B-RN-ISEE

The facility nurse and I had a good professional relationship. Case in point my husband and I ran into her shopping one day and she embarrassed me by telling him "she is amazing...she works so hard and I am glad to have her in my facility." Both the staff and I had a great working relationship I mean I remember several times when I would go in and they would tell me how grateful they were to see me. What was interesting to me was the timing of the facility's complaint against me - they didn't report the "incident" till the evening after I had been there. I don't know I believe that no matter what I had done that day the facility would have had a complaint. This is the first time in my career in the health field I have had issues like this come up and I don't know how to prevent future issues like this. Thanks for your response.

My position as a Hospice RNCM was terminated because 2 facilities did not want me to care for the patients due to "poor communication on my part" Facility 1: My patient was reporting verbal pain of 8 and after 3wks of persuading her attendant to place an order for morphine they finally wrote one. I informed the facility LPN that the patient was reporting verbal pain of 8 and crying and should please get the morphine. The LPN I spoke to sent a different LPN to give the patient Tramadol instead of the morphine. I politely asked her the reasoning behind giving the patient Tramadol which takes 1 1/2 hrs. to work instead of the morphine. She proceeded to tell me that I didn't know the patient - they knew the patient and they knew what was best for the patient. She walked over to the nurse's station and started telling the LPN I had originally spoken to very loudly "who the f* does she think she is telling me what to do and how to treat my patient." Hearing this I went over to apologize for causing her to get opposite - I stated that for weeks now I had been trying to get the patient's pain under control and finally had the medication needed to manage the pain. Well I was called into my supervisor's office and informed that the facility did not want me there. Facility 2: I received a message in the AM stating that my patient had been found on the floor but was okay. After my am meeting, I called and spoke to facility RA manager who stated that the had found patient leaning over his walker, and upon assessment decided he was okay. I informed her I would be there later today to assess patient. A few hours later I get a text from the LPN/manager stating that patient's family was freaking out regarding patient's mental status and I should come ASAP. I responded stating I would be there in half and hour. I arrived there and met with LPN who stated that patient had been assessed and had no changes and was fine - the family was just freaking out because he didn't recognize them and she thought it was because he was depressed. She asked that after I had assessed him I should talk to her. Patient was assessed VSS, with poor tracking. I told the family that facility had told me he did not hit his head and patient could not shake his head "yes" or "no" when asked if he hit his head. I told family that I would like to observe patient for any changes prior to sending him out because we generally didn't want to send patient to the hospital unless something was severely wrong and so far I couldn't see anything wrong except for poor eye focus/tracking. I went and told the LPN my observations and she said they the facility didn't want patient to go to the hospital either. I went back into patient's room and the family started insisting that the patient had a CVA - I explained to them I couldn't agree or disagree with them because all I had was my assessments which showed that the patient didn't exhibit signs of a CVA. The family and I went back and fort over the issue of patient being a DNR, hospice, and what treatments he would/wouldn't get if admitted. The facility administrator came in to discourage the family from sending patient to ED - which I insisted that it was both the patient's and their family's which to know what had caused the change. Two days later I was called into my supervisor's office and informed that the facility stated I didn't communicate well with them and I was trying to one-up the family when discussing sending the patient to the hospital and they didn't want me back in their facility. The next day my job was terminated because I couldn't go into two ALFs and facility 2 had threatened not to use our services if I was sent there. Oh yeah forgot...patient had an intracranial bleed. So what should I have done differently, I had called my administrator and supervisor reporting all of the issues I faced during and after this incident.

I made the mistake of pointing out flaws in two ALFs and my Hospice organization terminated my position. I did not know asking why a patient wasn't getting the prescribed pain medication would lead to me losing my job.