I am a new manager in an LTACH facility. We have critical care/acute care patients here for about 3 weeks. It's a for profit facility where it is very kiss-butt customer service oriented, but I believe it is beginning to compromise patient care. There is one patient who's daughter is an LPN in a nursing home. She is nasty and mean and thinks she can actually make orders. Well, the Dr. got sick of her, every time she "orders" something he writes it. I have dealt with this woman on numerous occasions. Many disagreements, but our CEO want sus to kiss these peoples butts. This time, I got angry. She went out of our facility for a same day wound debridement. Then she gets back and the daughter insists on her getting a PICC line and start her on an anticoagulant. Tuseday was the debridement, wednesday the anticoagulant was begun, thursday was the picc(where she started with me because i wouldn't let the wound vac leave the hospital, we are not supposed to, I eventually gave in only beacuse there was a code and the procedure was being held up over this) then friday I walk in to work and she bleeding big time from her sacral wound!!!! I am assisting the house md in stiching it (yes, I am nurse manager who gets active, bot just sits on my lazy butt despite all the work I have to do) I tell him she is on arixtra. he is shocked ot hear this. I was ****** it was started. but the Dr ordered it because the daughter said to, fresh post a major debridement! And she was oozing at the PICC site too:)
The another family member keeps complaining about the care of his father. His father is vented, nothing really upstairs. The patient spikes a fever, and is compensating against it and he is freaking out that the nruse didn't stay at his beside while the fever was breaking. *****? The nurse did everything right. Checked the temp, say the spike, gave tylenol and drew BC as ordered, called the ID and even called the house DR bc the patient was in mild resp distress while the RT was at the bedside. he is timing everything... the nurse waited by the phone whens he paged the house dr so she can explain the situtation. The RT was there. Well, the son flipped about everything. Well, in my eyes, everything that was done was done correctly. The nurse is a seasoned nurse who knows what she is doing. The son doesn't understand the process of a fever breaking. The sweat is normal. She HR being high at the beginning of the fever is normal, the way to take it down is to take the fever down. All this was explained. And then he is convinced his father is being fed too much. He thinks his stomach is too disteneded. Feeding only at 30cc/hr. Belly soft, positive BS, having BM's, no residual. feel we should stop the feeding. WHy? So his wounds don't heal? me and the director fo quality insurance handled him. She wasnted ot apologize for everything. I did not. I felt everything done was appropriate. If we apologize to make him happy,t hen it makes it look like we are doing something wrong. I explained the natural process to him, everything in laymans turns and said sorry if you don't feel like this situation waS handled correctly, but it was.
Sorry for the long vent. I believe in family members being involved in the care, but not dictating it. We are the medical professionals. The dr's have to stop encouraging this. And customer service is customer service, but not when it compromises care. Anyone agree?
I agree that NURSES (note I made no division between grades) are the worst family members. Especially when they are outside "their own area of expertise".
Thankfully, Canada doesn't have for profit hospitals. But the stories I could tell you involving LTC? Right up there.
Of course she is not actually writing orders, but she tells the nurse or the dr what she wants ordered and the Dr, not wanting to deal with it, writes the order. Some of my nurses unforntualey come from Sub acute or LTC and are very task oriented and not so much critical thinkers.... we are working on that, ebcause these are very sick patients. The Dr will be help accountable, I know, but it is getting bad and everything usually crashes down on the nurse at sometime.
Even if she was an RN, she should really not be "demanding" certain orders. Atleast ask the Dr's if a certain suggestion is indicated, she won't even listen, she knows it all.
Oh, we have another guy who's son dictates all the care. The patient is VERY old but the som believes he will live forever. They have private insuarnace and are very rich people and will pay for anything not covered. So, the son read somewhere that oxygen therapy heals wounds, now we have nurses taking their time to blow oxygen on his ass...... Oh, and his HD schedule is MWF and he doesn't want him going all weekend without any HD, so he gets an extra "mini" session on sat. Yup, you ehar me right.
I say just take them home and do what you want then
Wow, it's been a while since I came across such blatant classism. I deal with my share of people who don't know me pre-judging me based on my LPN, but that was outrageous. Wanna know who the charge nurses on my floor go to with questions, who the preceptors send new hires to for questions, who gets the hardest sticks on my floor? Me and the other LPN. You talk about delusions of grandeur and then presume to judge an entire group of nurses, who do one of the most thankless jobs in nursing, based on the fact that they have less education than I assume you do? How would you feel if a NP or a doc talked about you that way?
Sorry, I'm not usually in such a foul mood, but that really ticked me off.
