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]

I should add the only reason I took vitals is because I was calling the doctor. I did not expect her pressure to be low; I just never call a physician without current VS and the ones taken by the tech that morning were going on 4 hours old. Her HR was in the 60s, and I thought her writhing in the bed was throwing the dynamap off. If I had gotten a low pressure with the dynamap, I would have called the RR immediately. It just so happened I paged him on the way back to the nurses station to get my manual cuff out of my bag, anticipating a return phone call to take longer. I was actually worried he would hang up because he called while I was taking her pressure manually and so it rang like 6 times before I finished and could answer.

[vintagemother, BSN, CNA, LVN, RN]

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? 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.

Yes, I see your point. But berating the nurse providing care while s/he is providing said care does not help the pt to recv better care. This behavior simply makes you have more than 1 person to attend to.

[Tweety, BSN, RN]

On 1/29/2020 at 5:51 PM, Just me. said:

@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.

Thanks for clarifying your perspective.

Our Code Blue team has resident MD's, but our RR team does not have an MD. We have hospitalists but they see only the patients they are doing primary care on and are outside employees and don't have privileges on every patient. But that would be so cool to have an MD on the RR team.

[jobellestarr]

Ugh, this is why I am so sick of nursing. Abusive families, second guessing and unsupportive fellow nurses. Good lord. I think if you read the OP’s description of what happen, I think he/she did a great job. The daughter and your charge nurse are jerks. Even if the daughter was having anxiety about her mother’s condition, you still don’t have the right to speak to someone that way. And the charge nurse-meh. I’m not impressed.
To the OP, I’m sorry this happened to you but you are a good nurse ❤️

[MunoRN, RN]

On 1/29/2020 at 1:46 PM, Susie2310 said:

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.

As a RR nurse I feel it should be pointed out that calling a RR is not actually always "the most expeditious method of obtaining prompt assessment and emergent treatment", often calling the MD rather than a RR is far more likely to result in prompt treatment.

Something to keep in mind is that the premise of the RR has had trouble keeping up with the changes in patient acuity over the last 10-15 years. What was a clear indication for a RR 10-15 years ago are now just relatively common incidents in the general hospital patient population and really can't be dealt with by just a single nurse covering the whole hospital.

In a patient who becomes hypotensive in the setting of fluid overload, an over-full bladder, and fecal impaction I have no RR protocols I can initiate, the MD will need to be called. If the RN calls me to evaluate the patient, there will be x-amount of time until I can evaluate, and the result of that will be that I can't initiate my RR protocol fluid bolus and that the MD will need to be called. This may easily be 20-30 minutes after when the primary nurse initially called me and could (/should) have called the MD instead.

If I were to speak with the family member about their concerns I would point out that the quickest nursing assessment comes from the primary nurse, not the RR nurse, and if they feel this is something that requires the MD then that's what they should do, and I might also point out that overbearing family members actually worsen patient outcomes, and that maintaining a congenial relationship with their family members caregivers, rather than jumping to judgements, is the best way to ensure their family member gets good care.

[Just me.]

10 hours ago, jobellestarr said:

Ugh, this is why I am so sick of nursing. Abusive families, second guessing and unsupportive fellow nurses. Good lord. I think if you read the OP’s description of what happen, I think he/she did a great job. The daughter and your charge nurse are jerks. Even if the daughter was having anxiety about her mother’s condition, you still don’t have the right to speak to someone that way. And the charge nurse-meh. I’m not impressed.
To the OP, I’m sorry this happened to you but you are a good nurse ❤️

Personally, I do believe the OP did their best.

Sometimes when reading the Original post, you don't have all the facts. And it is easy to miss some details when they are revealed later in f/u posts. When I read the original post, it sounded like the daughter was there when it happened, expressing her concern(not in the right way). Later, it is learned that she was not. And the patient details and daughters location were revealed in later posts.

When in doubt, I don't think it hurts to call a RR. IF nothing else, you are not alone.

As far as abusiveness, our hospital has become increasingly responsive to abuse. Abusive family members have been removed from the grounds, others banned from the facility (unless they are dying), no trespassing orders. We do try to talk people down, but have a right to defend ourselves.

@Tweety I am going to clarify if the Hospitalist is on the RR team, I may be wrong. He may have just responded, it was some time ago. I will correct if I misspoke.

[Megarline, CNA]

Why is it so many abusive patients and others to American healthcare workers?

Wait. For people, you're subjected to abuse. It seems prevalent that many healthcare workers deal with this kind of people. Why are these people are not afraid to express this behavior with nurses? Is this because they're women? How do they behave around male nurses or male caregivers?

It's undeniably they are scared or worried, but I wonder if this behavior is consistent in other industrial democracies.

Sorry to hear that.

[socal1]

I noticed that in the US most female professions have these issues where it seems you are so worried about your license than actually the patient. You dont see this in medicine as much or with respiratory therapists. And often times its the nurses themselves who are in those power/controlling behavior to report nurses for no reason other than to feel better about themselves.

[Snatchedwig, BSN, CNA, LPN, RN]

You did good. That MAP is definitely over 60...she be alright lol.

["nursy", RN]

And what exactly is your expertise on "most US female professions?" I've been a nurse for 40 years, and worked with many "US female professionals" and I can tell you that we are very worried and caring about our patient's health status. No nurses would put up with the **** that we do, the hard work, the lack of respect, the ridiculous patient ratios, the paperwork, all because we are concerned for our license. Doctors have plenty of concern for their license, believe me, that is why they pay thousands of dollars in malpractice insurance. And when families come in and want to talk to someone about the care, they don't usually ask for the respiratory therapist.

[Serhilda, ADN, RN]

On 1/29/2020 at 12:34 AM, Susie2310 said:

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.

Wait, so her comment was "nasty," but being screamed at, cussed at, backed into a corner with hands waving and flailing in her face isn't abuse? You may as well have told her she's overreacting and to buck up. Doesn't quite seem you want to take your own advice here.

[Serhilda, ADN, RN]

2 hours ago, socal1 said:

I noticed that in the US most female professions have these issues where it seems you are so worried about your license than actually the patient. You dont see this in medicine as much or with respiratory therapists. And often times its the nurses themselves who are in those power/controlling behavior to report nurses for no reason other than to feel better about themselves.

Your misogyny was a bit too thinly veiled this time, it's showing pretty loud and clear. Go into welding, oil and gas, or literally anything else if you have a problem with women. No one is forcing you to stay.