In my opinion, if we nurses have a patient whom we transfer to another unit or facility, we should be able to obtain information as to the subsequent course of events and treatments of the patient. This information would be valuable to nurses so we can better understand the disease process and thus strengthen our nursing practise.
For instance, let's say I have a patient whose case is too complicated for my small hospital, who has a certain set of signs, symptoms, lab values, etc. The patient then gets transfered to a larger, better equiped facility for further evaluation and treatment. I think finding out the outcome of events would be extremely valuable to me, not because of idle curiousity, but because it would make me a more astute practitioner. It would broaden my perspective and give me a better grasp of what signs and symptoms led to what outcomes.
Therefore, I think we nurses have a 'need to know' the eventual outcomes of patients, even when they are no longer under our direct care. Knowing outcomes will make us better nurses!
I brought up the case because it made me aware of the fact that, once I transfer a patient, I am out of the professional loop and have no idea as to what eventually happened. This is not the case with MDs, they are able to follow the outcomes of patients whom that have transfered to the care of specialists. Nurses, however, are not trusted with this information. We are not deemed suitable to be included within the circle of professionals worthy to be trusted in finding out clinical outcomes of patients for whom we have cared.
I don't think it's that, exactly. I had a pt the doc wanted d/c'd. Well, the doc wanted the pt taught by nursing how to admin his own lovenox, and the earliest he could get his shot was after I left, so I arranged for the teaching and a supervised pt demonstration and I ensured he knew it was vital for him not to miss a dose. Plus the doc wanted d/c planning to make sure the pt knew where to get the dosage locally. They did that.
The pt called the next day after he was no longer my pt nor the hospital's, and he said the place that swore to our d/c planner they had the product ready to go said it would take 2 days. I said I was sorry this had happened to him, explained we got lied to and I wished it were otherwise, and I said if I were him, I'd grab the Yellow Pages and start calling until I found someone who had it.
Well another doc overheard this and complained to the first doc and the first doc went off on me, slamming around and fuming about how the pt could die and that all this was unacceptable since it was unknown whether the pt actually got the med (he's still mad at me a week later). As is my custom, I didn't respond. See, the pt was still *his* pt--I know because I typed up the d/c instructions and put in the follow-up appointment with this doc.
But the pt wasn't *my* pt any more (nor do I belong to the doc--so my pts are only those my charge assigns me). That's why I couched my reply to the pt in limited terms. And that's all I could do; he wasn't my pt; I was totally engaged with the 5 pts who *were* mine, and I was happy with the situation, because the law, in saying we have no relationship with pts who aren't currently assigned to us, protects us.
What more did I need to know? Actually I learned more than I normally would have. I know I successfully motivated him to be concerned about getting his med on time because he called and seemed determined to comply with his d/c instructions. But even lacking some of the feedback and learning opportunities that doctors may have that I don't, I'm totally satisfied with the tradeoff the law imposes on me.
I brought up the case because it made me aware of the fact that, once I transfer a patient, I am out of the professional loop and have no idea as to what eventually happened. This is not the case with MDs, they are able to follow the outcomes of patients whom that have transfered to the care of specialists. Nurses, however, are not trusted with this information. We are not deemed suitable to be included within the circle of professionals worthy to be trusted in finding out clinical outcomes of patients for whom we have cared.
I noticed you're writing of consults where the attending maintains an ongoing relationship with the patient. It seems that in the ancient and original professions (medicine, law, and clergy), the practitioner has an ongoing relationship with the pt (or client or parishioner). It may be that this is the origin of such professional rights/responsibilities as pt confidentiality.
So please pardon the sideways drift here, but this plays into several threads on the board about whether nursing is a profession. With the exception of say FNPs, it wouldn't seem to be a profession in this characteristic of having an ongoing relationship with the pt, which is normally terminated by clear notice on the part of either practitioner or client.
Anyway maybe this is a reason nurses aren't "kept in the loop."
As a nurse, I want to know if the patient I bothered the doctor endlessly about until he sent him or her to ICU actually had something bad wrong with them or I was way off the mark. And if I was right, what was I right about? I think that much I should be able to find out without HIPPA getting involved.
anonymurse
979 Posts
I don't think it's that, exactly. I had a pt the doc wanted d/c'd. Well, the doc wanted the pt taught by nursing how to admin his own lovenox, and the earliest he could get his shot was after I left, so I arranged for the teaching and a supervised pt demonstration and I ensured he knew it was vital for him not to miss a dose. Plus the doc wanted d/c planning to make sure the pt knew where to get the dosage locally. They did that.
The pt called the next day after he was no longer my pt nor the hospital's, and he said the place that swore to our d/c planner they had the product ready to go said it would take 2 days. I said I was sorry this had happened to him, explained we got lied to and I wished it were otherwise, and I said if I were him, I'd grab the Yellow Pages and start calling until I found someone who had it.
Well another doc overheard this and complained to the first doc and the first doc went off on me, slamming around and fuming about how the pt could die and that all this was unacceptable since it was unknown whether the pt actually got the med (he's still mad at me a week later). As is my custom, I didn't respond. See, the pt was still *his* pt--I know because I typed up the d/c instructions and put in the follow-up appointment with this doc.
But the pt wasn't *my* pt any more (nor do I belong to the doc--so my pts are only those my charge assigns me). That's why I couched my reply to the pt in limited terms. And that's all I could do; he wasn't my pt; I was totally engaged with the 5 pts who *were* mine, and I was happy with the situation, because the law, in saying we have no relationship with pts who aren't currently assigned to us, protects us.
What more did I need to know? Actually I learned more than I normally would have. I know I successfully motivated him to be concerned about getting his med on time because he called and seemed determined to comply with his d/c instructions. But even lacking some of the feedback and learning opportunities that doctors may have that I don't, I'm totally satisfied with the tradeoff the law imposes on me.