My Day At the Hospital....

TheCommuter, BSN, RN · Jun 24, 2012

I'm sorry to hear about your experience. Sometimes bureaucracies are operated inefficiently and seem so very nonsensical.

minnymi · Jun 24, 2012

Maybe the nurse didn't know you were there from "out of town" to take your brother home? Even when she did know, she said, "we will get this done tomorrow, if not tonight."

I drive an hour to work each day. It's a stretch to call that "out of town" as if it's a huge burden. The nurse has no idea where you live or why you're there. Your brother called you....not the nurse. For all she knows...you're there to visit.

Assuming you're a nurse, you should know that these things happen. Unless your brother called you saying he was being discharged THEN....he wasn't being discharged yet. The doctor wrote discharge orders...that doesn't mean he's ready to be picked up.

allnurses Guide · Jun 24, 2012

It is the lack of decent communication here that is at issue more than anything else. The patient himself deserved an explanation of what the hold up was after he'd been told discharge orders had been written. I really don't think there is any arguing with that.

minnymi · Jun 24, 2012

It is the lack of decent communication here that is at issue more than anything else. The patient himself deserved an explanation of what the hold up was after he'd been told discharge orders had been written. I really don't think there is any arguing with that.

When I was working as a student nurse, i can't count how many times a doctor went into a room and told the patient they would be going home without explaining any further what would have to happen first.

I can't count how many times I would walk into a room and the pt would say, "oh, i'm getting ready to go home," and when i would approach the nurse she had no idea the doctor had written the order for discharge because they would jump in the room, inform the pt, scribble in their chart, and leave the floor without ever telling the nurse.

one time i had a patient tell me the doctor said he needed to get up into the chair from his bed and then he could go home. of course the doctor didn't mention that physical therapy had been ordered to get him up and that physical therapy wouldn't be there until the next day. no doubt, he had called everyone he knew and told them he was getting ready to have the aide put him in a chair and after he sat up for an hour he could go home.

i wonder how many experiences nurses who are shocked by this kind of thing have actually had.....especially since i don't consider myself an "experienced nurse" and i've seen it.

allnurses Guide · Jun 24, 2012

Believe me, I am not saying the nurse is to blame. It was the social worker in the room who openly stated discharge by that evening was a reasonable goal, leaving them to anticipate going home. This individual then decided to leave for the weekend without updating the patient and/or family.

sapphire18 · Jun 24, 2012

This kind of lack of communication with the patient and family is unacceptable. I experienced a terrible lack of communication when I was recently in the hospital- despite the nurses doing "bedside report." It bought me an extra 1-2 days on an inappropriate unit before I was transferred to the place I needed to be. This is beyond frustrating.

sapphire18 · Jun 24, 2012

And let me tell you, 1-2 days when you're stuck in a hospital bed is a looooong time. Not to mention the extra money it is costing my insurance co, and myself.

jadelpn, LPN, EMT-B · Jun 24, 2012

Home Health is an option, but the question I would want answered is what exactly is your brother going to do when the dressing has to be changed after each BM? A Home Health nurse would certainly do a daily dressing change (providing that your brother is homebound)--but if you are going to be needed to do the dressing change after peri-care, I can see the point that a better discharge plan is going to have to be put into place. Unfortunetely, at the end of the day it is hard to put all of these ducks in a row. Yes, communication was not optimal, however, at least you were party to the conversations regarding the discharge plan. Perhaps a better option would be an outpatient visit daily for dressing changes, and you may have to hang out with your brother for a few days.....anyways, as a nurse you know that doctors are just looking at the wound, not at the big picture. Your brother is fortunate that he has you to help him look at the big picture. I would have the social worker call you when the plan is in place, and then call the nurse when you are on your way to hold discharge teaching until you get there, as if you are going to participate in his aftercare, you need to know what to expect. And as a complete aside, If the wound is large enough that it requires such packing, I would explore the option of a wound vac. Then perhaps the wound would heal quicker, and home health could be involved as a skilled need. (not meaning to sound like he needs a vac to get the visits covered--not my intent--just that the wound sounds pretty massive and may take a considerable time to heal)

roser13, ASN, RN · Jun 24, 2012

Maybe the nurse didn't know you were there from "out of town" to take your brother home? Even when she did know, she said, "we will get this done tomorrow, if not tonight."I drive an hour to work each day. It's a stretch to call that "out of town" as if it's a huge burden. The nurse has no idea where you live or why you're there. Your brother called you....not the nurse. For all she knows...you're there to visit. Assuming you're a nurse, you should know that these things happen. Unless your brother called you saying he was being discharged THEN....he wasn't being discharged yet. The doctor wrote discharge orders...that doesn't mean he's ready to be picked up.

My brother was told by the surgeon in the AM that inpatient care was no longer medically necessary and that he was being discharged. When I arrived, the social worker was in the room, asking my brother for the address to give the VNS that, as she explained to me, she was in the process of arranging. We never heard from/saw her again. It was only when we questioned the RN 2 hours later that we learned that there was any type of problem. Yes, of course I'm aware that these things happen. Because I'm aware and had covered all my bases ( or so I thought), yet it still happened, is the reason that I was so put out. The communication was so very lacking between all parties.

roser13, ASN, RN · Jun 24, 2012

Home Health is an option, but the question I would want answered is what exactly is your brother going to do when the dressing has to be changed after each BM? A Home Health nurse would certainly do a daily dressing change (providing that your brother is homebound)--but if you are going to be needed to do the dressing change after peri-care, I can see the point that a better discharge plan is going to have to be put into place. Unfortunetely, at the end of the day it is hard to put all of these ducks in a row. Yes, communication was not optimal, however, at least you were party to the conversations regarding the discharge plan. Perhaps a better option would be an outpatient visit daily for dressing changes, and you may have to hang out with your brother for a few days.....anyways, as a nurse you know that doctors are just looking at the wound, not at the big picture. Your brother is fortunate that he has you to help him look at the big picture. I would have the social worker call you when the plan is in place, and then call the nurse when you are on your way to hold discharge teaching until you get there, as if you are going to participate in his aftercare, you need to know what to expect. And as a complete aside, If the wound is large enough that it requires such packing, I would explore the option of a wound vac. Then perhaps the wound would heal quicker, and home health could be involved as a skilled need. (not meaning to sound like he needs a vac to get the visits covered--not my intent--just that the wound sounds pretty massive and may take a considerable time to heal)

Yes, this was a tough situation to figure out. I had already observed the dressing change and knew how to deal with it. Because of the location, anatomy-wise, a wound vac was out of the question. We have a plan in place for in-between "emergency" dressing changes in the event of a BM. Update: discharge came at 9:45 Saturday night. So much fun to deal with scripts, etc, into the wee hours of the morning.

morte, LPN, LVN · Jun 24, 2012

Frankly, I think 5-7 days in LTC would have been the more appropriate discharge....