Posted on 12/09/2014 3:19:18 PM PST by SWAMPSNIPER
I hope to God that I NEVER have a nurse such as that woman...what a harridan, it seems she wants nothing other than compliant zombies as patients, and if they’re almost killed, oh well, too bad, they’re dregs.
Yuck.
Ed
I saw such a disruptive persons “finessed” out of the system the second they showed signs of moderate sentience but still groggy with short term memory issues from drug over dose and etoh use. Their total CK’s were still way over the line and they clearly needed more IV fluids due to early rhabdomyolysis as well as psych consults. About 35 per cent of the time we’ll get them back within 1-3 months and we get many such “frequent flyers” in our ICU.
Drug abusers who have frequently come into the hospital for trumped up ailments to get drugs are encountering a hardened attitude about them receiving narcs which is spilling over onto patients who legitimately need them. Federal rules under Obamacare are tightening documentation requirements. The abusers are now being told informally that obamacare rules make us justify every narc giving out and we can give them drugs for withdrawal symptoms but not for the dilaudid they so crave. What follows is 3-5 days of hell as they detox in the ICU as they are not “medically clear” enough to be admitted to psych.
The younger docs and NP’s have become increasingly risk adverse and the older doc’s who have the experience to pin point the correct diagnosis with the correct treatments are becoming fewer and fewer!
As for your point about “getting rid of patients because we have no time for drama”, I recoil in horror at such a thought but I recognize the utilitarian ethic that has infested that sort of thinking.
Not every “disruptive” patient has come to the hospital to personally cause you trouble. Correct their acid base balances, get their glucose levels under control, thyroids may be over active, ect and most folks sweeten up and become ok patients.
If lawyers were to get ahold notes as you describe from a patient who just happened to die from correctable conditions (that would also help the “disruptive” state when treated) because no one took a second look to see what was causing the “disruptiveness” and instead “finessed” the patient to substandard care or no care, then you as an RN would be blamed for scripting your notes in such a way as to skew future physicians’ impressions of the patient. This causes a denial of patient care, for which you could be
potentially be held liable!
Why did the patient “ make a scene in the waiting room”?...a statement like that charted without context... context such as(” patient stated he was upset because he was in tremendous pain and had been waiting two hours. The patient became calmer when morphine was administered after Doppler revealed a DVT and heparin gtt was started”)...can forever mark a patient unfairly and get you SUED!
You are a freeper and I also remind you of your first medical principles. It is not “US vs THEM!” It you are resorting to passive aggressive destruction of a patient’s reputation via charting so that they are denied the best future care, then you need leave nursing or whatever scope of practice you are in!
mdmthis6 RN(28 years in practice and still going!)
I hate going to the doctors office. After losing a wife to copd and the amount of meds prescribed, they made the woman a virtual zombie. I am fixin to be 62 next month and officially retired. I am going to live till I die and do so without all the meds. Take this med take that med, this is what you have to eat, you must stop smoking, you must stop drinking, come back and see me in 30 days, we need to run test, you need to see a specialist. EF that. I am just going to lay up here in a country state of mind, catching these fish like it’s going out of style and drinkin this home made wine. and if the sun don’t come up tomorrow, people I have had a good time, just layin up here in a country state of mind.
I’m sorry for your loss; COPD is really vicious! Not all copd cases are caused by smoking...certain environmental causes as well as folks predisposed to upper respiratory reactive disease and asthmatics over time will develop it. Then if there is heart failure...the Cor pulmonale is a real misery to suffer and a challenge to treat. No matter the cause, I just try to help such patients where I can!.
I work in a hospital, and it is very difficult to get people psych care. In case you have not read the stories in the Puget Sound newspapers, the ERs have been boarding psych patients because there is no place to place them. It is extremely difficult for patients to access psych services on the west side of the state.
We chart what we see.If a patient exhibits bad behaviors, we chart that. We are supposed to chart that. Have you ever read a social workers chart notes? They completely write down behaviors of patients. Try reading a few outpatient or floor SW notes.
And no, we do not ignore medical issues. But, some patients want what they want- including narcotics. I almost got hit by a patient in a clinic who wanted an off work slip for his back, after he already was off work for months. MRI and neuro exam negative. Those are the patients we do not want back, and we will chart what we see.
That is why as a patient, if you show behaviors that could put the staff at risk, you get dropped from the practice with a certified letter.
You work in an ICU- all of your patients are there for a true medical need. Once they are extubated, and stable, you ship them off to the floor. Once they are awake, they are out of the ICU.
Clinic nursing ( which I did for many years) is a whole different game.
Physicians just dont walk out on a patient in the ER without provocation. They dont refuse service when they show up to the clinic. That actually constitutes abandonment. That could affect their Press Ganey Score, and get them in trouble with administration.That is why I think there is more to this story, we are not hearing the healthcare provider end of it.
I like your attitude! Have a relaxing time!
Reading this post scared me, I will admit. My husband's aunt was just diagnosed with COPD. She's not yet 70, still very beautiful, very active, and doesn't smoke. But she has had pneumonia several times, and apparently that caused the COPD.
She doesn't need to go on oxygen yet, thankfully. I admit I can't imagine this take-charge, type-A woman with an oxygen tank. Going to pray for a miracle, I guess.
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