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?

[GilligansPlace]

Thank you ❤️

[Susie2310]

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

It was clear, perhaps not to you.

I don't mean to be rude, but I don't see the necessity for this comment. I posted politely and respectfully and I believe I have the right to expect the same from other posters even if they don't agree with me; in fact, the TOS gives me that right. When I disagree with posters I don't make smart or nasty comments in regard to their posts. Perhaps you could extend the same courtesy.

[Tenebrae, BSN, RN]

OP from what you have outlined here you took all prudent steps that could have been taken in this situation. Family members can be asses. I like to hope its more due to the fact they are stressed out about the condition of their family member and are trying to cope with the situation the best way they can. Unfortunately they can often just be jerks

As long as you documented what you did with clear clinical assessment and rationale you should be fine and it will stand up in the event of scrutiny

I once had a scenario of a district nursing patient with diabetic foot ulcers on the medial and lateral aspect of the heel. I hadnt seen the patient for about 10 days (working in a different area) however when i visited that day I found the patients two diabetic foot ulcers had become one very large one indicating significant lower limb ischaemia. Long story short we got the patient urgently admitted and unfortunately due to the progression of their illness the patient ended up needing a below the knee amputation. The patients family member did his prunes, was threatening to take us to the health and disability commission. My clinical manager reassured me that we had done alll we could and the family member didnt have a case. I did have a look at my previous documentation and felt reassured i had documented all I could and done all I could

Dont let jerkish family members destroy your confidence. Like i said, from what you have shared it sounds like you did all you could

[Here.I.Stand, BSN, RN]

Quote

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

True.... and this daughter sounds like a pretty loose cannon, if OP takes my meaning.

Quote

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.

You’re kidding right? If not you need some serious education.

Quote

You said that the Charge nurse could see the daughter's point of view, and I can also.

I can’t. An appropriate response from the daughter would look something like: “Is the dr in-house? No? I think you should call a RR.”

Throwing a tantrum is the appropriate response from a 2-year-old.... Throwing a tantrum AND threatening behaviors are the behaviors of a loose cannon who needs to be removed by hospital security.

[allnurses Admin Team]

NOTE:

Posts have either been edited or removed entirely.

Please do not make comments personal one-on-one. This derails the topic.

Thank you.

[ruby_jane, BSN, RN]

On 1/28/2020 at 10:29 PM, TriciaJ said:

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.

That is something I wouldn't have thought of but YES. It is also possible you have an employee assistance program that may be of help as well.

[Defibn', RN, EMT-P]

1) The patient is fine

2) It doesn't seem like you did anything wrong

3) Your charge nurse sucks

4) You do not have to put up with a family member yelling at you

5) Stop worrying about it. You handled it well

[Susie2310]

The OP stated that the MD progress notes said that the daughter was upset but that he informed her that the nurse had called him and that he was en route to see her when the OP called the Rapid Response.

My understanding is that the daughter was upset because she believed her mother would have received care more expediently if the OP had called the Rapid Response as soon as he/she obtained the blood pressure of 60's/40's. The way I understand the OP and his/her subsequent posts, the daughter's concern is not that the OP didn't do his/her best to problem solve and wasn't conscientious in trying to do his/her best for the patient, but that the daughter (a nurse) perceived that the most expeditious method of obtaining prompt assessment and emergent treatment of the patient - a Rapid Response, was delayed.

I think it is important to keep in mind that as nurses we know (or should know) what the consequences of a significantly low blood pressure and MAP can be for a patient if this persists and is not remedied timely. My perception is that this may have been why the daughter was upset.

No-one is saying that the OP didn't make an effort to obtain care for the patient. The OP obtained physician orders and started an IV fluid bolus.

No-one is justifying threats or aggression or saying this is acceptable.

[Just me.]

@Susie2310: I have to agree with most of what you said (in the above post) I didn't think about it from the daughter's perspective.

The daughter was way out line in how she communicated her concerns. Her behavior was inappropriate.

I think the OP did their best. And the patient did not code.

When our hospital began the RR team, it was such a relief to know you could get help fast! You were not alone. I used the team a few times.

To the OP, I think you did try your best to help your patient! Use the RR team in like situations in the future and don't put all the stress and responsibility yourself.

[Tweety, BSN, RN]

On 1/29/2020 at 2:55 PM, Just me. said:

@Susie2310: I have to agree with most of what you said (in the above post) I didn't think about it from the daughter's perspective.

The daughter was way out line in how she communicated her concerns. Her behavior was inappropriate.

I think the OP did their best. And the patient did not code.

When our hospital began the RR team, it was such a relief to know you could get help fast! You were not alone. I used the team a few times.

To the OP, I think you did try your best to help your patient! Use the RR team in like situations in the future and don't put all the stress and responsibility yourself.

I totally agree but we must also not forget the RR team are not MD's and still have to call the doctor for orders. Most likely they would have called the doctor and got the same order for the bolus. So perhaps care wasn't delayed by starting that order prior to calling the RRT.

Still many eyes and heads are better than one alone and like I said, I do agree that not putting all the stress and responsibility on yourself might have been best.

[Just me.]

@Tweety When I was on the floor the Hospitalist was part of the team, but teams vary at different facilities. Not sure now who is on our team, I'll have to ask.

[GilligansPlace]

I definitely saw her point of view, but I don’t think she had all the information. I actually paged the physician before I had a BP (again anticipating asking for a urinary catheter order in a patient complaining of not being able to use the bathroom). He called back actually WHILE I was taking the manual pressure and then gave orders and said he’d come see her. Obviously once I had a blood pressure, her being able to void was not my priority anymore. While starting the bolus she had a BM. I then realized her complaint earlier had nothing to do with urinary retention, it was bowel related. At that point I realized her straining to have a BM probably caused the low BP and ended up calling the RR because the physician still hadn’t made it up to see her yet. I definitely think calling the RR was appropriate as a first line, but in my misunderstanding of her discomfort, I had already called the physician. I’m not sure if that’s easy to follow. The patients daughter was on the phone by this point and wanted me to call the RR, but again the physician gave orders, they were being implemented and he was en route. The manager of the floor (I’m in the float pool) texted me today to ask me about availability for some of her short days so I’m guessing she wasn’t too upset by it at least.