list. His wife is the jail matron and she even called me and wanted me to call a certain person in the finance dept at the hospital and tell them we coudn't pay the bill and send the inmate back to jail. I refused and stated the doctor and I thought this was a very inappropriate request. She got short and hung up the phone. I had to do the right thing, even though they were bullying me. It was really hard, and I was really disappointed in the commander and his wife, I was stunned that they would be willing to sabotage another human beings' health care, pull some one off their sick bed. Anyone else a lone ranger out there?

[crjnursewarrior]

NurseT...

I just want to say GOOD FOR YOU!! You stuck to your guns! You were in the right, most definitely. I have had several experiences along those same lines, in regards to sending inmates to hospital. In one instance, officers were in medical unit during an assessment of an inmate with CP and increased BP. After contacting dr. by telephone and receiving several different med orders, nothing seemed to be bringing this guy's BP down. Our medical administrator, who is a nurse also, was there helping us work on him, we had pretty much figured a trip to the ER was inevitable, one of the officers (a bossy seargent who thinks he is a dr) was there, standing outside the exam room, espousing his views that he was sure the guy was faking....I had my doubts about the validity of his complaints as well, but when a person's VS identify distress, we are obligated to treat NO MATTER whose toes it steps on! My medical administrator went up front to the administrator on that particular incident and let him know that we nurses did not appreciate being second-guessed by security. He took care of the matter right away. For the most part, I will say that our security staff works well with us, but you still have a few people who will question you because they THINK they have medical knowledge. We have several officers who are EMTs and in emergency situations are indispensable help to us, but ultimately WE NURSES are in charge. And they know that and respect it. We have the licenses to protect and any time my judgement is questioned, I tell the person that. I worked too hard for my license to lose it because I made a decision that is unpopular with the suits in the front office. Not only so we have a license to protect, but we are obligated by our oath to "do no harm". We are obligated to get a patient the treatment he needs or that we feel he needs at the time, we are duty-bound...the officers are not. If something goes wrong who do you think they'll blame...THE NURSE! So, hold you head high! Flo Nightengale would be proud! You did the RIGHT thing!