Should patients be allowed to refuse LPNs and CNAs?

[flashpoint]

Last night on our med/surg unit, we had an elderly woman who was in wiht consitpation. Very stable patient, vitals within normal limits, fairly negative past medical history, no home meds, independent with ADLs...again, a very stable patient. No BM for 8 days...came in to ER via private vehicle with complaints of abdominal pain.

We are a small rural hospital, average patient census of 10. Last night we had nine patients. This woman decided that she did not want any LPNs or CNAs in her room. OK...we try to accomodate such requests, but on nights like this, we have one RN on med/surg and one in ER. ER was pretty busy, so the ER nurse did not have time to come to the floor to help. Other than the charge RN, we had two LPNs and one CNA...staffing well above what we normally have. Certainly, the RN had time to care for this patient, but this woman didn't even want the CNA or one of the LPNs to do the simple things like taking her vital signs, refilling her water pitcher, or emptying her commode. So...the RN not only was charge over 9 patients, but had to do all cares for this patient, simply because she did not want anyone but an RN.

I agree 100% that there should be an RN available for all patients, but not all patients require an RN as their primary nurse. In a small rural area like this one, sometimes you have to take an LPN, especially if you are stable and have a predictable outcome. Had we been busier or had an unstable patient, would we have been out of line to explain to this patient that there was an RN available if anything unexpected happened, but that due to staffing reasons, her assigned nurse would be an LPN? This happens every now and then and usually we are able to accomodate the requests of RNs only, but what about when we just can't do it?

[llg, PhD, RN]

While this exact scenario has not been asked before, similar requests have been discussed (students, gender, race, ethnicity, etc.)

When a hospital receives such a request, it is put in a terrible position. If they insist that the patient accept care from someone they have requested NOT to participate in their care ... both the hospital and the care-giver place themselves at an EXTREME risk for a lawsuit. While it may seem unreasonable, or offensive, to the person "not allowed" to care for the patient, the hospital is actually protecting that caregiver (and itself) by honoring the request.

It can cost many thousands of dollars to defend yourself in a lawsuit -- even if you do nothing wrong. Why take the risk?

It's sad ... but honoring the patient's request is often the prudent thing to do.

[directcare4me]

Sounds like an administrative issue to me. If I were the lone RN I wouldn't be trying to accomodate this type of thing. I would fulfill my duties to each patient as their needs dictated, and fulfill my other duties as charge nurse. If I had time I would certainly check in as often as possible, but I would do this with all patients.

I don't know the whole story here I know, but as it is described it sounds ridiculous, and I wouldn't care to participate in this type of coddling.

[directcare4me]

While this exact scenario has not been asked before, similar requests have been discussed (students, gender, race, ethnicity, etc.)

When a hospital receives such a request, it is put in a terrible position. If they insist that the patient accept care from someone they have requested NOT to participate in their care ... both the hospital and the care-giver place themselves at an EXTREME risk for a lawsuit. While it may seem unreasonable, or offensive, to the person "not allowed" to care for the patient, the hospital is actually protecting that caregiver (and itself) by honoring the request.

It can cost many thousands of dollars to defend yourself in a lawsuit -- even if you do nothing wrong. Why take the risk?

It's sad ... but honoring the patient's request is often the prudent thing to do.

llg (ddd is my home account)

I read your post after writing mine. You are right about this.

[flashpoint]

While this exact scenario has not been asked before, similar requests have been discussed (students, gender, race, ethnicity, etc.)

When a hospital receives such a request, it is put in a terrible position. If they insist that the patient accept care from someone they have requested NOT to participate in their care ... both the hospital and the care-giver place themselves at an EXTREME risk for a lawsuit. While it may seem unreasonable, or offensive, to the person "not allowed" to care for the patient, the hospital is actually protecting that caregiver (and itself) by honoring the request.

It can cost many thousands of dollars to defend yourself in a lawsuit -- even if you do nothing wrong. Why take the risk?

