I have been a CNA for 5 years. i am also a nursing student (BSN/RN) on my last quarter. i work as a registry CNA right now, so i see a lot of different nurses and units etc.
I was on an ICU unit with a elderly female pt who was there for encephalopathy after trauma to the head. she fell outside a liquor store. she has history of alcohol abuse but she denies recent consumption. the liquor store owner states she regularly buys alcohol. she takes anxiolytics at home for anxiety. shes also on SSRI antidepressants. she has a history of chronic lower back pain, neck pain, and states she has pain all over.
I was called in to sit with the patient. when i came she was really agitated and anxious and kept trying to get out of bed. she is A/O X4. shes been there for 5 days now. she continuously asked for her pain and anxiety meds. she had, tylenol q4hr prn (mild to moderate pain 1-6) norco q4hr prn (sever pian 7-10), lorazepam q2hr agitation (on a scale CIWA scale 0.5-2g).
she knows her meds but doesnt know what times theyre suppposed to be given. she asked the nurse but the nurse refused to give her the times because she thought the patient was addicted and drug seeking. the nurse would say "thats all you care about is your painkillers to get off. you dont ask about anything else".
i was sitting with her the whole time and she was shaking and visible anxious the whole time. the nurse would refuse to give her lorazepam or pain meds until she was literally ready to get out of bed.
based on her CIWA she was suppsoed to get at least 0.5 to 1g q2hr however she only gave it twice the whole shift. at the beginning and at the end.
the mobile xray came. from her xrays i saw she had plates pins and other surgical metals in her neck. so that explains the neck pain.
the nurses excuse for withholding the pt meds was that her blood pressure was too low and her respirations were too low. her blood pressure and respiration would naturally lower when she fell asleep but shot up to normal when she was awake. so the pt is anxious so is constantly looking at the clock, so i advised her to relax and try to sleep so that the time passes faster. now, the nurse comes in to assess the patient but every time she would come, the patient was napping. the nurse would write down pt's v/s and leave. then the pt would wake up and ask for her meds and anxiolytics. the nurse would come in and say that her v/s are too low even though they arent when shes awake. so this goes on for the whole shift. i told the nurse that shes axious and in pain but the nurse just shrugs it off and says shes an alcoholic, all she wants to do is get high.
this RN was floating from another unit to the ICU. shes from a medsurg floor.
in my head this is not ethical practice. is it? pain and anxiety are subjective. sometimes objective data can help us assess a patient's pain or anxiety but the patient's word should be taken as truth when it comes to pain or other subjective data. or at least thats what our nursing school teaches us. im always learning so please do provide constructive criticism thanks!
Without hearing the RN's version of events, it's hard to tell what really happened. Was the nurse being rude to the patient? Yep, sounds like it. Was she medicated inappropriately or having meds withheld for inappropriate reasons? Not necessarily. Again, I'd have to hear the nurse's version of this story before coming to any conclusions.
I will agree with the previous commenter though. You violated HIPAA by reading the patient's chart. You are employed by the hospital as a CNA/sifter, and your job was to sit with the patient. That did not require accessing her H&P, MAR, etc. The fact that you are also a nursing student is irrelevant.
I am curious what the VS were when the pt was sleeping. The reason I ask this is that after the meds are given the pt will be .... sleeping. Each time the nurse rounded on the pt the pt was .... sleeping. I have a strong sense that this is a biased version of the story. If I was the RN and each time I checked the pt she was sleeping, and her vitals were low I wouldn't pass the meds either. She wakes up long enough to ask for more meds, then falls asleep again .... sounds like a manipulative pt, and a gullible CNA. The comments by the RN were totally inappropriate, but also possibly true lol.
Oh, I'm certain that's where you got it from. I just find it ironic that your title mentions ethics. Meanwhile, you violated HIPAA. You stated you're in your last year of nursing school. You should know by now why this violates HIPAA.
I sorry for piling on, but this may not end well for the OP, particularly if he uses the same login as he uses for school. I'll be completely honest, I have to question the judgment of a nursing student in his last quarter who finds it acceptable to 'learn everything' about a patient when he is "only" a sitter.
Specializes in Med/Surg/Infection Control/Geriatrics.
Theres a whole lot of all of wrong with this.
A medsurg nurse in the ICU? Only critical care certified (AACNs ECCO, not necessarily CCRN or PCRN) can go to the icu in our facility. If we have to pull someone from PCU/stepdown then that medsurg goes to pcu and takes non critical patients.
This situation can't be corrected now, but next time... Speak with the icu charge nurse, unit manager, another nurse... Anyone, and share your concern. Make a fuss. Stand in the doorway and protest loudly the patient needs reassessment. Have current vitals in hand. I'm assuming you took the patients vitals while agitated, as you knew they were risen at that time vs from when she was asleep. And really her vitals are important to consider when giving meds. She could be 120/80 awake and agitated but if she 98/68 while sleeping how much further will that ativan and Norco drop her? Especially if they are given close to one another. That aside, the nurse was completely wrong in how she acted with that patient and the way she spoke to her. Always speak up if you think somethung is wrong or someone is being treated unfairly or wrong by their nurse. I don't care if your an aide, the custodian, a lab tech... Whomever. Say something.