To the OP: Lordy do I feel your pain! There are some family members I'd love to give a piece of my mind to. I can understand requests within reason, but it certainly sounds like what you're dealing with is beyond ridiculous. No constructive advice to offer, unfortunately, since it seems like you're stuck between a rock and a hard place. Grab a glass of wine and a bubble bath and at least be secure in the knowledge that you are not alone.
NO matter what you do . Families often try to run the show. I have just accepted it. What is needed is a doctor with a pair who is willing to speak to the daughter and explain that although her input is needed, he write the orders. Period. I have NEVER met a SNF LVN who was capable of safely writing orders or think out of the box. I have seen SNF LVN's hold life saving antibiotics because the doctor didn't specifically write clearly enough a dose. I have seen them hold... meds for clarification and never call anyone. One of my hospice patients who had pneumonia, was probably going to pass anyway. Them holding a med, and calling the MD went on for 3 days! I had another SNF LVN who got orders for a Duragesic patch at 3:00 on afternoon. It was delivered at 8pm. It was held until the next morning to start at 9am....becuase that is how that SNF worked. Meds ordered scheduled times... started the next day at 9am. The patient had cancer. Do you think the family was happy? no. The family knew all about it just becaues they sat bedside 24/7. I had a one and one with the DON. Professionally I explained, I'd like the rataionale explained why? a new pain medication was held from a General Inpatient Hospice Patient.. the family is aware and they are ready to take thier complaints to where it matters...
These are mistakes made by LVN"s in a snf world. Not all are as simple minded as this. But I have a hard time taking the dtr who is on your first patient seriously. 1 year of nursing school has given her huge huge case of delusional grandeur.
Rude......just straight up R-U-D-E
Hope you don't break your neck when you fall off that High Horse yer ridin' :)
When people feel in shock and without control of their loved ones they will react with lots of power seeking behaviors. This is human nature and I see it a lot. I wonder if the RN is going to end up being responsible for the administration of the anticoagulant? We are usually the ones that take the hit because we are supposed to see how ridiculous some orders are. Maybe the doc was hoping someone else would just refuse to administer so he didn't have to be the one making the daughter angry?
These days with all the patient satisfaction pressure most facilities have some liason/advocate/or some other such title person who has talents to quell the out of control family or family member.
I probably would not carry out any order that looks fishy. Certainly contact the physician, document, refer to my superior....anything but administer something screwy.
I find it pretty easy dealing with the family member with this psch dynamic going on. I usually try to find 20 minutes or so (really, it's possible) and take them aside and get them going with what is affecting them, let them vent, sometimes they even start to cry then....and then we can discuss how all people have this desperate feeling of wanting to be in charge etc etc and why they feel that way etc etc...but that the physician went to school for a long time and knows what the patient needs....and the RN as well as the family member has to surrender (within reason) to the treatment. Also making clear that in the end it is no human's power that saves a life....it it some power some call God that makes the final decision. We only work with the body system....stuff like that. And then document the entire thing well. Of course, if I think the family member is correct...that the physician is truly not acting or ordering correctly...then I would have to adress that to superiors asap.....sticky....
Specializes in MCH,NICU,NNsy,Educ,Village Nursing.
I think we forget that family members may feel the need for control of any kind. They can't heal their loved one but they can help. The probably is more than that though--it's the pervasive attitude (it seemed) of the OP that LPN's as a whole are "no good" (my words, not the OP's, but that's what it seemed to me). I've learned a lot in my career from LVN's/LPN's and if it hadn't been for them on many occasions, I would have sunk. This is ONE LPN, who is also the daughter. She may very well be feeling powerless, and her "bossiness" is an attempt to help. The doc is the one who needs to say "no" if "no" is appropriate. Personally, I wouldn't want to be a patient in this particular LTC facility, nor a family member. I wonder how much of the OP's hostility filters through to the patients & family members.....just wondering....
NO matter what you do . Families often try to run the show. I have just accepted it. What is needed is a doctor with a pair who is willing to speak to the daughter and explain that although her input is needed, he write the orders. Period. I have NEVER met a SNF LVN who was capable of safely writing orders or think out of the box. I have seen SNF LVN's hold life saving antibiotics because the doctor didn't specifically write clearly enough a dose. I have seen them hold... meds for clarification and never call anyone. One of my hospice patients who had pneumonia, was probably going to pass anyway. Them holding a med, and calling the MD went on for 3 days! I had another SNF LVN who got orders for a Duragesic patch at 3:00 on afternoon. It was delivered at 8pm. It was held until the next morning to start at 9am....becuase that is how that SNF worked. Meds ordered scheduled times... started the next day at 9am. The patient had cancer. Do you think the family was happy? no. The family knew all about it just becaues they sat bedside 24/7. I had a one and one with the DON. Professionally I explained, I'd like the rataionale explained why? a new pain medication was held from a General Inpatient Hospice Patient.. the family is aware and they are ready to take thier complaints to where it matters...
