To quote or not to quote...

[themoreyouknow]

Our director is now writing people up for using quotations in their documentation. She states it is a red flag for a lawsuit.

I thought that when you had a non-compliant patient or a pt who refuses treatment, their refusal should be documented in their own words. (The same goes for an unruly patient.)

For example:

You walk into the room to do a fundal check on a mom who has delivered lady partslly. The husband stands up and yells "If you're coming in to push on her stomach, you can forget it. It makes her cry and it hurts and nobody is going to hurt her while I'm here!" You explain that fundal checks are done to be sure the uterus is firm. A soft uterus can lead to hemorrhage. He says "You nurses think you know everything. You can just get OUT because it isn't going to happen!"

My director says we shouldn't document what the husband said in quotes because it sets the hospital up for a lawsuit AND because "the patient didn't actually refuse." She states we should write "Husband non-compliant with fundal checks". How can he be non-compliant when he doesn't have the fundus???

Those who use quotations are being written up.

Does your facility have a policy against quotations? What have you been taught to do?

Does anyone know of any professional organization that says to use quotations? (ANA, etc)

[leslie :-D]

i think it's pretty shabby that you nurses will be written up, if you use quotes.

how does one do their job as it should be done, with threats/write-ups forthcoming?

me...i'd still write what the husband stated, and leave the quote marks out.

leslie

[themoreyouknow]

Thanks :) I realize the follow up would be to notify the charge nurse, the md, etc. We didn't have an issue with a fundal massage I was just using an example.

We had a situation recently with a very foul mouthed patient who refused to wear her monitors, refused to wear her gown (then later said the nurse never offered her one!), etc.

Sometimes I feel that it is important to capture a picture of the patient's attitude. This particular patient told a nurse that she was mad because her doctor wasn't on call that weekend. She stated she would not return to the facility. She would not follow up with her doctor. And we could all just f* off if we couldn't get her doctor in to see her whenever she wanted him. She was NOT in labor. She demanded to go home. The nurse was worried that she would refuse to come back in if she had any complications at home and documented her statements. She was written up.

Guess what? That same little pt returned. Again, she complained as high up the chain of command as she could that the nurses were mean to her. Even though she refused to wear her monitors, etc. She was upset that her Dr. wouldn't come in to see her in the middle of the night and was again going to fire all of us. (Esp her doctor!)

The director talked to her. Sent her flowers. And guess what? This same foul mouthed, "F- you" young lady returned again. After her discharge, my director received another call that THOSE nurses were "b*tches too!"

I guess I just find it frustrating that some managers take "the customer is always right" attitude with every patient. Even those that have a documented history of being crude and non-compliant.

[zofran]

Dumb rules/managers like this are the reason I quit my hospital job.

I used to quote pts and visitors frequently because like the OP said, it does convey the attitude better than the RNs own words. And it is sometimes necessary to quote visitors. Sometimes they make it impossible for the pt and nurse to have any interaction.

Good luck OP...I am still looking for a job I can stand!!!!! LOL, Zofran.

PS. Yes, I am broke but happy :)

[Flying ICU RN]

All the quoting in the world does not relieve a nurse of her responsibility to care for a patient no matter how much the patient is swearing.

Because the patient and family are laymen, and you are the professional, a very basic premise.

You have to push it (whatever the issue) right up to the line of refusal of treatment by the patient or proxy.

A caveat, the proxy is not the proxy until the patient is clearly incompetent. Some proxies, seem to think otherwise.

[diligent-trooper]

Actually, she is correct. The woman is not the one refusing, but the husband is. I am not sure why the UM has to be so hard*** to write people up. It is actually a teaching moment.