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?
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Others (including me) already addressed religious or sexual abuse history concerns. Of COURSE you accomodate urgent needs or situations like this wherever possible. However, Neither of these were presented as this woman's problem, therefore, she has no reason to create a staffing nightmare because "she wants the RN". She is simply manipulating the whole situation for her own benefit, not NEED.
And, I agree again, with the poster who said to kindly offer her the services of a private duty RN or transfer (if appropriate) to an all-RN unit would be sensible. And this would NOT violate her rights in any way.
If I were very ill, I would want an RN....can't deny that. However...I would have no problem with anyone from the MD to a CNA or anyone in between helping me to the commode or emptying my bedpan. The patient in question would get angry any time an LPN or CNA even came into her room...she would put on the call light and when someone went in to answer it, the first words out of her mouth were, "Are you a registered nurse?" If you were not, you were told to leave. I think it would have been appropriate for the RN to explain to her that LPNs and CNAs are quite competent at things like emptying commodes...and that while the RN would try to provide all of her cares, do assessments, etc, that she would have to either allow the LPNs and CNAs to empty her commode or she would have to put up with the smell until the RN could ge there. As it ended up, the RN went in every time the light went on...she was late to report, she had to interrupt rounds with a doctor, and one of the LPNs had to resolve a staffing issue because the RN was not available. Not a huge deal, but it did interrupt care for others and upset some staff members when an LPN was scrambling to make patient assigments for the next shift because the RN did not have time.
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...
"If I were very ill, I would want a RN" that's an interesting statement. Veteran LPN vs. new grad RN. In my opinion, the LPN would probably make better choices or be able to see potential problems more quickly. And it actually would have nothing to do with their education; but with their experience. If a patient has a problem with their nurse due to the care they are recieving, then of course they have the right to refuse that nurse. But if they are refusing simply because the nurse is an LPN then that's a different story. In my opinion, society is simply not aware that there are different types of nurses. Most people assume that if you are a nurse you must be a RN or better yet if you are an LPN then you are only qualified to empty bedside commodes. I just think that society as a whole needs to be educated.
"If I were very ill I would prefer a LPN" that's an interesting statement. Veteran LPN vs. new grad RN. In my opinion, the LPN would probably make better choices or be able to see potential problems more quickly. And it actually would have nothing to do with their education; but with their experience. If a patient has a problem with their nurse due to the care they are recieving, then of course they have the right to refuse that nurse. But if they are refusing simply because the nurse is an LPN then that's a different story. In my opinion, society is simply not aware that there are different types of nurses. Most people assume that if you are a nurse you must be a RN or better yet if you are an LPN then you are only qualified to empty bedside commodes. I just think that society as a whole needs to be educated.
I believe my statement was, "If I were very ill, I would want an RN." I don't mean it to be insuting or anything...I am an LPN and a pretty good one according to comments from patients, families, coworkers, doctors, and my annual performance evaluation. If I were very sick, in frequent need of IV meds, hemodynamically unstable, etc, I would want an RN...not necessarily because of increased competence or better assesment skills, but because if I needed IV Morphine, etc, they could give it...the LPNs have to track down an RN, since most of them cannot push IV meds.
But, if I were in for something like consitpation, I really wouldn't care who my nurse was...I would probably prefer a female if I were getting multiple enemas or something, but if I were bad enough to come to the hospital for it, I would take whoever I got!
As far as patient ratios go...my state still considers LPNs to be nurses. The way my hospital is strucured, there is usually two RNs, two LPNs, and one NA for every ten patients...sometimes more staff, sometimes less. The LPNs do primary care, the NAs assist with things like vital signs, and the RNs supervise. The RNs assess the patients once per shift (more if their conidtions warrant) and take care of most IV meds, rounding with doctors, calling families, etc. RNs are very rarely assigned to primary care, but are available if anything comes up. We are a very small rural hospital and most of our patients are quite stable...the ones who are not stable are transferred to a larger hospital 75 miles down the road.
The night with this patient was one of those odd nights where one RN called in sick and there was simply no one to replace her. A manager was on call "just in case," but overall the patient load was pretty light, so she stayed home.
