Patient’s family threatening to report me to BNE

[GilligansPlace]

So, long story short, my patient’s daughter (also a nurse) threatened me and informed me She was reporting me to the BNE. The patient had a hypotensive episode and she was upset I called the physician (who then said he would come see her right away) versus calling a Rapid Response. I implemented the physicians orders and then I did actually end up calling a RR because he did not arrive as quickly as I expected. The whole incident from onset to RR was 27 minutes.

The physician’s progress note states (in his own words) that the daughter was upset but he informed her that the nurse had called him and he was en route to see her when I called the RR. Nothing was done in the RR except labs being drawn because I had already started a fluid bolus prior to calling it per the orders received from calling the physician. The physician was actually going to leave the patient on the OBS floor, but ended up transferring her to IMC to appease the family essentially.

Myself, the charge RN and the physician all documented the aggression of the patients daughter, but I’ve never been threatened before and I’m honestly more upset of being accused of being a bad nurse than anything else.

I did tell the daughter that I would not stand backed into a corner while she yelled at me (my tech actually came in from three doors down to see if she needed to call security because she was yelling so loud) and I think that really set her off.

The family ‘fired’ me and I left the room (patients pressures were 90s/60s at this point and literally everyone else had left the unit from the RR, including the doctor). I charted her threats, quoted some of her comments and noted that she was extremely aggressive and displaying threatening body language (leaning toward me, waving her hands and pointing at my face).

I guess I’m just wondering if anyone else has been threatened with report to the BNE and what happened? The physician said he thought I acted appropriately, the charge nurse said she could see the daughter’s point (and honestly I do too, I’m more upset about the confrontational aspect of it than the actual criticism I think). Thoughts or advice?

[chare]

26 minutes ago, GilligansPlace said:

So, long story short, my patient’s daughter (also a nurse) threatened me and informed me She was reporting me to the BNE. ...

Reporting you for what, exactly? You notified the physician, implemented new orders, and called a rapid response. Seems to me that your actions were all appropriate and timely. If she does report you, I can't imagine the BNE taking any action.

I only have one comment on your actions, and this is advice and not criticism; for your safety, NEVER let an irate family member come between you and the exit.

As for being "fired" by the family, never let this bother you.

Best wishes.

[GilligansPlace]

Thank you. I’m so upset that anyone would think I wasn’t acting in the best interest of my patients. I was so surprised to have another nurse act that way. I know it’s a high stress situation though.

[SaltineQueen]

My only question is how low was her pressure when all this started? Would protocol have been to call RR first at that point? Was she symptomatic? But realistically, the time from when you started the bolus to when RR would have been able to start a bolus probably isn't a whole lot different, I'd guess?

I wouldn't worry too much. Sounds like you were on top of it & no harm came to the patient.

[GilligansPlace]

Well, initially it started with the patient complaining “she couldn’t go to the bathroom”. I had personally walked her to the bathroom about two hours earlier and knew that she had voided without difficulty so my concern at the time was actually that she was having urinary retention. I grabbed the dynamap out of the hall to get a set of vitals. She looked super uncomfortable was complaining about that, so I wasn’t too surprised when I couldn’t get the dynamap to pick up a pressure because I thought it was because she was moving around with discomfort. I went back to the nurses station to get my manual blood pressure cuff and page the doctor in the meantime, anticipating getting an order to cath her if I bladder scanned her and got a high volume back. It just so happened that the physician called back while I was getting the manual pressure which was 60s over 40s at that point. She was in with CHF exacerbation so he immediately told me we had probably over diuresed her and start a fluid bolus. After I came back with the supplies to start the bolus I realized she was actually trying to have a bowel movement. She did pass a large piece of hard stool followed by diarrhea And then I realized she had probably vageled down trying to move that stool out. I paged the doctor again to ask him if he wanted me to continue the bolus because her ejection fraction is like 15% and I thought the culprit was probably the bowel movement and I didn’t want to get her in volume overload if that was the problem. I ended up calling the rapid response because he did not return my page and had not made it to the bedside. I actually called the rapid response because I wanted an opinion on whether or not I should have continued the bolus, I was so afraid I was going to put her into flash pulmonary edema for an episode of a vagal response that would resolve itself. Her pressures were up to 80s/50s by the time the rapid response team and the physician showed up. He instructed me to continue the bolus and dictated which labs he wanted drawn. The physician and the rapid response team left once her pressures were in the 90s and the only changes to her orders were to DC the diuretics. He initially instructed me to keep her on our floor and then ended up transferring her to IMC because the daughter showed up at that point and threw a fit in the hall about it.

["nursy", RN]

For the nursing board to take action, the complaints have to meet a specific criteria, i,.e., violation of nurse practice act, incompetence, fraud, diversion, etc. When you file a report, you have to submit a detailed description of what you found negligent or inappropriate. If she actually gets that far and starts putting it down on paper, she may realize that she doesn't really have a case. From your description, she didn't even arrive until after the fact, and the patient was not harmed in anyway. So, I wouldn't worry about it.

