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?
here is how i would handle this situation. i am here to take care of this nice lady. if you would like that to happen, i suggest you stop with the verbal abuse. i don't care if her son is a doctor, lawyer or the us president. nobody deserves to be abused like this and if that don't work, next time you work have a copy of the federal guideline of a hostile workplace and abuse in your pocket. show them to the son and advice him you are as of now documenting all abusive behavior. this will be reported to the state's medical board and the local ombudsman. then, for god's sakes, follow through. we put up with way more than we should from doctors, it drives me insane!below is a quote from the federal policy regarding a hostile work environment. and, please don't think for two seconds you not being discriminated against because of your sex and education (or what the good doctor sees as your "lack" of education)
the question of liability arises only after there is a determination that unlawful harassment occurred. harassment does not violate federal law unless it involves discriminatory treatment on the basis of race, color, sex, religion, national origin, age of 40 or older, disability, or protected activity under the anti-discrimination statutes. furthermore, the anti-discrimination statutes are not a "general civility code."4 thus federal law does not prohibit simple teasing, offhand comments, or isolated incidents that are not "extremely serious."5 rather, the conduct must be "so objectively offensive as to alter the 'conditions' of the victim's employment."6 the conditions of employment are altered only if the harassment culminated in a tangible employment action or was sufficiently severe or pervasive to create a hostile work environment.7 existing commission guidance on the standards for determining whether challenged conduct rises to the level of unlawful harassment remains in effect.
the saga of the "good son" continues unabated. today our hospice team had an interdisciplinary team, which is where we get together for an hour to talk over what's been going on with our patients and what we are doing or what we would like to do about their problems. during our meeting, the subject of this pt and her "good son" came up, and our team doctor said "just tell them to revoke! tell him flat out if they don't like what we're doing, go sign up with someone else, then let them find out there is no one else!"
downstairs, i was in conversation with our patient care coordinator, and our acting patient care manager. the pcm told us that she had gotten a "very ugly" call the day before from the "good doctor son", and of course he gave her an earful about the stupid gerichair and why haven't we gotten rid of it yet? since she was acting on behalf of our usual pcm who went on vacation, she wasn't quite familiar with the situation, and asked "uh, excuse me but who are you?" the "good son" responded with "i am john doe (not his real name of course) and i am better known as doctor john doe of the university hospital system!" of course the pcm's attitude upon hearing this was "well, whoop-dee-do!" well word got around real quickly around the office, and now whenever the "good son" name comes up, we all stand up and say in unison "better known as doctor john doe of the university hospital syatem!" a little levity in this otherwise unfortunate situation.
on a different note, the social worker covering this case contacted the "good son" ("better known as doctor john doe of the university hospital system!" and told him that we wished to have a family meeting to discuss his concerns over the care we and the facility are providing his mother. he asked the social worker, "what are you doing in the middle of this?" to which she replied that as one of the hospice provider's social workers, it is her job to do so. we are arranging to have the good doctor ("better known as doctor john doe of the university hospital system!" ), a social worker from us, and the facility, the facility's don, one of our community education reps, our chaplain, our general manager or patient care coordinator, and at least one hospice doctor present. the plan is for everybody to put our cards on the table, and gt it out in the open just what in the heck is the problem, what will make everybody happy, and what is reasonable or not. we also plan to tell him that if he wants us to provide care, then he needs to trust us to do our job. i am really loking forward to that meeting, because we are going to adress once and for all the issue of pain control for his mother, which is absolutely crucial that we have a hospice doctor present.
anybody ever see the tv show "house"? i am reminded of a conversation that dr. house had with a family member of a patient on the show. the mother was aghast at how dr. house was talking to her. she said "who the heck are you to be talking to me like that?" dr. house's response was "i'm the doctor who's going to save your son's life, and you are the mother who is trying to keep me from doing it!"
in this case, i am the nurse who is trying to take care of his mother, and he is the family member who is keeping me from doing my job.
more later, guys, keep those posts coming!
