Where Do I Draw The Line Between Right And Wrong?

[ZinnianWolf]

Hello everyone. I am a nursing student who is currently on vacation. I took a private duty job that was given to me by one of my relatives. In the short period of time that I have worked with the person (who has parkinson's disease) I have notice a lot of things that should be done not being done. The person is very unstable and is left unsupervised by the other workers. He has a nob on his knee from falling, has fallen into one of the mirrors that is on his closet door, which is now shattered of course, and has fallen hard enough into the wall that there is now a big hole in it. I have come in on to take the place of the person on the night shift and has found him urine soaked in bed, and on occasion come in on the afternoon shift to find him reaking of urine, nails dirty, teeth not brushed, and greenish-yellowish discharge coming out of his eyes. He is currently complaining of pain in his right leg where the nob is and has even more trouble walking. His legs also swell and are not elevated unless I am there. One of the persons who is supposed to be caring for him went on vacation and was paid for work (51 hours) that she didn't do. Her family (who are the other workers) are covering for her. I decided to tell his accountant and have left the job. I also recommended that his family be contact and a home care agency with a nurse to evaluate him come in. I have been catching heat from my aunt because she says that I shouldn't have said anything. I am confused because in my heart I feel like I did the right thing. As a soon to be nurse I feel I did the professional thing, but I don't know if I was wrong for betraying my aunt, and the others. I have been up all night with this and on the verge of a panic attack because the only people who are behind me are my classmates and I just feel like crying because my aunt will probably not speak to me again. I thought that the patient's safety should be first and I feel like the others are taking advantage of this person and something needs to be done. He is on carbadopa-levadopa and he isn't given his meds as scheduled. The whole situation is a mess and I don't know what else to do. I just want to go to bed at night knowing that I did the right thing and that the patient will be safe, clean, and cared for the way they should be. PLEASE HELP. ANY ADVISE WOULD BE VERY WELCOMED:o

[kids]

I know that these people are probably going to lose there job, but I told on them anyways because they can find a job somewhere else (hopefully not one where they are in charge of the care of another person).

Please make a report to Adult Protective Service any way, for the simple reason their next job may also provide an oppertunity to victimize a vulnerable adult.

I realize you are a student but, if you were licensed you would be required by law to make the report. Please call APS, do not count on the accountant to protect others from these people.

[Hellllllo Nurse, BSN, RN]

ZinnianWolf.

I am happy that you are doing the right thing. I know it is very hard sometimes. This is an example of the "ethical dilemmas" which are discussed in nursing school.

All the best to you and God bless you, too.

[sweetcheekers]

There is right and there is wrong. Maybe sometimes the line is foggy. Be thankful this isn't one of them. A great nurse does what is right regardless of who may have their toes stepped on. That IS our duty. You made the right decision and should be patting yourself on the back. You have not only the authority to bring matters such as these to someone's attention, you have an obligation. It is not optional. Being a Pt advocate IS part of being a nurse, and it should be practiced regularly as any other skill. It is NOT a nice little extra that really good nurses provide (or it should'nt be). It is a required part of the job!!! Many nurses that I believe probably began with high hopes and good intentions allow negative responses from others work on them until they become complacent over the years because its easier than taking crap from people. They somehow forget that aspect of our job is just as important as administering medications, performing assessments, and providing emotional support. If you aren't looking out for a patient's safety, you are not doing your job. After all, we are taught in school that first and foremost is patient safety. If we haven't a patient, we haven't a job. Good call. Give yourself a pat on the back!

[leslie :-D]

this poor man is very lucky to have found you. you should indeed be feeling much peace with yourself...this poor soul being grossly neglected and in pain, that is unconscionable.

you were his guardian angel. and i agree. call adult protective services asap with your statement. you've done wonderfully.

leslie

[Tweety, BSN, RN]

What everyone else said. Patient advocate first and foremost. Hopefully your aunt will eventually understand that. Good luck!