[LovingLife123]

I would not worry, you did nothing wrong. I work in icu and if I get a pressure like that we normally start with giving a bolus. Obviously, we don’t call RR in icu, but I would not have called. I would have ran the bolus, checked the BP every 10 minutes to ensure the pressure wasn’t going lower.

Nothing will come of this. IF, this person even takes the time to call, they will roll their eyes. That’s a tidy lots threat to make. Your charge should have gone in and backed you up and handled it. She doesn’t get to tell you how to do your job.

[GilligansPlace]

Thank you so much. I was seriously questioning my own judgement here but I just didn’t get that gut check that this a situation that couldn’t be handled.

[JKL33]

Your assessments were appropriate, you had a timely response to your phone call, you were implementing your interventions in a timely manner and the patient was not further decompensating during that time. Your actions were not inappropriate.

Regarding the irrational family member, though:

On 1/28/2020 at 9:08 AM, GilligansPlace said:

I did tell the daughter that I would not stand backed into a corner while she yelled at me (my tech actually came in from three doors down to see if she needed to call security because she was yelling so loud) and I think that really set her off.

First, I agree w/ @chare, don't ever let anyone back you anywhere, or get between you and the door in this type of situation.

Secondly, I know it is extremely difficult to not say much when being verbally attacked, but I do everything in my power to not inflame people any further as soon as I can see that they are irrational. "I'm not going to stand here and listen to this!" or "You can't talk to me that way" or even "Stop yelling"....or any other hints of chastisement or indignation are exceedingly unlikely to help and they may make the irrational person even more determined to have the last say, so-to-speak. I make sure I am in a safe position (or immediately move there if I'm not) and start dialing my phone and ask for mgr/supervisor/security to join us ("are you able to join me in _____ room; the patient's family has some concerns") -- meanwhile whoever you call can hear the chaos, which is also helpful.

I have stopped addressing anything they are actually saying if they are completely misrepresenting the situation; they are not in a position to hear anything right at that moment. The more calm you stay (soft voice, un-threatened posture, eye contact), the less likely it is that things will escalate--and the more obvious it is to witnesses that you are not provoking the person's behavior. During these times it's very important that your actions and words be as unimpeachable as possible. So just stay calm (at least on the outside) and get help.

[GilligansPlace]

Yes! Thank you. I definitely wish I had handled the verbal exchange with the daughter better. I should have kept quiet and not tried to defend myself against the allegations. I was trying to explain to her my thought process (she showed up after the incident was over) but she was not in a position to hear it. I will definitely take that lesson forward.

[Susie2310]

What was the threatening behavior and what threats were made by the patient's daughter besides the fact that you found yourself backed into a corner by them? You said that they were aggressive. This wasn't clear to me from your post.

The public has the right to report a nurse to the state Board of Nursing if they believe this is indicated.

You said that the Charge nurse could see the daughter's point of view, and I can also. As I understand it she was very concerned and upset about the condition of her family member (severe hypotension) in a patient with serious heart problems, and expected a timely response from their nurse in the form of a RRT. When this didn't happen, she became more upset. In this situation, where the family member is trying to protect their loved one and get them the necessary medical attention in a timely manner, they aren't going to be speaking in soft voices; they are going to be very upset and their voice will reflect this, and they are likely to be asking the nurse what they are doing and telling the nurse what they believe needs to be done.

Facilities I am familiar with allow the patient or family members to call a RRT if they are concerned about the condition of the patient or if the staff are not responding appropriately to their concern, and I believe having this option available for patients and family members is very necessary.

[JKL33]

On 1/28/2020 at 2:09 PM, Susie2310 said:

What was the threatening behavior and what threats were made by the patient's daughter besides the fact that you found yourself backed into a corner by them? This wasn't clear to me from your post.

It was clear, perhaps not to you.

On 1/28/2020 at 2:09 PM, Susie2310 said:

The public has the right to report a nurse to the state Board of Nursing if they believe this is indicated.

I am not sure anyone is debating that?

On 1/28/2020 at 2:09 PM, Susie2310 said:

As I understand it she was very concerned and upset about the condition of her family member (severe hypotension) in a patient with serious heart problems, and expected a timely response from their nurse in the form of a RRT. When this didn't happen, she became more upset. In this situation, where the family member is trying to protect their loved one and get them the necessary medical attention in a timely manner, they aren't going to be speaking in soft voices; they are going to be very upset and their voice will reflect this.

Be that as it may, it is not clear that the OP did anything wrong. She actually attended the matter immediately and began to intervene immediately and has appropriate rationales for the actions she took; it is clear she was attentive and was processing the assessment information.

On 1/28/2020 at 2:09 PM, Susie2310 said:

Facilities I am familiar with allow the patient or family members to call a RRT if they are concerned about the condition of the patient or if the staff are not responding appropriately to their concern, and I believe this is very necessary.

That's fine, as long as we all understand that a family's concern about condition =/= staff not responding appropriately or not attending the patient appropriately.