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 think what I posted lacked insight and proper response. I know nurses are human, errors are made and have been made. My point is that the LVN or LPN has no authority, experience or ability to run the show. The fault lays with the MD who is willing to be dictated too by a dominant family member who is completely off base as far as her role.
Sorry about the comments that may of offended. It seriously was not intended.
Is there no end to your prejudice? "My point is that the LVN or LPN has no authority, experience or ability to run the show." I know this Topic didn't start off about LVN/LPNs but dang! I've been a LPN for 20 years and a Paramedic for 30 and I'm pretty sure I could run circles around most RNs I know but I certainly don't tell them that.
How can you lump all LPNs into the same box. I don't know, you just really tick me off with your attitude. As I said in my 1st post..........R-U-D-E
Is there no end to your prejudice? "My point is that the LVN or LPN has no authority, experience or ability to run the show." I know this Topic didn't start off about LVN/LPNs but dang! I've been a LPN for 20 years and a Paramedic for 30 and I'm pretty sure I could run circles around most RNs I know but I certainly don't tell them that.
How can you lump all LPNs into the same box. I don't know, you just really tick me off with your attitude. As I said in my 1st post..........R-U-D-E
Part of being a class act is acknowledging when you offended, or unintentionally spoke without much thought which is what I did. I apologized. Is that not enough. It was said without much thought...... I apologize. Those scarios I posted did happen. But nurses area only as good as their supervisors. Sometimes this happens. Please accept my humble apologies.
I have been an RN 20+ years. I also noticed the nurses ( RN'S LVNS AND EVEN CNA"S)_ who go around spewing their resume, saying I can run circles around you.. ( which I never said ) are often the most insecure people. Good nurses... and excellent nurses don't self promote. Good day.
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......
This was cut and pasted from my original comment word per word. If you get upset because I referred to an over zelous family member in this way I am sorry. But when the daughter of a patient is insisting upon dangerous treatment and thinking she can write orders via MD... she is delusional. Perhaps my post was taken out of context. It was in reference to the family member who opened up her Cheerios this morning and found a Medical License in it to practice medicine. ( if this offends anyone, sorry.. but there are ALOT of want to be MD's out there, and this person dictating her fathers care, and he doctor who is letting her are both wrong. )
More than anything, I run into people who question treatments and prefer NOT to have certain things done. Either way I say..go home if you want to do things your way and feel you know better.
It makes me sad that a doctor doesn't have the guts to refuse to write dangerous and unnecessary orders.
Specializes in drug seekers and the incurably insane..
It defintely wasn't be bashing LPN's. I thI was bashing her. I mentioned it,because she thought she was the know it all nurse and could scare us because she is in the medical field. However, I do feel I may have some better critical thinking as an ICU RN than her as a LTC LPN. Just like the maternity nurse knows alot more than I do in her specialty. But no one is better than the next, although this woman is a miserable dumbass know it all.
Oh, here we go again....you work in a different specialty, yes, of course, the "critical thinking" will need to be there, but have you worked in a LTC? Different specialty and different skill-set required.
I have never worked in a LTC. The facility I manage is not an LTC. She is trying to bring her "skill set" into my specialty. LTC is different than LTACH and many pt's are like ICU patients, which is my real specialty as a bedside nurse. So in my opinion she can run the show in her facility of her mom was in her facility. But her mom was in MINE where the setting and care is different.
regardless, the Dr is at fault here. SO are the higher ups (above me) for giving in and apologizing to these patients when care was excellent, whether or now it was what they wanted.
There is a facility in my town I won't work in because they are so "customer service oriented." When I was a student, this facility had an a la carte style dining arrangement. One of my patients, a diabetic, ordered mac n cheese, grilled cheese sandwich, peaches and an ice cream dessert.
At the time, the patient's sugar was 256 (yes her meds had been passed) so I asked my preceptor if the patient should really have something else for lunch. The patient complained to the supervisor that I made her "uncomfortable" because I told her I wanted to ask the nurse about her ordered diet and that she felt she had the right to control her in-patient diet. She also told me (and the supervisor) that if she went into type II style DKA, we would have to "fix" her and that it would be our fault.
I could go on and on about how bizarre customer service is in nursing but this example just kind of stuck out for its absurdity...like I can control what diet the doc ordered!
The supervisor apologized and I still get shivers thinking about that place!
Specializes in Trauma Surgery, Nursing Management.
i agree with the poster who stated the dr needs to grow a pair.
but...
keep in mind, that none of us are obliged to follow orders that we find unsafe or outrageous.
i have also expressed my concerns, in my nsg notes.
i would hope we are not a bunch of sheep.
leslie
Very good point, Les! (And that was me stating the "growing" comment.) I have flat out refused to give a medication that I thought was unsafe for a pt. Most of the time, it was an oversight on the part of the MD (ordering MS04 for pain when the pt has an allergy to it), but a few times the doc was not aware of the latest set of labs, so I didn't give them, paged the doc and the med was d/c'd.
I agree that we must be patient advocates first and foremost, and I believe that is what the OP was venting about.
Mudder
59 Posts
Is there no end to your prejudice? "My point is that the LVN or LPN has no authority, experience or ability to run the show." I know this Topic didn't start off about LVN/LPNs but dang! I've been a LPN for 20 years and a Paramedic for 30 and I'm pretty sure I could run circles around most RNs I know but I certainly don't tell them that.
How can you lump all LPNs into the same box. I don't know, you just really tick me off with your attitude. As I said in my 1st post..........R-U-D-E