Pt. Choice -vrs- Pt. Safety

[mrnurse2]

I was reprimanded today at work by hospital administrator. I thought this might start an interesting debate of thought.

Basically I had a heavy set fully hoyer transfer dependent gentleman who in no way can bear weight with assaultive history, fall history and periods of confusion.

Pt. did have Stage II ulcers on coccyx and was soiled. When CNA attempted to care for him he was striking out at her and demanding to be taken to the toilet for BM.

I told the CNA to offer bedpan because of safety, his fluxuating mentation and animated behavior it was unsafe to hoyer transfer to high rise toilet.

CNA did not like my answer and went to administrative nurse who took two other CNA's in room and took him to toilet in the manner described above.

I was upset for not being consulted as to why I chose the action I did and I was in charge of that pt. The pt. in bed was in no eminent danger and my plan was to re approach and negotiate with pt. when he settled down. Yes I was going to let DOC know but I was trying intervention first being going right to chemical restraint.

The administrator told me that the administrative nurse had every right to superceed. The patient had a right to choose to be taken to bathroom over my judgment that he was unsafe. The administrator told me that all the patients are ours (meaning the clinical staff) and that her license hangs on the wall too. It was not my patient but all clinical staff have a right to intervene and care for patients.

So what is everyones else's opinion and have you had similar situation?

[NurseyBaby'05, BSN, RN]

Document your behind off. CYA. If your co-workers want to put their butts on the line literally and figuratively, let them hang themselves. If the pt is coherent at the time, he is entitled to make the choices he did.

That being said, I don't think your co-workers should have undermined you without discussing it with you first. It damages your credibility with the patient and splits the staff.

[Kiya]

Is the CNA that went to the administrative nurse used to working in a nursing home? In the long term care field, patient choice is a huge bug in the eyes of the state. However, operations in a hospital are quite different from the LTC scene. All you can really do is document document document why you made the decision you did and the document the evidence that supports your judgement. Keep in mind though, medical politics will always prevail.

[mrnurse2]

I have only been working at this place for a month. I am not one to jump ship when things are not my way. However it is a hard day when you don't have the philosophy of the administration.

I work PRN for another facility and when I posed the question above to them I got the best answer yet. I was told that we had to meet both needs. The patients and his right to safety. I was told we would not admit a pt. unless we had the adaptive equipment/ and or lift to ensure safety of pt. and staff and we would also have to be able to accommodate his needs.

Wow, I thought a place that cares for their staff and their patients. They don't pay a lot but they sure give you a warm and fuzzy feeling inside when you work for them.

[canoehead, BSN, RN]

I think the patient has a right to endanger his own safety, but not the safety of the personnel caring for him. If the CNA's felt the Hoyer was unsafe for them, then that would not have been a choice offered or allowed the patient.

I don't think TPTB should have superceded your order without discussing it with you, but the CNA was right to speak up for her patient when she thought his rights were violated. That said there might have been a little "get back" in her motivations. Perhaps your supervisor would agree to speak with you before making a decision next time. You might have had information that would totally change the situation.