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?
btw...yesterday, the rn was helping the patient up to the commode and she (the patient) fell...broke her hip, sprained her wrist, dislocated her elbow. when she was transferred to a the nearest hospital to see the ortho doctor, she told the paramedics that she fell because was so upset because only rns would come into her room and rns don't know enough about moving patients...
:smackingf i guess you guys can't win with this one, can you? what would she have said if the cna was with her? i guess you need pt's on hand for all transfers (now there's an idea... )
:smackingf i guess you guys can't win with this one, can you? what would she have said if the cna was with her? i guess you need pt's on hand for all transfers (now there's an idea... )
i for one would love this...'wait for the pt mrs jackson'...hehe! yeah that would really fly.. :rotfl:
Did anyone notice, this was a woman in for constipation? Definitely someone anal.
Just kidding folks. :wink2:
:yeahthat: I love it!!!! BTW I can't understand these 'constipation' admissions. Can't you take care of that at home? Without getting personal, I can thing of a number of things I'd try before I decided to go to the ER. Hust go down the isle at the drug store (or the supermarket, for that matter!!!)
:yeahthat: I love it!!!! BTW I can't understand these 'constipation' admissions. Can't you take care of that at home? Without getting personal, I can thing of a number of things I'd try before I decided to go to the ER. Hust go down the isle at the drug store (or the supermarket, for that matter!!!)
I have a patient who's c/o constipation despite being on several stool softeners and a mild laxative.
She told me what she takes at home:
Fibercon, dulcolax, sennakot, miralax, colace, and about three others--EVERY DAY.
So yeah, I guess once you're THAT dependent on laxatives, you can get stopped up just by not taking them.
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 had a patient once refuse to have a certain aid come in for his cares because this person was Filipino. So, everyone started redoing the work assignments... It was a real mess I just said to the man look she is a good aid very kind and gentle.....if you want to refuse care from this person thats fine but we aren't changing everyone elses assignments.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I have a patient who's c/o constipation despite being on several stool softeners and a mild laxative.
She told me what she takes at home:
Fibercon, dulcolax, sennakot, miralax, colace, and about three others--EVERY DAY.
So yeah, I guess once you're THAT dependent on laxatives, you can get stopped up just by not taking them.
well these "emergencies" really burn me up. Does NO ONE talk to these folks about laxative dependency and its dangers??? GOOD GOD. There are people out there dying and they come into the hospital for constipation!
A lot of bogus admissions occur because it is often easier to admit the patient, especially when the family is standing there in the ER and demanding that the doc must admit their family member and will not take "no" for an answer. A few such family members have been known to just drop Uncle Fred or Aunt Ethel off in the ER at night and leave, so there is no other way but to admit the patient.
well these "emergencies" really burn me up. Does NO ONE talk to these folks about laxative dependency and its dangers??? GOOD GOD. There are people out there dying and they come into the hospital for constipation!
Yeah, but sometimes you just can't convince some of the elderly that some people DON'T have 1,2, or 3 BMs EACH day, though. Some think if you miss a day, you're stopped up.
Kinda like my step-Grandma. It's like talking to a wall when it comes to the subject of BMs.
Did anyone notice, this was a woman in for constipation? Definitely someone anal.
Just kidding folks. :wink2:
It's a strange request because I would think that everyone in the hospital would want as much help as they could get. But, I really think it's her own prejudices that had her requesting such a thing. She needs to understand that care is the result of many caregivers working together. The more people helping the more she is likely to be happier and get discharged sooner. She should also understand that in no way are LPN's or CNA's less of caregivers than an RN.
I don't know what state you work in, but in California LVN'S are not independent practioners, they work under the license of an RN or MD in a clinic setting, even if the patient was assigned to the lvn, it's still the RN's responisbility for the assessment and care plan, plus iv meds. Maybe the RN should have explained to the patient that they were a team, working together to give her the best care. Every patient has the right to an RN. Being the only RN on the floor for 10 patients seems pretty unsafe for the patients and the nurses. Thats why we have worked so hard in California to have ratio's. Which are 1 nurse(we in the CNA take that to be an RN) to every 5 patients on the med-surg floors. It was 1 to 6, but we have won over the governor who tried to hold it to 1 to 6. When I work on the med-surg floor and I am given an assignment with an LVN, I always explain that I am the nurse who is legally responsible for these patients, so I will be doing all the assessments and charting the care plan. Because If anything goes wrong you can bet your last dollar that it will be my license that is on the line not the lvn's.
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?
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renerian, BSN, RN
5,693 Posts
My thoughts are diagnoses do change periodically and I have seen many mental health patients misdiagnosed. That is where I was coming from.
Sorry I also did not remember it being part of original post.
Everyone have a great day!
renerian