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?

[TriciaJ, RN]

1. Paragraphs are your friend. Ours, too.

2. Was this the first obnoxious family member you've had to deal with? I hope I'm wrong, but she probably won't be the last.

3. Are you sure she's a nurse, other than she said so? If she really is, her conduct was unbecoming and unprofessional, even if she wasn't on duty.

4. Never defend yourself when someone is being that aggressive. It actually makes them feel more powerful and escalates the situation because they're enjoying it. It works better to stand up straight, make firm eye contact and say: "You need to back up. And put your arms down." "You need to lower your voice." Speak slowly, clearly. You can speak with volume, but do not let your pitch go up any octaves. That is how you regain control. "I will get the charge nurse for you if you have issues with how things were done."

5. Complaints to the Board? Yeah, right. Go for it.

6. Lose the idea of being a "good" or "bad" nurse. You are a proficient and conscientious nurse. Other people's behaviour reflects on them, not you.

7. It always feels crappy afterward to have been slimed like that. That's how the daughter feels most of the time, until she has occasions to transfer some of her slime to others. At this moment, she's probably fighting with the power company because her bill is too high, or with the barista because her latte was too hot. It's what she does.

Treat yourself to something nice today, as a reward and compensation for having been slimed. It goes with the job sometimes, but can serve as a handy excuse to treat yourself.

["nursy", RN]

The best way to handle someone who is out of control is to say absolutely nothing and let them rant. Typically they rant and rant. Even when they pause, I say nothing, and they immediately start back up. Eventually, they start to hear themselves and that they are the only one yelling, and they actually start to feel a little self conscious and embarrassed, and usually they end up apologizing. It takes a lot of self control to not try to defend yourself, but you never win in these situations, because people are too emotional.

[Susie2310]

On 1/28/2020 at 2:31 PM, JKL33 said:

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.

The time from the onset of the incident to the Rapid Response was 27 minutes as reported by the OP. As I am understanding the situation, it would have been appropriate to call a Rapid Response immediately as the patient's blood pressure was severely low (60's/40's) in a patient with serious heart problems.

[ruby_jane, BSN, RN]

While it's fresh in your mind, write yourself a nurse's note on a legal pad or a diary or anything where it's apparent that you haven't torn out pages. Don't access the chart to do this unless you have a need to be in that chart. Don't second guess whether or not you should have called RR vs the doc. Just document why you did what you did, and the yelling and such. When you're done, sign it like it's a nurse's note.

That way, if it does happen that you're reported for unsafe care, you've got it all documented.

I start a new legal pad with each new job. Everything I didn't want to put in a patient's chart including family interactions and interactions with supervisors where they would not respond in email as documentation, for example.

BTW anyone can report us at any time, for any thing. And the BON in my state seems to take every allegation seriously. But you don't need a lawyer now.

[JKL33]

9 minutes ago, Susie2310 said:

The time from the onset of the incident to the Rapid Response was 27 minutes as reported by the OP.

I am sorry you feel that prudent nursing care delivered immediately in response to a patients change in condition is no longer acceptable.

Beyond that, I will now take my own advice.

[Tweety, BSN, RN]

I've given many a bolus for low blood pressure (with an MD order and them being aware) and not called a rapid response if all else is well (other vitals normal, A&O with brain perfusing). I've also called RR when they haven't responded to the bolus.

This past year we have a "rapid response nurse" that we can now call to give him/her a heads up if we have a situation that might deteriorate and they come and advise.

I think you handled the situation appropriately and the daughter was just running off at the mouth. As I've mentioned before I have a serious problems with nurses as the family member being disrespectful to peers. But even if she does alert the BON there isn't a case as is stated above.

[chare]

1 hour ago, 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? You said that they were aggressive. This wasn't clear to me from your post. [Emphasis added]

Really? Generally, any time someone has me backed into a corner I consider that threatening behavior at least, if not outright aggressive. However, if that's not enough there's always this:

6 hours ago, GilligansPlace said:

... (my tech actually came in from three doors down to see if she needed to call security because she was yelling so loud) ...

And this:

6 hours ago, GilligansPlace said:

... 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). ...

And finally, this:

5 hours ago, GilligansPlace said:

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.

[Just me.]

I once visited a friend in the hospital who was having a sudden onset of sob, sweating profusely and in obvious fluid overload. The nurse was not convinced she was deteriorating, I was. I asked the nurse to call a rapid response she was overwhelmed and so was I. Is it correct the daughter was present? She could have asked you call, even though you were handling the situation.

@ruby_jane I think it is a great idea to document the incident. I have done that myself in the past when I felt a doctor acted negligently and another incident involving a nurse.

[TriciaJ, RN]

1 hour ago, ruby_jane said:

BTW anyone can report us at any time, for any thing. And the BON in my state seems to take every allegation seriously. But you don't need a lawyer now.

I think most BONs are required by law to take every allegation seriously. Or at least pretend to. When I was investigated by the Board, they told me no fewer than three times that it could just be a vendetta. I wondered why they kept saying that, didn't they want me to take their investigation seriously? When they finally told me what I'd been accused of, it became clear. They also seemed to be having trouble not laughing.

So they HAVE to investigate, no matter how frivolous. But they get a lot of people just being malicious and they can usually sift the wheat from the chaff. Board investigations are a lot more scary until you've been through one. (Unless you actually divert, neglect patients, etc.) If you're conscientious and operate within the nurse practice act and applicable laws, even a bad judgement call won't rise to the level of a Board action.

[ClaraRedheart, BSN, RN]

It's hard to defend behavior like the family members. If the doctor is involved, there is no need to call a rapid response unless a critical care team response possibly involving chest compressions and a code are needed. She called an RR when she could no longer get a response from the doctor, as she should have. The nurse acted prudently in this situation. The family member was irrationally inappropriate.

[GilligansPlace]

Her daughter was not present until afterward. She was on the phone with her father and when I left to get the fluids to start the bolus he handed the phone to my tech who was still at the bedside said the daughter was yelling at her to ‘call a ****** rapid response right now’. Once she got there, one of her accusations was that I ignored her direct request. I had to explain to her that she hadn’t spoken to me on the phone at all.

She was then upset I left the bedside to first, get my manual BP cuff and then to get fluids out of the Pyxis. The tech was at the bedside and I can’t summon things with my mind so I’m not sure what else I could have done? Calling another nurse would have delayed it longer.

[TriciaJ, RN]

2 hours ago, GilligansPlace said:

Her daughter was not present until afterward. She was on the phone with her father and when I left to get the fluids to start the bolus he handed the phone to my tech who was still at the bedside said the daughter was yelling at her to ‘call a ******* rapid response right now’. Once she got there, one of her accusations was that I ignored her direct request. I had to explain to her that she hadn’t spoken to me on the phone at all.

She was then upset I left the bedside to first, get my manual BP cuff and then to get fluids out of the Pyxis. The tech was at the bedside and I can’t summon things with my mind so I’m not sure what else I could have done? Calling another nurse would have delayed it longer.

Now you're just second-guessing yourself. You responded promptly and prudently and implemented additional actions as the situation warranted. Every time I'm in a hospital or clinic, I see signs on the wall about treating staff with respect, because they're not there to tolerate abuse.

You were subjected to abuse. You should probably submit an incident report on that basis, just because it's good to start a paper trail. There is a 99% chance you've heard the end of it. Try not to let it keep playing in your head. We've all been there and we're all (well, most of us) behind you.