occupational health argument

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Hello fellow nurses,

I am looking for your input in this issue...:I recently started working at my first nursing job, and I had an awful experience with a nurse from occupational health that misinterpreted my PPD test. The first encounter was filled with negative vibes...I started telling her I have developed a sensitivity to one of the preservatives from the PPD/TB test shot, and my forearm tends to get red and swollen. She asked me where I am from, and told her from Eastern Europe, then asked me if I had the BCG vaccine done, I told her no, but she said I must have been had it done because most people from that part of the world received it (whaaaat? I have given them all my childhood immunization info, and the BCG was not a part of it, so I did not receive it). Still, she insisted that my sensitivity was actually a positive reaction, although I have been having the same reaction for the 5 times I had the TB test done and it was documented as a negative. I come back after 48 hours, the TB test site looks the same as any other time, and she freaks out saying that is a positive. I told her it is not, there is no induration, only erythema, but she insists there is an induration, and starts documenting it. I begin to lose my temper, and tell her that is a negative, and she gets all defensive saying she knows better than me she has 30 years of experience. On top of that, she alerts my manager that I have some kind of anger issues, and I have been called to meet up with 2 unit representatives to be scolded upon for my behavior.

What I wanted to ask you, is it legal what the occupational health nurse did? I believe she falsified my medical records. I have been sent to get a blood test for TB which came negative, and she told me the positive TB skin test is because of my BCG vaccination, which by the way, never happened!! I have never had the BCG and I do get a skin irritation from the preservatives, but that is not a positive TB. I now have false data on my medical records, and my managers think I have an anger issue because I protested against it :( What should I do??

Sorry for the long post !

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Specializes in Complex pedi to LTC/SA & now a manager.

If you have such a reaction you should have been referred for a chest xray or the blood test long ago. Even if its an allergic reaction to the preservatives or solution the reaction can exacerbate therefore your private physician or an occupational health physician should have recommended against getting the PPD in the future.

If the nurse felt an induration how is it falsification of your medical records?

While it's clear you feel strongly about your reactions, you lost your temper and ended up in a heated confrontation with the occupational health nurse as you were questioning her skills and judgement as a professional nurse so heated that hospital administration was notified. You might want to sit down, be quiet and be happy that you still have a job.

Oppositional & belligerent behavior before you even start orientation could be grounds for revocation of the job offer. Your reaction seems grossly disproportional to the scenario and appears to definitely be grounds for concern by hospital management.

Whatever management recommends as the course of action to evaluate or curtail what is perceived as an anger issue, you might want to consider doing. Honestly,your anger and frustration are palpable even in this post. You need to be able to control your emotional responses especially when working as a nurse in a hospital environment where stress levels and emotions of family and patients are at all time highs.

Consult with your private physician or an occupational health specialist as to whether its safe for you to continue getting the PPD test or if you should be getting the blood test instead.

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Specializes in Critical Care.

I'm not sure I'd get all that upset about a potentially misread PPD since a PPD does not diagnose TB, it only suggests the need for further testing.

I'm a little skeptical that you're from Eastern Europe but never received the BCG vaccination since it's been essentially required in Eastern European countries for almost a century now.

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Saying that people from Eastern Europe get the BCG is discrimination, you cannot generalize your patient. Your patient must be treated in a holistically way, and not being put in the same boat with all other people that come from the same region. In case you did not interact with people from Mexico, you would find they are very different in terms of culture, medicine and preferences and so forth. There was no induration The size of induration is measured 48–72 hours later. Erythema (redness) should not be measured. 72 hours later the redness was gone.

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Just beachy nurse :)

Thank you for your support! May Jesus bless you for all the days of your life! Be thankful you walk and breathe, and can eat by yourself. Being grateful should be part of everyday`s state of mind and soul!

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Specializes in Critical Care.
Saying that people from Eastern Europe get the BCG is discrimination, you cannot generalize your patient. Your patient must be treated in a holistically way, and not being put in the same boat with all other people that come from the same region. In case you did not interact with people from Mexico, you would find they are very different in terms of culture, medicine and preferences and so forth. There was no induration The size of induration is measured 48–72 hours later. Erythema (redness) should not be measured. 72 hours later the redness was gone.

It's not discriminatory to point out that all central and eastern european countries have comprehensive BCG vaccination programs, it's a verifiable fact:

http://apps.who.int/iris/bitstream/10665/55554/1/bulletin_1998_76(1)_85-91.pdf

My "official" vaccination record has only about half of all the vaccinations I've received, so given the established fact that central-eastern european countries have established BCG vaccination programs and that vaccination records are often not complete, it's not unreasonable to consider the possibility that you did possibly receive a BCG vaccination.

