Written up and confused.

[pageturnstyle]

I have been a nurse for 2 years now and have been fortunate enough to avoid any deaths on my shift until recently. Last week I had a hospice patient with a DNR who was exhibiting Cheyne-Stokes breathing, fixed pupils, and a thick green secretion in her mouth. She also was known to pocket food- I found bits of banana pocketed in both cheeks at the time. Without a second thought, I retrieved the suction machine from the crash cart and used a Yankauer to suction the pocketed food from her cheeks and some of the green secretion around her teeth. The family was present and was very grateful and surprised by the things coming out of her mouth. The patient hung in there until the next shift at which time she expired. The next morning my new unit manager wrote me up for suctioning without a physicians order. Her MD had a standing order to suction PRN and the only Hospice orders I could locate in the chart said to D/C all previous meds, not all previous orders. Her hospice has no standing order to suction, however. This supervisor threatened my license and basically called me a lousy nurse for my actions. Am I completely wrong here?

[BrandonLPN, LPN]

It's much harder to contest a write up that you signed.

[imintrouble, BSN, RN]

Was it a LTC setting? You have to have an order for everything in LTC.

I would be upset too, if I thought my boss was out to get me. However, I can guarantee you no BON in any state would consider jerking your license, because you suctioned a dying pt's mouth.

[mathilda843]

This kind of thing is exactly why I would never encourage anyone to go into nursing at this point in time! It's only going to get worse as far as non-clinical management setting priorities and goals when they have absolutely no idea how to care for a patient! Yes, some things look just ducky on paper, don't they? But we all know that in real life there's most often not only black and white choices.

You certainly did the right thing...get out of there while you can!! What a shame that managers and administrators are ruining new nurses with their (managers, admin) view of patient care...

[pageturnstyle]

I spoke to my DON and she advised me to attach my own written statement to the write up. She said signing the write up only indicates that it was read to me, not that it was an admission of guilt. She agreed that I was providing comfort care and said she would look into the matter. She also said she would do an inservice for the unit managers to help prevent intimidation and other inappropriate behavior in the future.

[CapeCodMermaid, RN]

You did the right thing.

[brandy1017, ASN, RN]

No you did the right thing! IT was a comfort measure otherwise the patient would choke and not be able to breathe!

[netglow, ASN, RN]

Does she know you did oral suctioning? Was she thinking you deep suctioned for some reason? Check to be sure she understands it was oral suctioning you did - not deep. This is because deep suctioning causes pain and choking (as you know) but maybe you don't if you've not done it to an awake vent assisted patient. The look in their eyes if they've had some uncaring RTs do it - pure terror.

Hospice pretty much is against deep suctioning. Patients are put on Scop patches hopefully before it gets to that point. But oral care is given often, and suction is very commonly ordered as DME in case of this very thing happening.

[RNsRWe, ASN, RN]

Dumbfounded, I am.

I can understand if you did deep suctioning (endotracheal); facilities and RTs can be weird about who is allowed, etc etc. But a YANKOWER?!

In NO WAY could clearing crap out of a dying patient's mouth be considered anything but compassionate, BASIC care. It wasn't going to prolong her life (unless, of course the plan was to MAKE her choke on old food??).

Ridiculous, and I'd fight it tooth and nail. Your manager is a nincompoop, period.

[netglow, ASN, RN]

Your NM could also be "one of those". The type of nurse that believes all hospice patients need to just die and the faster the better. Choking/drowning is fine to them whether on food or bile or blood or what I call lung water. Some of this type actually believe that you are making them live longer if you try to give comfort care. To these nurses, you either let the person die naturally by any means (hands off, except for changing briefs) or you just load that syringe and push fast.

[LivingADream]

You did not do anything wrong! This is total BS. When a pt is a DNR you are still supposed to make them comfortable. You were looking out for your patients best interest. You need to go above your supervisor on this one.

[echoRNC711, BSN]

She also said she would do an inservice for the unit managers to help prevent intimidation and other inappropriate behavior in the future.

Well done. It's hard to be courageous. Great job!

[MADALENE4591]

My heart goes out to you! I have been in your shoes and in the real "nursing world" please be extremely careful when you venture in

following the so-called "chain of command" path. I got terminated for doing the "right" thing and at times Administrators are in a fantasy world and don't want any employee rocking the boat! If you are seeing " red" flags that managers are piling up derogatory

reports, you need to have an escape plan and look for employment elsewhere as the integrity of the manager is questionable and you are in a very hostile working environment. If you don't have strong alliances at the top , you are putting your nursing career on the line

It caused me dearly and my 25 yrs impeccable nursing career got ruined because of senseless and malicious gossips !!!

I fought hard because of good principle but unfortunately , I was dealing with different caliber of people .... Take care and good luck!

P.S. If managers are issuing Corrective Actions ... make sure you write a rebuttal on the C.A. Statement. Unfortunately, the prevailing rule per institutional policy = refusal to sign is automatic termination on the spot unless you file a grievance with HR and again make sure you have a strong basis to support a claim and always have a witness during any disciplinary proceedings and make anecdotal notes in your memory bank of issues that might back fire.