Why is it always my job to go further?

495 Posts

Specializes in Surgical Specialty Clinic - Ambulatory Care.

Here are some scenarios.

1) I admit a patient and have weekly, verbalized her medication list to her. She confirms her medications. I was very aware that she has issues with pain and has been fired from a pain medicine doctor. Her current pain meds are followed by her current pain doctor and for the 4 months I took care of her she never asked me to call a physician for more or increase pain medications. She had pain but said her pain MD had it under control. I didn't have the pain MD listed as someone I could take orders from as she is getting wound care and IV atbx. There are concerns regarding her gait and her pain meds but I knew she was intentionally not telling me who her pain medicine MD was out of fear of having any of her pain medications taken away. She refused PT and that is where I left it. Because I don't feel like I am there to deal with her possible addiction to pain meds. I am there to heal her wound and take care of her infection. I did my part of addressing pain meds and gait by educating her that there could be correlationed to each other and making sure she understood that risk. Well her infection got worse, she was hospitalized, and at discharge a different nurse did her resumption of care. Wigged our about the pain meds and gait like I hadn't done enough. So the other nurse starts this big investigation in to who the pain MD is, the patient didn't tell her either. I found the MD first and let him know our concerns, the pain and contacted the patient with the fact that I called about those concerns and now the patient is VERY pissed because she feels like we went behind her back. I understand as a nurse that I have the right, when caring for a patient, to bring up any issues that I feel I need to bring up with any physician. But I don't feel like I am there to get up in every patient's business. That we cannot force every patient to make the best decisions, and getting up in their business to discover every issue the patient could have is not what I am there for. I am there to help with everything the patient will allow me to. So if they don't want me to dig into their pain meds I don't. Does this mean I am not doing my job as a nurse?

2) Elderly patient that is really not capable of safely living on her own. She can exit the house in a fire, she can preform ADLs and small meals, just not safely. I tried to convince her to go to Assisted Living. I tried to get her son to take more responsibility. I tried to get her to agree to private duty assistance. MSW has consulted with the patient. Patient is forgetful but AxOx4. I feel I have done all I can. Another nurse who is senior to me says I should report the son for neglect or the patient to the state. I feel that this old lady wants to die at home. She is not making the safest decisions, but they are decisions that fit her goals. Why is best nursing practice to try to force the issue anymore than I have?

3)A post op patient has had a bulky dressing on for 5 days. He verbalized that he wants it changed but orders are that drsg to stay in place until follow up in 7 more days. Previous nurses have just been reinforcing drsg which has made it that much larger. There are also 2 drains. One quit draining 2 days ago. I called the MD office they say I can change the dressing and pull the drain. My background is ER, I have never pulled a drain in my 10 yrs as a nurse. But as an ER nurse I'm pretty confident if something happens I can make a plan. I look at the drain, see no sutures, I pull very gently and it just comes right out. I chart it. All my coworkers start clucking as to how home health nurses don't pull drains and why would I do something like pull a drain if I have never had any training on it. To be honest with out YouTube and my best guesses I wouldn't have done half of the procedures I have had experience with. I only had one job for 2 years that actually had an educator. Otherwise I would beg another nurse to watch me, or often just try on my own because everyone else was to busy. I would never make it home to my family if I did it any other way. Have I learned that sometimes the way I did something wasn't best practice? Hell yes, but I feel like if I put my foot down and refused to provide care until I have had someone demonstrate to me every new thing I see, I would be fired...and would have been fired from every job I had before this one. So does this mean I am gambling with my license? I really don't know how anyone else has made it as a nurse without taking reasonably safe chances like this.

So am I to risky as a nurse? Others make me feel I am not being careful or diligent enough. I don't feel this way. But it bothers me to think that maybe I am. I have never had a patient die due to error. I have caught several close calls on other's errors, but I feel that the way medicine is that is how we should be operating. Medicine is scary, the system isn't safe, we have to quit pointing fingers at others near mistakes as such a shameful incidence. But what do you think?