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Specializes in Psych ICU, addictions.

(emphasis mine)

I told her it is not, there is no induration, only erythema, but she insists there is an induration, and starts documenting it. I begin to lose my temper, and tell her that is a negative, and she gets all defensive saying she knows better than me she has 30 years of experience. On top of that, she alerts my manager that I have some kind of anger issues, and I have been called to meet up with 2 unit representatives to be scolded upon for my behavior.

There is a big difference between protesting and losing one's temper....and apparently what you did in "losing your temper" was enough that the nurse felt compelled to get management involved. I wasn't there so I can't say whether she was overreacting and/or your behavior was off the chain...but before you meet with the representatives, I would take an honest look at yourself and how you reacted. Because how you address this with them can make things better...or worse.

Also, it's not false documentation if she did feel an induration. Induration is not always glaringly visible, but it is palpable.

I agree with Beachy: talk to your primary care provider to determine if you should get the x-ray or blood test instead. Given that you have a history of sensitivity to the tuberculin, you may just want to automatically ask for the x-ray/blood work. Having to do that will not hinder your job hunting prospects nor will it mark you with a scarlet T...healthcare workers having to ask for alternate TB screens is rather common.

Losing your temper, on the other hand, will not do you and your career any favors.

Best of luck in resolving this.

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You do not know what country I am from, and I will not divulge it as it would be an identity identifier for myself. In addition to this, few Americans know what happens in Europe in actuality, and few have been there to see it with their own eyes. I have lived there and here, and I am entitled to have an informative opinion, and I know far more about it since I traveled a lot and have seen what a positive TB reaction looks like. Nursing school teachers have warned us that very few nurses have seen a positive TB test, and once you see it, you will never make a mistake. So unfortunately, few American nurses have seen one so they misdiagnose most of the time. No big deal, but at leas admit it that you might be wrong, and give me the option to get a second opinion. As a patient, I have certain rights, and the occupational health nurse violated them.

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Meriwhen,

You misinterpreted my words. "Losing my temper" was a methapor/figure of speech. The conversation was all about I am right/You are wrong going back and forth between us, hence her saying she felt insulted I doubted her intelligence.

I already met with management, they just said that I should continue to be assertive, but work on becoming more sneaky in getting my point accross, not so blunt. They are very good people, we are a team and have the same goals, so this was just a matter of protocol.

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Specializes in Critical Care.
You do not know what country I am from, and I will not divulge it as it would be an identity identifier for myself. In addition to this, few Americans know what happens in Europe in actuality, and few have been there to see it with their own eyes. I have lived there and here, and I am entitled to have an informative opinion, and I know far more about it since I traveled a lot and have seen what a positive TB reaction looks like. Nursing school teachers have warned us that very few nurses have seen a positive TB test, and once you see it, you will never make a mistake. So unfortunately, few American nurses have seen one so they misdiagnose most of the time. No big deal, but at leas admit it that you might be wrong, and give me the option to get a second opinion. As a patient, I have certain rights, and the occupational health nurse violated them.

It really doesn't matter which eastern european country you are from since there is not a single one that doesnt' have a comprehensive BCG vaccination program.

The occupational nurse did not violate any of your rights. The occupational health nurse is obtaining information on behalf of your employer, not you. You are free to obtain a second opinion on your own for your own personal medical record.

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Specializes in Complex pedi to LTC/SA & now a manager.

What patient rights do you feel that the occupational health nurse violated? If she read a screening (not diagnostic) test as positive and then appropriately referred you for further testing which came out negative (the blood test) this is the appropriate conservative course of action. Did you ask for an alternative screening because you react to the preservatives?

I've reacted to the PPD solution but the hive & erythema in my case is gone before 48 hours. In my case, if the erythema and welt ever persisted past the 48 hour mark I would be referred for the blood test or a chest x-ray and not permitted to PPD screen at my employer moving forward.

You are a potential employee not a patient and as such the rights are slightly different.

It sounds like you went on the offensive attack and for self preservation the occupational health nurse went into defense mode. If you did not "lose your temper" the scenario may have ended very differently (with a simple referral for a blood test and perhaps a recommendation to decline PPD in the future instead of a potential loss of job offer and mandated meeting with hospital administration). Nursing is a small world. Hopefully your meeting with hospital administration will go well. If not this encounter may follow you as you apply for future nursing positions.

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The occupational nurse violated my right as a patient as she did not exert compassionate, respectful care, did not practice active listening, did not take my concerns into consideration. When I met with her the first time, I requested the blood test because I did not want them to get confused, but she insisted I get the TB skin test first. I am aware that I am fresh out of school and feel strongly about compassion being an integral part of nursing, as this is what we have been taught all along.

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