These are mistakes made by LVN"s in a snf world. Not all are as simple minded as this. But I have a hard time taking the dtr who is on your first patient seriously. 1 year of nursing school has given her huge huge case of delusional grandeur.
My first job as a newly minted RN was in a nursing home. The orientation was brief, but not inheard of for a LTC. My first night in charge was horrible, falls, chest pain needing to go to ER, lots of bumps in the road. The longest 8 hrs of my life. Would you like to know how I and my residents made it through safely? THE FANTASTIC LPNS! There years of experience were invaluable, they were so supportive and willing to teach, I would have floundered without them. So there.
BTW, EVERY nurse has the potential to have a brainfart, LPNs AND RNs, bet you've made some too. I have.
NO matter what you do . Families often try to run the show. I have just accepted it. What is needed is a doctor with a pair who is willing to speak to the daughter and explain that although her input is needed, he write the orders. Period. I have NEVER met a SNF LVN who was capable of safely writing orders or think out of the box. I have seen SNF LVN's hold life saving antibiotics because the doctor didn't specifically write clearly enough a dose. I have seen them hold... meds for clarification and never call anyone. One of my hospice patients who had pneumonia, was probably going to pass anyway. Them holding a med, and calling the MD went on for 3 days! I had another SNF LVN who got orders for a Duragesic patch at 3:00 on afternoon. It was delivered at 8pm. It was held until the next morning to start at 9am....becuase that is how that SNF worked. Meds ordered scheduled times... started the next day at 9am. The patient had cancer. Do you think the family was happy? no. The family knew all about it just becaues they sat bedside 24/7. I had a one and one with the DON. Professionally I explained, I'd like the rataionale explained why? a new pain medication was held from a General Inpatient Hospice Patient.. the family is aware and they are ready to take thier complaints to where it matters...
These are mistakes made by LVN"s in a snf world. Not all are as simple minded as this. But I have a hard time taking the dtr who is on your first patient seriously. 1 year of nursing school has given her huge huge case of delusional grandeur.
Geez I just got a papercut...can somebody tell me how to open this bandaid because I am just an SNF LPN without enough common sense to come in out of the rain. Whatever!! I work in a Rehab hospital with RN's and LPN's and also a SNF with mostly LPN's. I have to honestly say I would much rather have those SNF LPN's caring for me or a loved one then some of the RN's at the hospital (not all...some). SNF nurses are mostly overworked and overwhelmed at times, but dedicated and caring because they work through the stress...because they care about their residents. They are not just a patient or a resident...they become our family. Yep we only went to school for a year, but we didn't need more to learn love and compassion. Common sense and compassion are some important traits for a good nurse and those can't be taught in a classroom. I have seen amazing LPN's and RN's....and I have seen some pretty crummy LPN's and RN's. Let's not fuel the fire of class division when we should be working together as a team to get the job done!!
My first job as a newly minted RN was in a nursing home. The orientation was brief, but not inheard of for a LTC. My first night in charge was horrible, falls, chest pain needing to go to ER, lots of bumps in the road. The longest 8 hrs of my life. Would you like to know how I and my residents made it through safely? THE FANTASTIC LPNS! There years of experience were invaluable, they were so supportive and willing to teach, I would have floundered without them. So there.
BTW, EVERY nurse has the potential to have a brainfart, LPNs AND RNs, bet you've made some too. I have.
Thank you from all us LPN's that work hard to provide excellent care and believe in our capabilities to do so!! :heartbeat
Specializes in Trauma Surgery, Nursing Management.
Hey guys, I just re-read the OP's post again and I don't think she was intentionally torching LPNs. If I am reading it correctly, the daughter of the OP's pt happened to be an LPN. She could have been an RN and the scenario would have been the same. I think the OP was simply frustrated that the daughter, who was a healthcare worker, was running roughshod over the doc. I think the fault here lies with the doc.
Fiona59
8,343 Posts
I agree that NURSES (note I made no division between grades) are the worst family members. Especially when they are outside "their own area of expertise".
Thankfully, Canada doesn't have for profit hospitals. But the stories I could tell you involving LTC? Right up there.