The saga of the "good son" continues unabated. Today our hospice team had an Interdisciplinary team, which is where we get together for an hour to talk over what's been going on with our patients and what we are doing or what we would like to do about their problems. During our meeting, the subject of this pt and her "good son" came up, and our team doctor said "just tell them to revoke! Tell him flat out if they don't like what we're doing, go sign up with someone else, then let them find out there IS no one else!"Downstairs, I was in conversation with our Patient Care Coordinator, and our acting Patient Care Manager. The PCM told us that she had gotten a "Very ugly" call the day before from the "good doctor son", and of course he gave her an earful about the stupid gerichair and why haven't we gotten rid of it yet? Since she was acting on behalf of our usual PCM who went on vacation, she wasn't quite familiar with the situation, and asked "Uh, excuse me but who are you?" The "good son" responded with "I am John Doe (not his real name of course) and I am better known as DOCTOR John Doe of the UNiversity Hospital System!" Of course the PCM's attitude upon hearing this was "well, whoop-dee-do!" Well word got around real quickly around the office, and now whenever the "good son" name comes up, we all stand up and say in unison "Better known as DOCTOR John Doe of the University Hospital syatem!" A little levity in this otherwise unfortunate situation.
On a different note, the social worker covering this case contacted the "good son" ("Better known as DOCTOR John Doe of the University Hospital System!" And told him that we wished to have a family meeting to discuss his concerns over the care we and the facility are providing his mother. He asked the social worker, "What are you doing in the middle of this?" To which she replied that as one of the Hospice provider's social workers, it is her job to do so. We are arranging to have the good doctor ("Better known as DOCTOR John Doe of the University Hospital System!" ), a social worker from us, and the facility, the facility's DON, one of our community Education reps, our chaplain, our general Manager or Patient Care Coordinator, and at least one hospice doctor present. The plan is for everybody to put our cards on the table, and gt it out in the open just what in the heck is the problem, what will make everybody happy, and what is reasonable or not. We also plan to tell him that if he wants us to provide care, then he needs to trust us to do our job. I am really loking forward to that meeting, because we are going to adress once and for all the issue of pain control for his mother, which is absolutely crucial that we have a hospice doctor present.
Anybody ever see the TV show "House"? I am reminded of a conversation that Dr. House had with a family member of a patient on the show. The mother was aghast at how Dr. House was talking to her. She said "Who the heck are you to be talking to me like that?" Dr. House's response was "I'm the doctor who's going to save your son's life, and you are the mother who is trying to keep me from doing it!"
IN this case, I am the nurse who is trying to take care of his mother, and he is the family member who is keeping me from doing my job.
More later, guys, keep those posts coming!
Wow, what a terrible situation. I hope that it gets resolved quickly so that this poor pt can get the care she needs and deserves.
As for the prescribing to a family member and treating fam. members- does that apply? It seems that he is basically refusing treatment. What a shame that this poor woman has these people controlling her medical care.
And as a side note, I hope I never end up under this guy's "care" in an ER!
I'm glad a meeting has been arranged. It sounds like they are gearing up for a lawsuit so jsut keep on documenting. Good for you for getting the ball moving here. Looks like the hospital will be well represented for the meeting which is key. Could they include someone from your legal department?! I don't know what policy is, but I would suggest they be there.
Question: In a situation like this where the nurses are being abused and working in a hostile environment do they have to continue care for this patient?! I know the actual patient isn't the issue, but at what point does a higher up do the care or insist they leave?! TY. Just curious.
POAs come with limitations. They are not enforcable if the patient is capable of making a decision. She may be aphasic, but can she still make decisions. If I found myself in this situation, I would feel compelled to notify Adult Protective Services, and have her evaluated before the family can move her. What they are doing to this lady amounts to abuse. What city do you live in? I want to stay out of the ERs there.....
