What to do when a patient alleges staff abuse?

[IreneTouTheou]

Non-nurse seeks wisdom/advice on this scenario:

A patient tells an employee that they do not want a certain staff member (who I'll call "X") to care for them again, because X has been rude and "abusive" to them, both in attitude and care. The patient says that they did tell their nurse about X's actions, and they requested that X doesn't care for them again (but they are worried that this request may not be honored), and the patient doesn't want further advocacy. The employee feels torn - they know and are friendly with X, and wonder if X's no-nonsense manner may come across as rude, or if in the course of no-nonsense physical care, the patient may have interpretted it as abusive.  So, the employee relays this conversation to their own boss, without giving any names or identifying info (since the patient didn't want the employee's advocacy and asked that they not speak out about it). The employee isn't sure of what to do beyond this, since the patient said that they told their nurse. The employee wants to ensure the patient's safety and wellbeing, but doesn't want to betray the patient's request not to say anything more, nor do they want to put X through the process of allegation/etc., but they DO want to make sure that they do the right thing, whatever that is. And then they also wonder: if they do something more, should they tell X, and the patient, that they did? 

[Davey Do]

Whenever a patient would say something like, "Now don't tell anyone this..." I would inform them that I was a professional and a member of the treatment team and it was my duty to inform other caregivers. Otherwise, that which is said is fodder for a power struggle.

A patient has the right to not request a specific caregiver. Both patients and surgeons alike have refused to work with me without good reason. So be it, for as nurses, we are there to serve the patient and follow the guidelines of those in power.

 

[IreneTouTheou]

I see what you mean about immediately letting the person know that as a member of the care team, I'm responsibile to share their concern with the other caregivers. I just don't know what to do about it now. 

[Davey Do]

If the patient informed the attending nurse of not wanting a particular individual to care for them, and the nurse supervises this individual, then the request is not honored,  the patient needs to follow the chain of command and inform the nurse's direct supervisor.

[IreneTouTheou]

thank you, now wondering if it is then ethical for the employee to go against the patient's wishes and  1)speak to the nursing supervisor to make sure they know about the patient's request and to reiterate the patient's complaint's of "X's" rudeness and possible abuse? and 2)to go back to their (the perplexed employee's) boss and name the patient and the name of the staffer who is in question? Employee feeling quite in the middle here ... 

[Davey Do]

Davey Do said:

If the patient informed the attending nurse of not wanting a particular individual to care for them, and the nurse supervises this individual, then the request is not honored, the patient needs to follow the chain of command and inform the nurse's direct supervisor.

The most that can be done at this point in the scenario is to inform the patient that, after careful thought and consideration, it would be best for all involved if they handle the situation as described above. Otherwise, it could turn out to be a no-win situation.

[IreneTouTheou]

interesting, thank you. To encourage the patient that IF they want to speak out about it, they have that option. My concern remains with the alleged rudeness and "abuse" that the patient described, and whether to report it again?

[Davey Do]

Edgar Cayce said, "You can get no one in more trouble than they can get themselves into".

I've gone as far as reporting, in objective documentation, a Tech for insubordination & circumventing chain of command and nothing was done, as the Tech was a drinking buddy of the supervisor.

Following Mr. Cayce's advice, I let the matter rest.

Sometime after my report, a patient said the Tech acted toward them inappropriately. The video of the allegation showed proof the Tech had, indeed, behaved inappropriately, and was subsequently terminated.

Instant Karma

[JKL33]

IreneTouTheou said:

thank you, now wondering if it is then ethical for the employee to go against the patient's wishes and  1)speak to the nursing supervisor to make sure they know about the patient's request and to reiterate the patient's complaint's of "X's" rudeness and possible abuse? and 2)to go back to their (the perplexed employee's) boss and name the patient and the name of the staffer who is in question? Employee feeling quite in the middle here ... 

This patient can't have it both ways. Either they are making an actual allegation of abuse or they aren't. While we all want to protect patients, it certainly would not be the first time that a patient used inflammatory (exaggerated) language in hopes of effecting the outcome they wanted but then also coupled it with trying to bind others from doing what one should normally do when an accusation is made.

Some may disagree with me but based on years of patient interactions I would now seek to clarify immediately; I would directly ask if they are saying that a nurse abused them and let them know that if that's what they are saying then I will need to follow with making an actual report of abuse.

I'm quite curious to know what your role is that the patient brought this up to you. And what was your boss' response when you told them of this situation?

 

 

[IreneTouTheou]

Thank you, The  snag here is that I won't be able to speak to the patient for a while because of circumstances, so I can't follow up right now. I am so worried about the possibility of the patient's speech being "inflammatory" and calling this "abuse" when it may not have been -- but also worried that maybe it was and maybe the staff member's behavior does indeed need to be called out. I am also worried about getting the staff member in deep trouble when they may not have done something wrong. I am also thinking this: I asked the patient when they told me about this if they told someone about this incident when it happened (and I don't how long ago it happened before the patient told me about it) and the patient said that they did, and described the conversation a bit. If I raise the issue now, will I also be implicating the staff member who first heard about this? I mean, what if they did not take action or report/address the situation? Will I get them in trouble as well? Of course, if the incident really involved abuse, then who cares -- then we need to sound the alarms, but if not, well ... 

I feel so in the middle and haunted by this. I feel bound by the patient's request not to say anything, but scared that if I don't, something bad, legally or otherwise, may happen. Oh, and I'll state my role in a vague way here, as one of the "psycho/social/spiritual" staff. Thank you. 

[Emergent, RN]

Call a Code Karen alert!?

[IreneTouTheou]

Oh, I SO appreciate the humor because this thing is eating me alive!  But seriously folks, I have been a "Karen" several times in my life ... ugh ... Thanks for the smile :).