"I want him extubated NOW...I dont care if he's not ready"

Nurses General Nursing

Published

So here is my new horror story from my unit:

We have this CRAZY family member (the POA), who has barely enough medical knowledge to make her dangerous...we all know the type :)

Background: patient is in severe heart failure, pulmonary edema, intubated on high peep/Fio2, inotropes, awful Swan #'s, not a candidate for LVAD or transplant. We are just trying to stabilize and dry him out, basically.

The POA is aware of this, doesnt care, but wants him extubated bc she read "somewhere" that being on a vent can cause VAP, etc. Ugh.

Here is her list of "demands":

1. That we turn off his sedation, skip weaning, and just immediately extubate (bc of the risk of VAP). She has come into our unit in the middle of the night (thank you, open visitation!) and tried this several times in a row. She doesnt listen to reason from the nurses or MD's (she demands to speak with the MD's at 4 am on the phone btw).

2. After trying to get #1 and failing, she changed #1 to: "well if you have to reintubate him, then thats ok I guess, but I want his ET tube changed out. I think there's some bacteria growing on it":banghead:

3. When we DO extubate him (not like we are going to in his present condition), she wants us to d/c the sedation, then immediately attempt to stand this 350 lb patient up on his feet, wean him standing up in that position hooked to the ventilator, and then d/c the ET tube....all bc she says "at home, he has to be in a high position to breathe". LOL:yeah:

4. She demands to read his chart/lab values/look at his chest xray every day... ok I know she is the POA, but there is still a formal process to view PHI at my hospital, and she hasnt gone through it :nono:

The other day, a nurse caught her smuggling out a urine sample from the patient's foley bag!! When she was stopped and asked what the _____ she was doing, she replied "Dont you worry about it, mind your business." Presumably, she wants to get his urine analyzed somewhere else...who the heck knows for what. It is unreal the kinds of things she has done/demanded.

The whole situation has gotten completely out of hand. Numerous incident reports have been filed, but nothing has been done. My manager seems to be turning a blind eye. We all believe she is setting up to sue (but doubt anything will become of it d/t her crazy behavior--- I mean, obtaining a urine specimen and putting it in her purse?? OMG). The nurses that care for this pt are charting to a "t", noting all her actions, RN responses/actions, and charting the constant phone calls to the MD and unit manger. Every time she comes in, the nurses watch the IV pumps and ventilator like hawks to make sure she doesnt do something really stupid and harm the pt, but they cant police her 24/7.

My question is: what will it take to get this lady REMOVED FROM THE HOSPITAL ?!! Press Ganey can take a leap off a cliff!!

Specializes in ER, Family Practice, Free Clinics.

Wow. I thought *I* was a pain in the ass family member... and all I ever asked for was lab reports!

Specializes in neuro, ICU/CCU, tropical medicine.
...wants him extubated bc she read "somewhere" that being on a vent can cause VAP, etc. Ugh.

Tell her that we use evidence based practice, and that if this is what she wants done, to provide you with the peer-reviewed literature that supports the actions she demands. You can't do it just because she 'heard it somewhere.'

After trying to get #1 and failing, she changed #1 to: "well if you have to reintubate him, then thats ok I guess, but I want his ET tube changed out. I think there's some bacteria growing on it"

What she "thinks" is irrelevent. There probably is bacteria in the tube, but she needs to demonstrate to you and the medical team that the presence of bacteria is harming or has the potential to harm the patient to a greater degree than a severe hypoxic event and emergent reintubation - risk to benefit ratio. Ask her to provide peer-reviewed literature for evidence that the actions she is demanding are supported by science.

she wants us to d/c the sedation, then immediately attempt to stand this 350 lb patient up on his feet, wean him standing up in that position hooked to the ventilator...

Is that the standard of care at your facility? I didn't think so. Peer-reviewed literature, evidence based practice... I suggest that very quickly become your mantra. She needs to provide you the evidence to support her demands.

In the mean time I suggesat that you to back up what you are telling her with printed standards of care and peer-reviewed literature - and be sure to document your teaching. Document your sources and that you provided her with hard copies.

she replied "Dont you worry about it, mind your business."

It is your business!

My question is: what will it take to get this lady REMOVED FROM THE HOSPITAL ?!!

The answer to that question is: Do you believe that her behavior is jeopardizing the safety of your patient?

Specializes in ICU, PICC Nurse, Nursing Supervisor.

good grief...sounds like she needs a psych eval. you need to stand up for your patient cause she is going to kill him.... and then sue you and the hospital because he died....

Specializes in subacute/ltc.

She needs to be 5150 to the nearest psych unit...sheesh dangerous broad.....

Tres

if the manager is turning a blind eye, bring it to the don or cno.

get the darned doctor involved.

why is this visitor getting away with this?????

this is dangerous and irrational behavior.

i would have gone right up the chain until someone got involved...

as well as filling out incident reports and documenting everything.

i'm stunned this is still going on.

get security and haul her sorry butt out!!

leslie

Specializes in midwifery, NICU.

She sounds as if one or two wee screws are loose up top!!!!! What a pain in the rear to deal with, my thoughts go out to those who deal with these kind of people..you must be Saints!!!:bowingpur:saint:

My one question, what is a POA? Iv'e tried working it out but :bugeyes: cant get it!:chuckle

My one question, what is a POA? Iv'e tried working it out but :bugeyes: cant get it!:chuckle

power of attorney.

it is a legalized authorization to act on someone else's behalf.

leslie

Specializes in midwifery, NICU.

Thanks Leslie, I could so not work that out! Cheers!

Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

3. When we DO extubate him (not like we are going to in his present condition), she wants us to d/c the sedation, then immediately attempt to stand this 350 lb patient up on his feet, wean him standing up in that position hooked to the ventilator, and then d/c the ET tube....all bc she says "at home, he has to be in a high position to breathe". LOL:yeah:

Oh My!!!!!:bugeyes:

There is a lot of good advice here, such as going up the chain of command, risk management, hospital lawyers, etc. Maybe even suggest that peoples lives and safety are much more important than customer service.

Calling security should be an option if she poses an immediate danger to the pt. Her behavior is jeopardizing the pts. safety. I wouldn't be surprised if she tried to extubate him herself.

There is a lot of good advice here, such as going up the chain of command, risk management, hospital lawyers, etc. Maybe even suggest that peoples lives and safety are much more important than customer service.

Calling security should be an option if she poses an immediate danger to the pt. Her behavior is jeopardizing the pts. safety. I wouldn't be surprised if she tried to extubate him herself.

i'm shocked she has gotten as much reign as she has.

she needs education, limit-setting and close supervision...

and a swift dopeslap to the nm, who is turning a blind eye.

leslie

Specializes in Cardiac stepdown Unit & Pediatrics.

Is there anyway the hospital can provide a sitter, not to sit for the patient but to sit for the family member who is a potential risk to the patient?!

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