Patients families dictating care and treatment

[MomRN0913]

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?

[leslie :-D]

I agree that we must be patient advocates first and foremost, and I believe that is what the OP was venting about.

i agree.

it's just that too many folks are focusing on noey67's comments about lpn's.

(i knew this would happen...sigh)

op, as a mgr, you may want to advise your nsg staff that they can be held liable for any ill-advised orders they receive and administer.

i so appreciate you trying to sustain the standards of care that should be upheld.

leslie

[Horseshoe, BSN, RN]

i agree.

it's just that too many folks are focusing on noey67's comments about lpn's.

(i knew this would happen...sigh)

op, as a mgr, you may want to advise your nsg staff that they can be held liable for any ill-advised orders they receive and administer.

i so appreciate you trying to sustain the standards of care that should be upheld.

leslie

very important point.

[MomRN0913]

It is a very tricky situation because if the pt did get a DVT and the nurse didn't give the anti coagulant, guess who would have been held responsible and i owuldn't want to put that on the nurse. Flowtrons would have sufficed I believe. the woman had been sitting in bed for 2 weeks already without any prophalaxysis..... Of course I in conjunction with the house Dr said HOLD THE ARIXTRA when the bleeding occured. It was my first thought. I am trying to get my nurses to critically think.

There was a patient once in my ICU with a K+ of 4.2 with an IV run of 20KCL ordered. It was form the previous shift, not given yet, the oncoming nurse quesitoned it.... the previous nurse figured the MD had a reason for it.... The patient was already in RF.... the oncoming nurse called the nephrologist to question it.... turned out he was looking at the wrong days labs! he DC's that order....

[carolmaccas66, BSN, RN]

If family members interfere, I ALWAYS tell them they must discuss any concerns/changes in orders/changes in medications to the doctor. I say we are nurses, not medical doctors, and cannot just 'change' everything cos they want it. I don't argue anymore. I never get involved in lengthy talks with families cos it deteriorates to the point of anger - and they won't listen anyway. I say we as nurses can only follow what the doctor has written, take it up with him/her.

You need more supportive managers and doctors methinks, and you maybe need to be more aggressive standing up to them, but if you HAVE to kiss their butt, I don't know how ur going to achieve that.

[carolmaccas66, BSN, RN]

Yes 4got to add if you and the other nurses are just following what the doctor and families say without questioning patient safety, or what is obviously best for that particular patient, etc you will be held accountable if anything untoward happens, and you KNOW what ur doing is against your better judgement. I'd be reporting this whole scenario higher up if it becomes a bigger issue.

[leslie :-D]

It is a very tricky situation because if the pt did get a DVT and the nurse didn't give the anti coagulant, guess who would have been held responsible and i owuldn't want to put that on the nurse.

it's not your call...or any other nurses.

there is a standard of care that dictates anticoags et al, be stopped at least a few days pre-surgical procedure.

your facilty should have a policy about it.

all pts have this same risk when having to stop their meds before a surgery.

leslie

[MomRN0913]

no, the craziest part of this was she was in our facility for 2 weeks and had none ordered previously. The daughter wanted it started AFTER the debridement.

[SoCalRN1970]

MOM RN proceed with caution. This one has lawsuit from crazy family.

[MomRN0913]

I know it does. it scares me. It's been like the crazy daughter has been looking for one since admission. I have also noticed when she gets on the elevator, she NEVER goes past the nurses station. Almost every visitor does. She however, sneaks around so she doesn't see us. She is a freaky woman.