Published
To all,
I am a Hospice RN/Case Manager who just recently assumed care of an elderly Nursing home Pt who has a son who is an ER Doctor. This man is completely involved in the care of his mother...can't blame him for that,.....except that we can't do a single thing with his mother without clearing it with him. I mean, I can't even have the mattress changed without running it past him.
THe issue that I have a real problem with is that this lady has a Stage III wound on her heel which requires daily wound care. It is very painful to her. I can tell, even if the lady is aphasic, because she pulls her foot away, and starts breathig heavy and "sputters", and moaning. When I first took care of her, I called this son, and asked him if I could PLEASE order up some Roxanol liquid Morphine for her to have 1/2 hour before wound care, to ease her pain. I got an earful about how "I don't want anybody doping my Mom up, my mom doesn't do well on morphine, she received it post-op, and it just knocked her out." I told him that I wasn't going to give her a large dose (POst-op doses are much higher and usually given IV, are they not??) but he cut me off, saying, that "I know how nursing homes operate, if they have it, they'll give it, and pretty soon, she'll be a zombie." Getting nowhere with him, I next consulted with the lady's husband who is her next POC. I told him that I was concerned about her pain, but that their son said no, and we have to go by his decision. Ten minutes later, I got a callback from this same son chewing me out for "trying to go behind his back." I told him of course that I did no such thing, that I was talking to his dad at his request, and was reporting on my observations as her new Case Manager. But again, his mind was made up, don't confuse him with facts. He said that his decision was final and under no circumstances, was his mother to receive any narcotic medicines.
A couple of days later, I was taking care of this lady at the same time as her husband was there, and I did her wound care. He would not stay in the rom while I did it, but waited in outside. When I was done, I wheeled her out to him, and of course she was still showing s/s pain. I told him "Do you see, sir, that she hurts? THat would care is very painful to her, see she still hurts." HIs answer was "Look, she is just going to have to hurt. MY son and I have made our decision, she is not going to get any narcotics of any kind, and that's all I am going to say about it, so I'd appreciate it if you din't bring it up again." I of course documented everything that was said, and reported same to the facility nurses who basically just shook their heads and said "we've all dealt with that son!"
THis lady has actually been with several different hospice providers before us, and was d/c'd from the last one for long-term prognosis, or as the son said "she wasn't sick enough." I feel very stymied by all this. My first instinct is to recommend that this lady be discharged, and tell the son, you want to take care of her, well here she is, have at it, since we can't do anything without his sayso anyways. THis lady has a past history of seizures and Tegretol was ordered, and the next day this son cancelled the order. Anybody got any thoughts on how to deal with this unfortunate situation?
I think the son should come in and assist or just watch for a few days while you do the dressing change, maybe seeing his mother writhe in pain may snap him into reality. I hate when family thinks their loved will get "addicted" when they are on hospice....they are dying...it is a non issue at this point.
Shuu says "I think the son should come in and assist or just watch for a few days while you do the dressing change, maybe seeing his mother writhe in pain may snap him into reality. I hate when family thinks their loved will get "addicted" when they are on hospice....they are dying...it is a non issue at this point."
THe other day, the good doctor son did come in, and he did that very thing, watch his mother's wound care. I was tehrer to make a nursing visit to his mother, and he gave me an earful about the gerichair that she was in. Seems that his mother was on a spoecial wheelchair that belonged to the therapy dept, and they needed it back, and requested that we provide a gerichair. When he saw it, he went through the roof. He said it's not padded enough, and his mother will get decubitus on her arms and backside. He told me "YOu get the right kind of chair, and I want it done today! I don't want to hear about how you can't provide it. I've been in medicine for 15 years and I know what can be done. If your supplier can't provide it, tyhen you'd better fire your supplier and find another one. And don't tell me your company can't afford it, your financial problems are not mine. And if I have to end up buying it, then you people will start getting charged for my professional time!" The good doctor then demanded that I do would care right now on his mother. I went to go find the facility would care nurse, and she was busy at the desk. I told her what the son wanted, but before she could respond, the good doctor came down and said "When the hell are you going to do wound care? I don't lkike asking twice." I told him that this was the facility wound care nurse, and she doesn't take orders from me, only the DON of the facility. We went down to do the wound care, and he observed everything. He then told me that he expected me to carry out his wishes without any more fuss, and that "You represent these people here."
I sent the problem up the chain of command to my General Manager, who, afer some investigation, found that there is a such thing as a "Cozy Cushion Gerichair cover" available, that will cost us $100. We have gone ahead and ordered it, but I am afraid that the good doctor will not accept it, as he wants "the right kind of chiar."
