Was I too pushy?

[new_mom26]

Hi. My 74 year old father is in a nursing home right now for some physical therapy. He has parkinsons disease and also has NPH and has a VP Shunt on the right side of his head. Last wednesday morning (around 2am) he got out of bed and went into the bathroom and fell and hit the sink.. He had a huge goose egg above his right eye.. (I don't know when the night staff realized he fell) The day shift nurse called me at 9am that wednesday morning and told me my dad had fell during the night and had a pretty bad bump on his head.. I asked if he seemed like he was ok and she said yes.. Then I asked if he could have a CT scan to check the VP shunt to make sure it was ok.. She told me that the doctor said it didn't need to be check and then proceeded to tell me that insurance wouldn't cover the CT scan.. (Even though in the past when he has fell at home I take him to the er and they always do a ct scan.) To make a long story short yesterday the nurse called me and told me my dad wasn't doing very well and said he was having a hard time walking.. I became very upset and went right to the nursing home to see him and on my way in the DON stopped me and asked if anyone had called me about my dad.. I asked her if they were going to call the doctor and let him know about him and she told me that there was nothing to do.. I told her that if they didn't do something that I was going to take him out myself and take him to the hospital and have his neurologist check him out and also told her that the shunt in his head should have been checked to make sure that it was ok a week ago when he fell.. She just looked at me and rolled her eyes and walked off... (I'm not a doctor and I don't know if this even has anything to do with him falling but, its just very upsetting.) I feel kind of bad today but, I feel that if I wouldn't have said anything then who knows what could happen..

[SouthernLPN2RN, MSN, RN, APRN, NP]

I feel you were well within your right to ask for and recieve quality care for him. I too would insist on a neuro check.

[CoffeeRTC, BSN, RN]

Heck no you weren't pushy. I can't beleive the staff wouldn't have asked the doc if he would order a CT scan and let the doc know that family wanted it. MOst of our docs would, just even to CYA. Given his history of a shunt etc, I as a nurse would definately be proactive.

Maybe why they don't want to send him to the hospital is because it becomes a reportable incident? At least in our state, if a incident ie fall happens and the resident is sent our of the facility for treatment a report needs to be made to the state.

Whats up with the DON, could she have taken your questions in a wrong way? Do they know you are a nurse?

Did your dad have a risk of falls? What was his level of orientation? What was the facility doing to prevent falls? Make sure the intervetions are in place to prevent further falls (call bell working and in reach, maybe a bed alarm, urinal or bedside commode near bed, etc) With a fall like this we would definatly be doing neurochecks for 3 days etc.

What did the faciliy end up doing? How's dad doing?

[Antikigirl, ASN, RN]

Heck no you were not out of line or pushy at all! If you are a medical representitive of your father, or if he is he could insist and request evaluation by an MD or at an ER and that falls into the patient rights act, and not giving such service at time of request is a violation of it!!!

Despite that, it is not ethical to say no to a patients request for an evaluation, even if it comes from a family member. Heck, I have sent in folks on family request to the ER over hemorrhoids...they didn't believe me that that was the case, and though perhaps they had a GI bleed...of course I was right, but best to let the family know that and know it 100% instead of being in doubt (which doubt turns to anger, distrust, and usually grows exponentially!).

One time the paramedics that arrived for one patient didn't feel that her fall was bad enough for transport (which is funny since they seem to send everyone in for CYA). However, thanks to a family member, she got in...was diagnosed with cancer with brain mets that was never found before...and was put on hospice to pass in peace when she got back! If it weren't for that family member insisting to back me up...she may not have been transported to an ER that was smart enough to find this probelm (obviously her PCP wasn't as smart to look).

I say listen to family carefully, and either do as requested within reason...or sit down and comprimise! This is also when I get my best teaching in!!!

So as far as the nurses you complained about, I feel they may have chosen to work with you better(I have done conference calls with the MD with family before...very helpful!), and reminding them of that like you did...is a-ok!

[GooeyRN, ADN, BSN, CNA, LPN, RN]

No, I don't think you were too pushy at all. Falls do happen, and what matters is what is done about the fall. Someone with that kind of history should absolutely have a CT scan done. ESPECIALLY if he is having problems after the fall! I hope everything turns out ok with him. Let us know how things go.

[RosesrReder, BSN, MSN, RN]

I would have done the same thing you did. Nope, you were not pushy. You have every right to deman the best care for him. Best wishes to you.

[Gompers, BSN, RN]

You were not pushy, you were in the right.

She was unprofessional, rolling her eyes in front of you. Very unprofessional.

[Dalzac, LPN, LVN, RN]

no way were you pushy, I have to add I would have taken him out the first time and taken him to the er myself. But then I know I am to pushy. When my mother wants something done medically for my Dad and she can't get it done she calls me and I go wherever they are and get it done with absolutely no finess.

[txspadequeenRN, BSN, RN]

I work in a LTC facility and with his hx if he fell on my shift he would been sent out to the ER. You as the POA can request that the patient be sent the ER for Eval reguardless of what anyone say's. My suggestion to you is to find another LTC facility he can rehab at. When the DON rolls her eyes at you ... you have become road blocked by your last defense. If you cant seek the DON for help... there is no help. I transfer people everyday from medicare facility to medicare facility it can be done ... so look into it. You only have one dad!!Good luck to you. Oh and I dont think you were pushy enough.

[nurse2be2007]

You were well within your right and you were right! My oldest daughter had a VP shunt and her neurosurgeon made it perfectly clear that if she fell and hit her head in any way or any part of her upper body that we were to take her immediately to the ER and have a CT scan done. The VP shunt usually drains into the stomach and the tube runs down the neck and down the back into the stomach (at least this was the case with my daughter). If she fell she could have crushed the tube causing a blockage in its path to proper drainage.

They should have done a CT scan regardless of whether he was altered or not. A small crimp in the drainage tube could cause slow but progressive complications.

Good for you for standing up to them!!!!!

[Simba&NalasMom, LPN]

I would definitely complain to the administrator of the facility, and depending on his/her reaction, even go as far as corporate. I can't believe the nerve of the DON; how incredibly rude. Unfortunately, in LTC facilities, there sometimes tends to be this "attitude" that the nurses get when they know family members are in medicine, kind of a territorial "don't pee on my fire hydrant" thing. :rotfl:

I hope all turns out well for Dad; I'm with one of the above posters; I'd definitely be shopping for a better facility. :)

[CoffeeRTC, BSN, RN]

This is so not the case, but sometimes when we have family members in nursing or medicine, they have an unrealistic point of view about what should be done in a LTC. A lot of it deals with denial and not being able to face the fact that say their 85 yr old mom with lung ca with mets and end stage Alzhiemers ain't getting better and rarely recognizes them any more.

I second what another poster said about the DON. You bet I would go above her and complain about the eye rolling.