Had family visiting a patient last shift, and when I walked in to do my initial assessment, etc, did a double take at one of the visitors. Before I could even open my mouth, he said, "I don't feel well, can you take my blood pressure? I've got the worst headache I've every had." Guy weighs at least 400 pounds, is sweating, grey in the face, and is just setting off all my "oh crap" alarms. I took his bp and his temp, since he was hot to the touch. Sky high bp, pulse so fast I can't count it, and temp 102.1. EEEEK! I told him to go to the ER, which he did. He was admitted, and I know his weight was over 400 because when they admitted him, he had to be put on an ICU bed in a med surg wing because he was over our equipment's weight limit.
Now, after he wheels down to the ER, my charge nurse tells me I should have never touched the guy, never told him to do anything, just referred him to his family physician. All I could think was, well, it would have looked real good at trial when the wife and patient/father says, "he said he didn't feel well, had a history of hypertension, and that nurse didn't do anything and he died from a stroke on the way home." Not to mention it's not going to help my post-MI patient if his son-in-law codes in his room.
How does your hospital handle this sort of thing? I'm still so new I practically squeak, and I've referred plenty of sore throat/look at this mole requests to "visit you physician of choice," but if you see a visitor who looks like he could be in real trouble, are you still supposed to wait until he hits the ground at your facility?
Your charge is only half right. You shouldn't have taken his vitals, but you should have referred him to the ED and told him in a way that ensured that he went.
Mearly telling him to 'take it up with his PCP' isnt' enough.
I agree with what you did as well. Although, in my old job we were told differently. In the PACU family members would drop like flies (although they INSISTED on coming in as soon as the surgery was done....haha), we were told only to offer them a chair, and then if they still didn't feel good our only words should be "you need to go to the ED." Something about how they aren't patients in the hospital so if you do something wrong the hospital would be held liable and they were never admitted, etc. etc. So silly, although I understand. But it's hard to listen to stuff like that when our main purpose in our job is to help people!:wink2:
Sorry you don't "get" it. But it's the right and legal thing to do to protect yourself and the hospital.
And that's the truth. If you begin treatment on someone, and then they refuse further treatment, then who is at fault when he drops dead? Your good deed will come back to bite you big time.
Why don't you swing by your legal department and ask them what they'd recommend.
Always do what is best for the patient or in this case almost patient, and you will always be right. It is never wrong to refer a patient to the ER if they are having problems.
How could you morally or professionally given him any other advice? You DID do the right thing, hands down.:heartbeat
This has happened nurmerous times to us on our floor....we've had family members passout, develop chest pain, vomit...you name it...
We give them 'first aid" as needed and take them down to the ER to be evaluated. I've had to "talk" a patient's mother into go to the ER by showing her how bad her b/p, heart rate was by taking vital signs...but that's the only time I can remember actually taking vitals...
You can never just tell someone having such 'omnious' symptoms...go see your personal physician...please! YOU DID THE RIGHT THING!
I think you did the right thing and good for you:yeah: I would have done the same thing. It might not have been the correct action "legally" but I think it was right ethically. You have to live with yourself and would have felt bad if you didn't do anything and this guy went unresponsive. I wonder if it would have been all right to do something then? Oh, but I guess that is different. And seriously, I don't think the hospital would be liable if something went to court, I'll bet the nurse would be. Crap runs downhill. That is my experience anyway. I also think that checking VS is an assessment, not a treatment. Good for you for doing what you felt was right. You will come up against those kind of decisions many times. Good luck!
Sorry you don't "get" it. But it's the right and legal thing to do to protect yourself and the hospital.
And that's the truth. If you begin treatment on someone, and then they refuse further treatment, then who is at fault when he drops dead? Your good deed will come back to bite you big time.
Why don't you swing by your legal department and ask them what they'd recommend.
And BTW, I'm a charge nurse too.
A charge nurse. Oh, okay, but I still don't agree with you. So we protect ourselves by just telling this guy to go away to the ED, maybe he will go and maybe he won't.....and without knowing the severity of his s/s. I'm very sorry, but I don't agree with you at all! When we see someone hurt on the road, store or in a parking lot, or elsewhere for that matter....are we to say "Go to the ER"!??? Or do we offer our help? I've been told that we are protected by the good samaritan law in situations like this.
This has happened nurmerous times to us on our floor....we've had family members passout, develop chest pain, vomit...you name it...
We give them 'first aid" as needed and take them down to the ER to be evaluated. I've had to "talk" a patient's mother into go to the ER by showing her how bad her b/p, heart rate was by taking vital signs...but that's the only time I can remember actually taking vitals...
You can never just tell someone having such 'omnious' symptoms...go see your personal physician...please! YOU DID THE RIGHT THING!
I think you did the right thing and good for you:yeah: I would have done the same thing. It might not have been the correct action "legally" but I think it was right ethically. You have to live with yourself and would have felt bad if you didn't do anything and this guy went unresponsive. I wonder if it would have been all right to do something then? Oh, but I guess that is different. And seriously, I don't think the hospital would be liable if something went to court, I'll bet the nurse would be. Crap runs downhill. That is my experience anyway. I also think that checking VS is an assessment, not a treatment. Good for you for doing what you felt was right. You will come up against those kind of decisions many times. Good luck!
A charge nurse. Oh, okay, but I still don't agree with you. So we protect ourselves by just telling this guy to go away to the ED, maybe he will go and maybe he won't.....and without knowing the severity of his s/s. I'm very sorry, but I don't agree with you at all! When we see someone hurt on the road, store or in a parking lot, or elsewhere for that matter....are we to say "Go to the ER"!??? Or do we offer our help? I've been told that we are protected by the good samaritan law in situations like this.
When you stop at the scene of an accident, you are protected by the Good Samaritan Law because you have chosen to render aid even though you have no established nurse-patient relationship, and thus no duty to act.
When you take the vitals of an ill family member in the hospital setting, you are crossing that fine line by establishing a nurse-patient relationship with someone about whom you know nothing (medical history, allergies, etc.) and someone whose future actions you have no control over. You begin to collect data, and you become obligated to see the person's care thru, whether or not you actually have the ability to do so. (You are not in the ER, you may or may not have the supplies, equipment and expertise necessary to properly care for the patient's condition, and you may not be able to persuade this person to obtain the follow-up s/he needs.)
By merely guiding the patient to the ER, you do not establish a nurse-patient relationship or a legal obligation to the patient.
I don't disagree with the actions of the OP. I believe they were appropriate. However they could come back to bite her in the butt legally if her assessment was off the mark, or if the family member in question refused to go to the ER and suffered ill effects as a result.
The response of her charge nurse was absolutely correct, from a legal standpoint, although most of us would agree that morally, we would act differently.
RedhairedNurse, BSN, RN
1,060 Posts
I DON'T GET THIS!!!