I believe my statement was, "If I were very ill, I would want an RN." I don't mean it to be insuting or anything...I am an LPN and a pretty good one according to comments from patients, families, coworkers, doctors, and my annual performance evaluation. If I were very sick, in frequent need of IV meds, hemodynamically unstable, etc, I would want an RN...not necessarily because of increased competence or better assesment skills, but because if I needed IV Morphine, etc, they could give it...the LPNs have to track down an RN, since most of them cannot push IV meds.
But, if I were in for something like consitpation, I really wouldn't care who my nurse was...I would probably prefer a female if I were getting multiple enemas or something, but if I were bad enough to come to the hospital for it, I would take whoever I got!
As far as patient ratios go...my state still considers LPNs to be nurses. The way my hospital is strucured, there is usually two RNs, two LPNs, and one NA for every ten patients...sometimes more staff, sometimes less. The LPNs do primary care, the NAs assist with things like vital signs, and the RNs supervise. The RNs assess the patients once per shift (more if their conidtions warrant) and take care of most IV meds, rounding with doctors, calling families, etc. RNs are very rarely assigned to primary care, but are available if anything comes up. We are a very small rural hospital and most of our patients are quite stable...the ones who are not stable are transferred to a larger hospital 75 miles down the road.
The night with this patient was one of those odd nights where one RN called in sick and there was simply no one to replace her. A manager was on call "just in case," but overall the patient load was pretty light, so she stayed home.
I think this subject has been beaten to death. We all have the right to our own personal opinions. As nurses we all have been subjected to a lot of crap during our careers but we stick to it and do the best we can for our patients. That is why we are, as a group, "one of a kind".....the best kind there is. What about a nurse who has drained your knowledge for her own gain under the guize of a "friend" then stabs you in the back when she gets where she wants to be and disregards you when you need something?
I have to agree with your thoughts here, unfortunatly, she has the right to have the nurse of her choice if at all possible. Often times the RN can go in and explain just what LPNs and CNAs are and that resolves the issue. There are people, and unfortunately nursing has itself caused these problems, who believe LPNs are not really nurses. Sometimes they just need to be informed that this is not true!
LPNer, you are absolutely right. I make an attempt for every patient to explain each member of the team-RN, LPN, CNA, or other title. This usually resolves the issue.
We have a duty to our patients to make sure that every healthcare member is recognized in order for their course of stay could at least be easier for everybody on both sides.
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?
I have seen this happen before in a hospital that I worked for 1 yr. ago....we basically had to "give in" to make the pt. happy and not cause any "problems" ...so an RN had to switch assignments with a very capable LPN....it is a shame that people are so predjudice against LPN's and CNA's ...it is sad ...I do agree that an RN should be available for all pts. , but in this case I feel as though the pt. was being very difficult..that is part of the reason I am continuing my education to become an RN, alot of pts., nurses , and doctors do look down on you if you do not have your RN degree ....
Specializes in ER, ICU, Infusion, peds, informatics.
while i was reading this thread, the first question that came to my mind is "why did this why this woman only want an rn to care for her? did anyone ask?" but then i went back and re-read the original post. as others have stated, the fact that no one else could even fill her water pitcher seems to reveal the problem-- she was being manipulative.
as it ended up, the rn went in every time the light went on...she was late to report, she had to interrupt rounds with a doctor, and one of the lpns had to resolve a staffing issue because the rn was not available. not a huge deal, but it did interrupt care for others and upset some staff members when an lpn was scrambling to make patient assigments for the next shift because the rn did not have time.
this is a problem. other patient's care was compromised because of her demands. to me, this is a huge deal. no one should have the right to disrupt your unit like that.
in my mind, the problem should have been dealt with as such: explain the roles of the care team members. when this failed, as i'm sure it did or would have, she would have had three options: 1. hire a privated duty rn for her care; 2. transfer to a facility capable of meeting her requests; 3. accept care from the cnas/lpns that they are competent to do. there is no degree required to refill a water pitcher. i did it when i was a 13 year old volunteer. and honestly, i don't remember it being covered in my rn curriculum.
i see this type of entitlement behavior everywhere in healthcare right now, and i think it is causing many of us to become burned out. it is so emotionally exhausting/draining to deal with it. patients come to the er with a cold, demanding to be seen now because they "can't breathe," screaming because someone who signed in behind them was taken to the back first.......and administration jumping up trying to accomidate them in the name of customer service. i'm sorry, i am the nurse, the professional. i went to school for this, not you. i took and passed a very long test to become licensed to do this. and i am the one to determine who needs to go to the back first; i am the one to decide which patients require the care of an rn and what tasks can be delegated to the lpn, cna as appropriate. if you take exception to this, feel free to go elsewhere.
