"Denial" situation update

[AtlantaRN, RN]

First thread is titled "Denial, not just a river in egypt."

This is an update--went to work today, my clinical manager tells me.......the above situation has turned into a "thing".

states should this situation happen again that we all need to "brainstorm", because this patient was lost to a competitor hospice. I followed chain of command, and I refuse to do a patient harm........ I didn't do anything wrong. Perhaps brainstorming equals giving the patient 80mg lasix IV before hanging a liter of normal saline?:angryfire

So that way family is placated, marketing is happy and they get their bonus:angryfire........................ Or, I could have thrown my coworkers under the bus. I could have said I would evaluate the patient in the morning, educate again that patient is overloaded with fluids and let the nurse the next day evaluate the patient then.....................thus putting it on the shoulders of another nurse............and let the revocation be on their shoulders?:angryfire

So in this situation, it looks like marketing is going to drive the plan of care, not the nurse. :angryfire

If i had to do the situation over again, i'd do it the same way. Isn't it our job to inform families of interventions that

will HARM a patient?

Atl RN

[tewdles, RN]

So is your manager implying that IDT is not "brainstorming"? Is she unhappy with MSW for not helping the family to come to terms with the situation? Is the clinical manager speaking with the medical director about not making a home visit to discuss the medical plan with the family? Or is the clinical manager's concern limited to the nurse's role exclusively? I imagine your clinical manager is present for IDT meetings, did she have input into the case or suggestions prior to the transfer? I fear that it is easy to point fingers at the case manager after the fact, rather than to work proactively as a team when the family is struggling with these issues.

I feel quite confident that your concerns about this family's denial are well documented and were discussed in the team setting. YOU are not a team of one and any suggestion that YOU should have solved this problem is out of line, IMHO.

[SuesquatchRN, BSN, RN]

Profit-driven end of life care. Yahoo.

[AtlantaRN, RN]

This was an admission, that didn't happen. I"m being blamed because apparently i wasn't hired for my clinical skills (3+ edema to ankles and audible crackles aren't enough to indicate fluid overload).

I figure if i'm written up for losing the admission, my response will be, "i'd rather irritate a marketer (for them losing $100 referral bonus) than lose my license for neglegence." IV fluids would hasten death.

[leslie :-D]

This was an admission, that didn't happen. I"m being blamed because apparently i wasn't hired for my clinical skills (3+ edema to ankles and audible crackles aren't enough to indicate fluid overload).

I figure if i'm written up for losing the admission, my response will be, "i'd rather irritate a marketer (for them losing $100 referral bonus) than lose my license for neglegence." IV fluids would hasten death.

iv fluids would certainly hasten suffering, for sure.:stone

you know what, atlanta? (the following is a scenario)

let's say for whatever reason, the family sued and you found yourself in court having to defend your actions.

you could truthfully and confidently tell them that infusing iv fluids would have caused further distress, as well as further stress on vital organs...

that not only would have pt suffered more, but it would have been dangerous to do so.

(being a hospice pt doesn't mean they are disposable-nevermind the burden of truly assisting in one's death)

just KNOW there are bad people everywhere in life...

those who lack a conscience and $$$ are the driving force.

more important, take comfort in your nursing and human skills.:redpinkhe

you haven't done anything wrong, and have handled this w/finesse.

keep it going.

leslie