It's sad ... but honoring the patient's request is often the prudent thing to do.

llg (ddd is my home account)

Exactly...but pretty unfair to the RN...and to the LPN and CNA who were essentially told that they were not worthy of emptying a commode! I felt so bad for the RN...this woman was on the commode A LOT and needed at least stand by assistance because she was afraid of pulling the IV or foley out if someone was not there to help. I know that LPNS and CNAs don't have nearly as much training as an RN, but I think sometimes patients need to accept the fact that they will be cared for by an LPN or CNA. RNs are always available for emergencies and every patient is assessed by an RN at least twice a shift.

Obviously, any patient who needs care above and beyond what an LPN can provide will have an RN. Any patient who becomes unstable will be reassigned to an RN if their nurse is an LPN.

[happthearts]

I was just wondering if it could possible be that this old lady had a problem with someome ethnic backround .When people are older or set in there ways They get this way.Maybe by having just one person in the room she felt only one would be accountable for stuff in her room.

I had this happen to me Where I had been taking care of an older gentleman very educated .We got along great together had been taking care of him for weeks. Then his family came along one night while I was one and said they wanted the other nurse.I told the other nurse if she wanted to switch It would be OK.She said no.

The other nurse handled it perfect When the family asked her to change.She said I am sorry but the Pt's were all ready assigned at begining of shift This nurse is your nurse.

[allamericangirl]

I have never heard of such a thing. Since when does anyone have such a choice or power to run a hospital? Was the hospital afraid of losing business? Where else was this woman going to go if it's the only place in town!? She should have been told that her care will be a combination of qualified medical staff on duty.

Patients have rights, but they do not dictate policy.

If a patient ordered a doctor to give her a certain medication or treatment because it is what the patient prescribed and the doctor complied, resulting in harm to the patient, who do you think would be at fault in a court of law? The doctor is the professional authority. The doctor would have been at fault. Patients can refuse treatment but they can' dictate their treatment.

She should have been politely told that, "upon admission you will recieve medical treatment according to hospital policy".

[explorer]

The patient should be made aware that she doesn't make the patient assignment, the RN does and she will have to work with whoever she gets.

The RN is more capable to know what is the best assignment for each staff member.

Case Closed

[apaisRN, RN, CRNA]

That's baloney. I would have left the commode umemptied until it got ripe and she gave in and let an aide empty it! Okay, maybe I wouldn't have done that, but I'd want to.

If she wants to request an RN to give her meds or start an IV - okay, I can live with that, although the LPN is perfectly capable. But for the other stuff I'd chart "pt refuses vital signs" and leave. She's lucky she has anyone to wipe her butt, with staffing how it is in this country.

[LydiaNN]

You have got to be kidding me. I don't think she should be accommodated when she wants to negatively impact that ability of the RN to do things that only the RN can do because the RN is busy doing what the CNAs on staff are available to do and are paid to do. Is she willing to pay extra for monopolizing the RN's time in this way?

[llg, PhD, RN]

You have got to be kidding me. I don't think she should be accommodated when she wants to negatively impact that ability of the RN to do things that only the RN can do because the RN is busy doing what the CNAs on staff are available to do and are paid to do. Is she willing to pay extra for monopolizing the RN's time in this way?

Are you willing to pay for the years of litigation that might result from the lawsuits she files if her request is not honored? It's not always about what is right or wrong ... fair or unfair. Sometimes you simply have to protect yourself (and your family) by tolerating something you disapprove of.

While such a patient would make me very angry, I wouldn't want to jeopardize my financial future just to prove a point to her. She isn't worth it. My life and well-being are more important to me than some idiot's biases.

llg

[DutchgirlRN, ASN, RN]

When doing charge occasionally I have a patient ask to speak to me and tell me that they don't like their nurse or CNA. I will reassign the patient without a problem. I would not ever reassign a patient simply because the nurse was an LPN. If there is a personality conflict with a staff member, fine, but based on their title, no.