I agree that this whole thing seems to have been going on awhile but if the lady's primary MD does not order any pain med then how are you supposed to give it? It seems to me the pain control issue sholud be addressed with the MD in charge of the woman's care and if he orders it (which it doesnt sound like he has either because he is intimated by the patients son or else he hasnt been asked) and then the son refuses to let anyone give it adminstration should handle it. I do not know much about LTC facilities or hospice policies though but it is a sad situation that the son seems to have the need to be so in control that he cant see what is best for his mother. Sometimes people have a need to be right that no matter who it hurts they will not change their mind. Sounds to me like the son is a control freak who needs to find things wrong or ways to stay in charge that by now he wont listen to reason because that would mean he'd have to give up his control and scare tactics.
Another note of concern I have is that if the son or anyone in the ER that this son works with sees this thread I do believe enough info is posted that the son would figure out it was him and his mother that was being discussed. I know you havent given any names however patient situation and events are pretty detailed. I just dont want any more amunition to be placed in the son's hands.
I don't understand why he has a say in it at all. Surely he isn't HER doctor. Why can't you call her doctor and get and order for what is needed? Do families really control prescriptive authority in LTC?
I've seen it happen also. :angryfire Administration and the MDs always knuckled under to the (medically ignorant but potentially litigous) family. We nurses had to fight all the way to the top for the helpless patients that were essentially trapped in misery and pain because of their families.
I've seen it happen also. :angryfire Administration and the MDs always knuckled under to the (medically ignorant but potentially litigous) family. We nurses had to fight all the way to the top for the helpless patients that were essentially trapped in misery and pain because of their families.
That is just sick and wrong.
I have seen this happen a few times, also. It always is a challenge not to strangle these "family members". I say that loosely, 'cause if it were me not getting pain relief I wouldn't claim my son, or my so as family!
POAs seem to have lots of sway with administration, if with no one else. I once had a pt that was aphasic from a CVA, had a PEG tube for years that we were using for meds and all feeding/fluids. Her son was the only family we thought she had.
After about seven years of this, the son dies of a MI. A daughter no one even knew about, let alone ever saw, shows up. She claims that her mom never wanted a PEG tube, claims to have papers to this effect. So admin caved, got an order from her PCP to hold all meds, fluid, feedings, and for pt to remain NPO.
So, this poor LOL, who was aware on many levels, slowly starved to death over 10 days. I say starved, b/c the PCP did order one med to be given with about 200 cc of water a day. I had some major issues with this, but was told it was legitimate with whatever paper work this daughter produced for DFS and admin.
So, you may be fighting a losing battle, but I can completely understand your feelings, and I wouldn't give up. I would fight to get the poor lol some pain relief. Even if you are shot down, at least you will know you did everything you could for her.
ShayRN
1,046 Posts
here is how i would handle this situation. i am here to take care of this nice lady. if you would like that to happen, i suggest you stop with the verbal abuse. i don't care if her son is a doctor, lawyer or the us president. nobody deserves to be abused like this and if that don't work, next time you work have a copy of the federal guideline of a hostile workplace and abuse in your pocket. show them to the son and advice him you are as of now documenting all abusive behavior. this will be reported to the state's medical board and the local ombudsman. then, for god's sakes, follow through. we put up with way more than we should from doctors, it drives me insane!
below is a quote from the federal policy regarding a hostile work environment. and, please don't think for two seconds you not being discriminated against because of your sex and education (or what the good doctor sees as your "lack" of education)
the question of liability arises only after there is a determination that unlawful harassment occurred. harassment does not violate federal law unless it involves discriminatory treatment on the basis of race, color, sex, religion, national origin, age of 40 or older, disability, or protected activity under the anti-discrimination statutes. furthermore, the anti-discrimination statutes are not a "general civility code."4 thus federal law does not prohibit simple teasing, offhand comments, or isolated incidents that are not "extremely serious."5 rather, the conduct must be "so objectively offensive as to alter the 'conditions' of the victim's employment."6 the conditions of employment are altered only if the harassment culminated in a tangible employment action or was sufficiently severe or pervasive to create a hostile work environment.7 existing commission guidance on the standards for determining whether challenged conduct rises to the level of unlawful harassment remains in effect.