i'm not sure i would have even put her options to her with a smile. i'd like to think i would do it professionally, but i have really had it with that kind of attitude. i find myself having to bite my tongue so often at work. i'm afraid i'm going to say something that is going to get me fired. i'm sorry, but i have only been a nurse for 6 years. i shouldn't be feeling burn out like this already. and i shouldn't have to cater to people to keep them from suing. i take care of paitents to care for them, not to keep them from filing a law suit. if we continue to practice to keep "high risk" patients from suing, eventually we are going to end up neglecting someone else, causing them harm.
:rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl: thankyou!!! i love your response.
while i was reading this thread, the first question that came to my mind is "why did this why this woman only want an rn to care for her? did anyone ask?" but then i went back and re-read the original post. as others have stated, the fact that no one else could even fill her water pitcher seems to reveal the problem-- she was being manipulative.
this is a problem. other patient's care was compromised because of her demands. to me, this is a huge deal. no one should have the right to disrupt your unit like that.
in my mind, the problem should have been dealt with as such: explain the roles of the care team members. when this failed, as i'm sure it did or would have, she would have had three options: 1. hire a privated duty rn for her care; 2. transfer to a facility capable of meeting her requests; 3. accept care from the cnas/lpns that they are competent to do. there is no degree required to refill a water pitcher. i did it when i was a 13 year old volunteer. and honestly, i don't remember it being covered in my rn curriculum.
i see this type of entitlement behavior everywhere in healthcare right now, and i think it is causing many of us to become burned out. it is so emotionally exhausting/draining to deal with it. patients come to the er with a cold, demanding to be seen now because they "can't breathe," screaming because someone who signed in behind them was taken to the back first.......and administration jumping up trying to accomidate them in the name of customer service. i'm sorry, i am the nurse, the professional. i went to school for this, not you. i took and passed a very long test to become licensed to do this. and i am the one to determine who needs to go to the back first; i am the one to decide which patients require the care of an rn and what tasks can be delegated to the lpn, cna as appropriate. if you take exception to this, feel free to go elsewhere.
i'm not sure i would have even put her options to her with a smile. i'd like to think i would do it professionally, but i have really had it with that kind of attitude. i find myself having to bite my tongue so often at work. i'm afraid i'm going to say something that is going to get me fired. i'm sorry, but i have only been a nurse for 6 years. i shouldn't be feeling burn out like this already. and i shouldn't have to cater to people to keep them from suing. i take care of paitents to care for them, not to keep them from filing a law suit. if we continue to practice to keep "high risk" patients from suing, eventually we are going to end up neglecting someone else, causing them harm.
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?
I have run into this situation. I (RN) explain that I supervise the LPN and CNA. They assist me. I have many very ill patients who have needs that only and RN can meet. If you insist that only an RN gives care then you will be without a lot of care. I am only one person and must rely one the LPN and CNA to get everything done.The LPN and CNA are fully qualified to give your care and anything that they are not qualified to do I will. Your needs are very simple and they can handle them.
we have had a similiar situation in which it would be very inconvenient for a nurse to have to go down a hall to care for a single patient...the patients family was advised that if they could hire a private duty nurse for one on one care if they felt it would better meet their needs but that assignments were made by head nurse
once a patient stated that her sil told her to demand a rn when ever she had to go to hospital and that she wouldn't take no for an answer...md was called and he went in and talked with her i don't know what was said but when he came out he smiled and said 'problem solved' and it was...we never had another complaint out of her during her entire stay no matter who was her nurse
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SmilingBluEyes
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Others (including me) already addressed religious or sexual abuse history concerns. Of COURSE you accomodate urgent needs or situations like this wherever possible. However, Neither of these were presented as this woman's problem, therefore, she has no reason to create a staffing nightmare because "she wants the RN". She is simply manipulating the whole situation for her own benefit, not NEED.
And, I agree again, with the poster who said to kindly offer her the services of a private duty RN or transfer (if appropriate) to an all-RN unit would be sensible. And this would NOT violate her rights in any way.