In the meantime, I came in on another day, and the lady's husband (the father of the good doctor), and he told me how unhappy he is with the care his wife is getting. He said "we were promised in your contract that ther would be no changes to her chair" I reminded him that the facility's thereapy dept insisted that the special chair be returned to them so they could use it for another patient. He said "IN that case, then you were obligated to provide the same kindof chair that she was on. MY son made it very clear to you that we won't settle for less than what she deserves." I told the man that first of all, the facility requested we provide a gerichair, and that is what we did, second of all, the special kind of chair is not called for in the plan of care specified by her attending doctor, who said "GERICHAIR" for patient comfort and mobility. I also pointed out that the pt was actually very comfortable in the gerichair, much more than I have seen her lately. He said that he doesn't care if she looks comfortable or not, he wants the same kind of chair. (this is the same man who said, when I pointed out that she is hurting from her daily wound care "well she is just going to have to hurt.") I stopped short of telling him that we can't provide that kind of chair just because eh wants it anymore than we can provide satin sheets, and a feather pillow.
There was another family member with him who nitpicked everything I did for mny assessment. "Aren't you supposed to hold the hand up to her heart when you use a wrist cuff?" I pointed out that her elbow is contracted, so I can't move her wrist up that far. She said "why are you putting that thermometer under her arm? You can't get an accurate reading that way, put it in her mouth!" "When did you do wound care? THis bandage isn't dated, how are we supposed to know when it was done? For all we know yu peoplke don't even check her wound, I can't believe this, your care sucks!"
I know that we are real close to telling this family that they can just go find someone else if they don't like the care we are giving, but I really want to see this through to the end. THere's just something very satisfying about being able to tell a jerk like that where to get off...professionally, of course.
You do not deserve to be abused in such a manner. Where the hell is the administration in all of this? They need to tell these jerks to back off or find another facility.
The lady has been a resident of the nursing home for over 4 years. In that time, the son has hired and fired 3 other hospice service providers besides us, and has also fired three different attending doctors from the case. The DON has told me that he knows not to cross the line over which the facility weould tell him to take his mother somewhere else. I wish they would just do it anyways. I feel for the staff nurses that they end up taking tehr brunt of it. In all that time she has been tehre, there's never been a word of thanks from this family, only complaint after complaint.
In my opinion, what he's doing has crossed the line. God bless you and give you the strength to care for this poor woman who is caught in the middle of this messThe lady has been a resident of the nursing home for over 4 years. In that time, the son has hired and fired 3 other hospice service providers besides us, and has also fired three different attending doctors from the case. The DON has told me that he knows not to cross the line over which the facility weould tell him to take his mother somewhere else. I wish they would just do it anyways. I feel for the staff nurses that they end up taking tehr brunt of it. In all that time she has been tehre, there's never been a word of thanks from this family, only complaint after complaint.
I am sorry, but this is downright abusive. They are abusing staff and the patient.
ARGGGG!!!!!!!! This makes me so mad reading this!!!!!
Makes me wish we could call the police on mean people!
If it were me I would be contacting admin every shift if necessary. Patient complaints are patient complaints and they have to deal with them. I think if they come to talk to the family every day they may get some idea of the horrible treatment being poured out upon the nursing staff.
The real loser in the whole situation is the poor patient. I wish I could go kidnap her and take care of her away from those meanies!
The more I think about it, the more I believe that administration and her primary doctor should sit this man down and tell him to cease and desist immediately with his bullying and abusive behaviour. Call him on it, and tell him it will not be tolerated any longer. No apologies, no waffling, just bluntly stating that enough is enough. That then puts the ball in his court, and any action that occurs afterward is on his shoulders.
Then they should meet with all personnel who come in contact with this family and coordinate a plan of attack, as it were. Make sure everyone is on the same page, and that everyone gives a consistent response to his behaviour and demands.
At this point, it certainly couldn't make him any nastier.
the son should not be involved as a prescriber - simple as ...
here in right pondia the professional guidelines for prescribers ( whether doc, dentist, nurse or pharmacist) frown on prescribing for self or family members other than 'minor' stuff or in a true emergency...
does the lady the OP is caring for have a none family member physician either their primry care doc or a specialist? perhaps this doc ought to talk to the son ...
Read this post last night and was sooooo mad I wanted too vent away. Have calmed down since that time. I agree with all other posters, he needs to be reported, and that family needs to be SHAKEN and BEATEN!
Okay no violence.....kicked a little?
I can't stand family members like this...I am not PC with them, and very often get into trouble for intervening and speaking my mind.
My mom had a sports medicine doc that didn't seem to care about patient pain or disability....basically, he believed in the "suck it up" mentality of medical treatment. Very conservative with pain meds. UNTIL, he injured himself, required surgery and PT..he became a very different man.
It seems this man needs divine intervention just like the above story....I just hope it's in time for mom.
Maisy;)
What more is there than morphine? Fentanyl patch? Other ? Induced coma?
Morphine is not effective for everyone. I have had 2 surgeries and 1 orthopedic injury in which morphine was completely inefective, but demerol, and even tylenol with codeine provided relief.
It is negligent to deny pain medication to a patient simply because one particular medication provided unsatisfactory results.
scattycarrot, BSN, RN
357 Posts
Unfortantly the gel doesn't penetrate the deep layers of the dermis so if its a deep wound, it won't do anything. I imagine this is a fairly extensive wound and so would be too big for LA. How often does she have her dressing changed? Is there any possibilty of a femoral nerve block? I know thats unlikely but I thought I would throw it out there! If her son is indeed an ER doc maybe he could come do the block himself!