This is horrible: the doctors and staff won't do anything

Nurses Safety

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I am new in this facility, less than one month in. I am also a new RN with lessI than 6 mos. Experience. So anyways, there is this patient who fell and hurt her arm at our ltc. 2 wks have gone by and it's gotten progressively worse. It's swollen, hard, and VERY tender to the touch. One nurse contacted the doctor about this, he looked at it, and nothing was done. Oh, advil was prescribed. Thats it. No xray, ultrasound, or mri. This area is raised and hard. The pt is whincing in pain and losing mobility in this arm d/ t pain. I was told to not bother the dr with this bc he had already seen it! I called anyways, and nothing was done! Just give cold compresses!! What should I chart and is there anything else I can do?! This poor patient!!

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Specializes in Post Anesthesia.

Does the patient ever get visitors/family? They may be able to get a response from the medical staff even if you can't. The tricky part is getting them involved without saying " I think this needs to be evaluated but the doctor caring for your loved one is incompetent." It'll take a bit of planning and linguistic slight-of-hand. The other option is you can report the problem anonymously to your states nursing home ombudsman assoc. In the mean time, careful assessment and documentation is a must to keep from being scapegoated if or when someone does take action. With any luck the lady will develope a URTI or somesuch that will require a trip to acute care- This happens- don't miss the chance to encourage the hospital/urgent care center, to evaluate the old injury. Unlike an ECF- they get paid for the proceedures they do.

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Specializes in SICU, trauma, neuro.

Talk to your facility's medical director. That poor woman. :no: Good for you, advocating for her the way you are!

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Please contact whomever oversees nursing homes in your state. Joint Commission? Ombudsman? Adult Protective Services? You may also want to file a complaint against that doctor with the state medical board. Please find someone outside your facility to report this to.

Meanwhile, document everything you observed about the patient and everything you did, in an objective, professional manner. Make sure you also state whose attention you brought it to, within your facility. (Of course you don't chart reporting it outside the facility.) Good luck.

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Did you ask for an x ray? Sometimes you have to ask for what you want - just an FYI for the future!

But yes state should be contacted if you've asked and doc won't give.

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I mentioned not seeing an order for an xray, mri, or ultrasound --- didnt get much of a responce (there was none ordered). I called the DON myself this morn and she acted like it was no biggie. Got permission to come in and chart added late entry nsg notes. At that time I asked a much more exp RN if she wouldnt mind looking at it w me. She and I marched right back to PT where the pt was observing (and probably being billed for) services and had a look togeather. Yeah, she and another staff member said it didnt look right--- not at all and so the dr was called again. Some progress was made, but it took some doing! Too many were accepting 'no' for an answer when it was clearly wrong....im disappointed and scared at how many were willing to turn a blind e y e

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I have received patients discharged home from rehab with existing issues that I've had to get on the phone right away and address and I've wondered how these things get missed.

If I have a concern, I'm on the phone saying I'm the RN with a concern about their (PCP or whomever is signing our POC) patient and in the majority of cases I am listened to. Doesn't matter if it's a dr I know or not. This didn't happen when I was new and young so it must have something to do with my persistent assertiveness, never rude or aggressive but persistent, and also how I present the info..."We have a patient with inflammation that hasn't resolved and remains painful to touch...we have no films done... Dr has seen it but it hasn't improved and I'm concerned that there is a serious underlying problem going on....."

Most physicians don't want to ignore an RN who's documenting everything, you've got to think about it like that.

If you're going to get a negative response, let it be from over advocating, not under advocating.

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So what has happened with this patient most recently?

Please remember to chart only objectively. Never get your emotions written down. And you should probably be more vague here in public. Change it to a male patient's foot or something similar.

As for this situation - I hope the doctor winds up, along with your boss and your chicken-hearted,

cold-hearted coworkers, in a nursing home bed, helpless, dependent on the sense and goodwill of staff like themselves - people with immovable hearts\& no compassion.

Keep advocating, take pictures, keep copies of what you chart somewhere at work (if you take them out of the building you could be in big trouble), turn in Incident Reports. Call the doctor's partners or NP when he is not on call. Involve more experienced staff, pray.

Don't criticize anyone, do not be verbal. Just be quietly persistent. If you are going to report to State or CMS, be prepared for lots of flak.

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Specializes in HH, Peds, Rehab, Clinical.

You should have a medical director that has the "right" to dictate orders on any resident in the building if the need arises. Where the heck is your DON? Or the residents POA?

As far as charting, write what you see and what you do. And someone needs to be an advocate for this poor lady---let it be you....

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Specializes in HH, Peds, Rehab, Clinical.

You know, there's a good chance that OP has already anonymous-ized her client! Maybe her resident IS a male with a foot injury and she changed it to a female with an arm injury to protect her identity =)

So what has happened with this patient most recently?

Please remember to chart only objectively. Never get your emotions written down. And you should probably be more vague here in public. Change it to a male patient's foot or something similar.

As for this situation - I hope the doctor winds up, along with your boss and your chicken-hearted,

cold-hearted coworkers, in a nursing home bed, helpless, dependent on the sense and goodwill of staff like themselves - people with immovable hearts\& no compassion.

Keep advocating, take pictures, keep copies of what you chart somewhere at work (if you take them out of the building you could be in big trouble), turn in Incident Reports. Call the doctor's partners or NP when he is not on call. Involve more experienced staff, pray.

Don't criticize anyone, do not be verbal. Just be quietly persistent. If you are going to report to State or CMS, be prepared for lots of flak.

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^LOL, thanks you two! And maybe the patient is a female with a thigh injury, or a male with a hand injury...

When I advocated for this patient (calmly), I called up and gave an actual SBAR to the doctor about this poor person in our care (found out that nobody else did that bc they 'didn't wanna get yelled at' or 'made to feel stupid' and some change was made, got some stronger pain meds, but that's about it. Oh, and one of the day nurses left a note in the MAR: 'Dr. such and such was kind enough to call in an order for such and such PRN pain medication. So, please give this BID.'

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When this incident occurred, was the POA not notified? If so, perhaps a follow up call to them is needed to advise that the pt is still in pain and hopefully they will get more involved.

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