Resident's family wanted to discharge AMA at 10:00 PM Sunday night!

[smartypants22]

Let me give you some background on this situation: I have been working at my LTC for about 5 months now, doing only weekend double shifts 6AM-10PM. The 10-6 nurse doesn't come on time because she has another job and I have had to wait for her to come. Also recently we got a new DON and she's been making some changes, mainly wanting my unit to become a medicare unit, having residents come in and out.

Now this past weekend, a new resident came in during the week, being transferred from a hospital during the week. He was a bilateral below knee amputee, but he planned on being at the LTC short term and going home when his therapy was finished. Sunday night, I finished my shift and was doing some computer charting while waiting for my relief to come. I thought something was fishy when this particular resident had his daughters come to visit him at 10:00. They rang the call light to his room, so I went to see what was going on. That's when they told me that they wanted him out of there. Apparently during the week, he had not been visited by his doctor even though the doctor was supposed to remove the dressing from his hip surgery, and he also had not had therapy. The daughters were not happy with his care. I didn't know what to do and luckily my weekend supervisor was still there so I went to her office and she got the necessary paperwork. The daughters said the hospital had transferred him to the nursing home without her permission, though the reason was because the doctor he had at the hospital practices at the nursing home. There was no talking them out of it so they signed the paper work, they also wanted me to remove his catheter, so I did that as well. To top it all off, since he didn't have a wheelchair, they wanted to get a wheelchair to take him out. There were no available wheelchairs at that time! All the wheelchairs belong to a resident, so they had to borrow a wheelchair. They finally got him out at 11:30PM.

What frustrates me about all this is that they chose to come so late at night on a weekend. I mean, who does that when they had all day to do this?

[LPNtoRNin2016OH, LPN]

I had a family do this the other day -- it was Saturday evening around 8 pm. I agreed with why they wanted to leave but I also encouraged them to wait till Sunday morning since the patient was stable. I advised them they would most likely be waiting in the ER for a bed till Sunday morning anyways and it would be easier on all of them. But ultimately it was up to them as the patients POA. I didn't voice this to the family but they had valid concerns no one had addressed during the week (I am PRN so only there few times/month) and I myself was wondering why it hadn't been taken care of before it go to the point of them wanting to leave.

[nurselabrat]

I actually was a daughter that did something similar, but it was in the daytime, about 7AM. My mother was in rehab, I went in early before I went to work, passed the nurse on the way out and she told me my mother had a good night and slept all night. I guess so, my mother was non responsive when I went in. I work for a physician, I called him and he told me to call an ambulance and have her transported to the hospital in his care. They told me I could not do that. I did it anyway. The EMT's had to start CPR on my mother before they left the parking lot. My mother survived and lived about 5 more years. She had a UTI because of the catheter and was septic. Her quality of life was awful after that. I'm sorry but over the years I've had some pretty bad experiences with LTC for my mother. There usually is not enough staff to care for the patients or residents. I don't think anyone would intentionally cause harm to a patient, but I think the system is broken. I thought I wanted to work in LTC once upon a time. Thought I might make a difference. But it didn't work out that way. And when I think about it, it still breaks my heart. My poor mother, I only wanted her to be taken care of as well as possible. I ended up staying with her as much as I possibly could. I was there before work, after work and at every break I could get. I would get up at 1, 2, 3... in the morning and go stay with her until I had to go to work. And it still wasn't enough. So you see, I understand how the daughters felt when they thought their parent wasn't being cared for. I also know that when patients don't get the proper care, they can die.