I must respectfully disagree with your comment regarding only certified nurses in the ICU. I worked ICU for a long time as a Med/Surg Nurse but was ACLS certified. Many hospitals across the country have Med/Surg RNs working ICU. Some of these patients require them.
You may have an ICU nurse who is accustomed to handling cardiac issues and neurological, vent, etc. but if it's an ortho/surgical patient, there are certain things the ICU nurse may not be use to doing and really may not have time to do, hence the Med/Surg nurse.
I must also disagree with making a scene in an ICU regarding reassessment. You can do that quietly and professionally, without alarming patients and visitors, as you certainly would do otherwise had she done what you suggest.
And it's a nice way to get fired.
I would suggest documenting the facts, leaving out the emotion. Then present it to the Director of Nursing first. If that doesn't resolve it, the Patient Rep. They have a lot of power so don't over-look them.
There are ways to deal with that without catering to drama and unsettling everyone.
how am i violating HIPAA? i am assigned to that patient. i am not looking at any other patients. she asked me if she had her anti anxiety ordered because she takes them at home. i checked (need to know basis) i m sure checking my patients mar more unethical than what the nurse did... (sarcasm). the patient also asked me why she was at the hospital, so i checked the H&P.
i am not using any patient identifiers. we only know that shes a female. so how is that a hipaa violation? so are all case studies hipaa violations too?
how am i violating HIPAA? i am assigned to that patient. i am not looking at any other patients. she asked me if she had her anti anxiety ordered because she takes them at home. i checked (need to know basis) i m sure checking my patients mar more unethical than what the nurse did... (sarcasm). the patient also asked me why she was at the hospital, so i checked the H&P.
i am not using any patient identifiers. we only know that shes a female. so how is that a hipaa violation? so are all case studies hipaa violations too?
based on 2018 hipaa, thats not a violation.
I realize you think you were being helpful, especially because you are sitting with the patient for several hours, but it sounds like the patient was trying to play you. It is possible that there was a plan of care that was handed off from RN to RN and you may not have been aware. The patient asking you why she was in the hospital could be two things, one she is trying to get to you, or two, she is confused. As an RN if someone asks me why they are in the hospital, first try and see what they know instead of just giving information. She may be tring to play a game with you.
All of those questions that she was asking you sound like should have been answered by the RN.
how am i violating HIPAA? i am assigned to that patient. i am not looking at any other patients. she asked me if she had her anti anxiety ordered because she takes them at home. i checked (need to know basis) i m sure checking my patients mar more unethical than what the nurse did... (sarcasm). the patient also asked me why she was at the hospital, so i checked the H&P.
i am not using any patient identifiers. we only know that shes a female. so how is that a hipaa violation? so are all case studies hipaa violations too?
based on 2018 hipaa, thats not a violation.
Because you were assigned as a sitter, so you did "not need to know". You did not have any medical reason to be in her chart as you were not assigned to care for any of her medical needs. If you truly are in nursing school the fact that you do not know this is very concerning.
Because you were assigned as a sitter, so you did "not need to know". You did not have any medical reason .
i didnt check because im the "sitter" the patient asked information about her care. is it normal practice to withhold patient care information from said patient? or is it normal practice to inform your patients and have them involved in their care? im apparantly not learning what i'm supposed to
i didnt check because im the "sitter" the patient asked information about her care. is it normal practice to withhold patient care information from said patient? or is it normal practice to inform your patients and have them involved in their care? im apparantly not learning what i'm supposed to
I am not going to defend the nurse, nor am I rip her to shreds. There may have been circumstances you are not privy to that caused the nurse to treat the pt how she did. OTOH, the nurse might be 100% in the wrong. I wasn't there, I don't know.
Either way, you are not allowed to go in that chart and look around like you did. If the patient has a request or questions, bring it too the nurse. If you feel the care is not appropriate, bring it to the charge nurse. But you cannot, under any circumstances, go looking through the chart of that patient. If you do not realize that, then, no, you are not learning what you are supposed to be learning.
ICUnurse990, BSN, RN
12 Posts
Without hearing the RN's version of events, it's hard to tell what really happened. Was the nurse being rude to the patient? Yep, sounds like it. Was she medicated inappropriately or having meds withheld for inappropriate reasons? Not necessarily. Again, I'd have to hear the nurse's version of this story before coming to any conclusions.
I will agree with the previous commenter though. You violated HIPAA by reading the patient's chart. You are employed by the hospital as a CNA/sifter, and your job was to sit with the patient. That did not require accessing her H&P, MAR, etc. The fact that you are also a nursing student is irrelevant.