[elkpark]

I agree with all that everyone else has said, and will also add that, if the care this man is receiving is being paid for with public funds (Medicaid or Medicare), this may well also be a case of Medicaid/Medicare fraud (people not providing the care to the man that was being paid for, and the woman being paid when she wasn't even there).

This is a big deal, and every state has a hotline for reporting this kind of situation. Like reporting possible physical abuse, you don't have to know for sure that fraud took place -- you just have to have a reasonable suspicion. It is the responsibility of the investigators to make a final determination about whether or not fraud has occurred.

The state and federal governments are working hard to decrease/eliminate fraud in healthcare services. These are our tax dollars we're talking about, so it is in all our interests to make sure the money is being spent appropriately. :)

[ZinnianWolf]

Well, today I spoke with his accountant early this morning. I have been up since 0300 and am exhausted of course. I told him what I knew and he was glad that someone finally came forward. He is behind me and he is going to help me file a report based on what I told him. Since a lot of the things that were broken in falls have not been fixed yet, when the state goes in the physical evidence will still be there. My aunt called me this morning asking me if I called anyone and I told her no. She wanted me to call the person who is in charge of his "care" because she says I should keep the job for the money. I don't care about the money!!! and I don't think she understands that. It wouldn't be good for me to keep a job where I am faced with trying to care for someone who needs more help than I can provide. I was only there for a few days a week, which means that the days I wasn't there, the care was minimal to non given at all. I would rather be broke than to take on a great responsibility like that, than to keep a job where I don't have good communication with the other people and patient advocacy and teamwork are lacking. I don't want to be put in the position of knowing that I didn't do what needed to be done and knowing that this man could possible be seriously injured and not do anything at all. I have made the mistake once when I started as a CNA 7 years ago of not speaking up and the patient fell and was hurt pretty bad. I still have to live with that and it hurts still to this day. I'll be damned if I make the same mistake again. My concern lies with the patient and I am slowly learning not be afraid to speak up for what is right.

[Agnus]

There is one very important element that you seem to be ignoring. Due to your choice of 'job' in most states, you are a mandated reporter whether you are licensed or not.

Over and over posters have told you to contact adult protective services. You have done very well so far and used good judgement and are very ethical. Now call them. This extends beyond what an accountant can or even should resolve.

Adult protective services will provide the support and back up and resources you and your patient desperately need right now.

[Spidey's mom, ADN, BSN, RN]

There is one very important element that you seem to be ignoring. Due to your choice of 'job' in most states, you are a mandated reporter whether you are licensed or not.

Over and over posters have told you to contact adult protective services. You have done very well so far and used good judgement and are very ethical. Now call them. This extends beyond what an accountant can or even should resolve.

Adult protective services will provide the support and back up and resources you and your patient desperately need right now.

Absolutely - great post Agnus. OP - you did the right thing. Keep on doing the right thing.

steph

[rnmi2004]

Zinnian stated "He is behind me and he is going to help me file a report based on what I told him. Since a lot of the things that were broken in falls have not been fixed yet, when the state goes in the physical evidence will still be there" so it sounds like she/he hasn't ignored the advice she's been receiving.

Zinnian, you are absolutely on the right side! It sounds like your aunt is now worrying about what will happen to her when this situation is reported. Don't let her get you down. You can look back on this incident as a positive learning experience instead of looking back with guilt. :)

[ZinnianWolf]

Hello again friends. I am sad to report that I am now the blacksheep, the bad guy, and anything else that would go under "bad" to my Aunt and the others. I am happy but sad at the same time. I just hope that my Aunt will get over it soon, and the other people, well I don't care what they think either way. I just wanted to say thanx to all of you for your support and reassurance about this matter. I know that I made the right decision and hope soon that the people who don't understand will some day realize that too. Thanx guys:-)

[rEAL nUT]

You should feel great that you made an effort to protect the pt. That is what nurses should do. It sounds like you are going to be an excellent nurse. Great Job and GET SOME SLEEP.