She was yelling and refused to leave the room. My Dad went to the ER this past Tuesday for severe diarrhea and possible exposure to a parasite in the water supply in the town where we live. (Yes, I give him bottled water, but can't get him to stop drinking out of the tap!) As has been my experience with this hospital system and their hospitalists, they did not follow his medication regimen. Dad is 91, has aortic stenosis, high blood pressure and orthostatic hypotension. As long as you don't "mess with his meds" he is perfectly fine. This time, I had to pitch a fit over the phone to get them to give him his night meds, even resorting to the "don't make me come back there" speech. These people do not listen! As it turns out, they found out I was right about the regimen, and his BP went too high. Instead of calling me and telling me, they gave him a dose of clonidine which should have never, ever been given to him. I found out about this about 12 hours after the fact when I was told by the doctor who started the conversation with "in the interest of full disclosure". They told me he was stable, which I knew he was not. Even though his BP readings were normal per their standards, it was not for Dad and usually a screw up like this takes about two weeks for him to fully return to normal. I took him home anyway (figured it was safer for him) and monitored him closely. Unfortunately, his BP was not recovering to the level it needed to be for him and his BP was running way too low and his BP specialist said to take him back. This time we went to a different location of the same hospital. He needed to be admitted and I would only agree to it unless a very precise treatment plan was developed and after I had requested hospital administration had been included at my request.
Everything was fine until his night nurse didn't want to stick to the treatment plan. It was going to be done her way. Meds first, BP second. NOPE!! She had an absolute emotional meltdown when I refused to allow her to even review the medication before the BP. What is the point unless you know what the BP is which will determine what meds to give?
Nurse started yelling. When I asked for the hospitalist she said no that I wasn't going to accuse her of anything and I wasn't going to tell people what she was doing. I wasn't going to accuse her of anything at that point, but I was going to have the doctor review the treatment plan with her since she wouldn't hear of it from me. She kept repeating the "accuse me" rant and I asked her to leave since she was still yelling, and she refused. By this time, another nurse had come to see what was wrong and it just continued to get worse. The charge nurse came in an allowed the night nurse to continue to yell, continue to tell me no, I could not see the hospitalist, no I couldn't see the administrator, no she would not be changed as my Dad's nurse. The charge nurse was allowing the yelling to continue in my Dad's room.
She acted like a nurse who has been on the hot seat before and was one straw away from from getting into some serious trouble, at least at the hospital. I made the mistake of calling her "this lady" and she yelled, "I am not a lady, I am a nurse!"
Should I file a complaint with the state board of professional registration? This action could potentially affect her employment anywhere, so I want to be very careful. However, this woman needs some serious something if she is going to behave like that in front of a patient. The hospital is on the hook for a charge nurse for continuing to allow her to be in my Dad's room.
Thanks for all the responses I hope to get!
Through many, many years of being a caregiver to both of my parents and being a nurse I have learned that there is a line between advocating on behalf of someone and alienating the support people who help our loved ones. It took me a while to find that line.
Besides that, listening to patient's families is pretty important. You dad might be a very slow metabolizer of clonidine - just experienced that with a patient of mine a few months ago, and advised that this ought to be on any list of adverse drug reactions for the future. Clonidine happens to be a good drug for certain things - and if for whatever reason its not on the list and someone goes and gives it again because they won't listen, that's bad care. Let me repeat - not listening makes for bad care! Cookie-cutter care and trust-my-judgement-because-I know-the best-way -to-do-everything care turns out to be bad care just as soon as anyone doesn't totally follow the textbook in how they present or experience things!
So sure, bake the cookies, build good will, make yourself appear reasonable and compassionate, but also make the report in good faith. Maybe you will be actually salvaging the career of someone who could potentially become a good nurse with a little stress management and/or training in how to better relate to concerned and upset families.
I read and re-read, and honestly, under the circumstances, don;t see where you were out of line for asking for BP check before meds - I mean as long as what you said was more like "My dad has a lot of trouble with any changes in his BP meds - he needs to maintain x/y BP to feel OK and not pass out or fall - and we just always check first because you can't un-give a med" rather than "you idiots always screw up and now you're gonna do it again to him!"
Reading your account of that lively evening, I can't see what you could have done differently that would have made this lady-nurse any less determined to have her own way come hell or high water. If I have a further concern, it's that her supervisor(s) weren't more competent in defusing the situation more quickly. But seeing as this is the kind of hospital that it takes the patient some weeks to recover from, it can't have been a surprise to you.
File a complaint? - against the individual seems a bit OTT to me. What she did was not only fail, but actively refuse, to follow charted directions; not because she disagreed with them, but simply out of a stubborn refusal to listen to her patient's relative. Now while that is unprofessional, I agree, it's a disciplinary matter that ought properly to be dealt with by her line managers. It is they I would want held to account, because her whole stinky attitude is a reflection of their apparent willingness to dismiss all external information. It's the hospital that's the issue, not Nurse Snitty.
In your place I would document every adverse incident that has taken place and submit a formal complaint to the hospital. And then keep doing that until something changed. There's a hospital in ?California - is it San Diego? - that has reduced its error rate by some fantastic percentage by allowing its staff to report absolutely every error, glitch, oversight and failure of communication without fear of comeback; we patient advocates need a lot more of their self-reflective, constructive criticism and a lot less bloody-minded backchat.
Should you report the nurse to the state? We say yes. There have been many excellent suggestions to also file a report with the hospital system, and that is a good place to start if you haven't already. Any investigation from the outside will start with whatever investigation happened inside - good, bad, or indifferent. Meanwhile, check your state government's bureaucracy closely. Based on what you posted, it sounds as if the entire hospital system needs to be reported to your state's licensing board. In our state, any communications with a medical facility oversight/investigatory entity is held confidential by that entity. In our state, there is a separate entity that licenses nurses, so a report probably ought to be filed there as well. (We don't know if this kind of a call is complaint is confidential or not.) Finally, at least in our case, if we are not happy with the care received by a provider of any sort, we can file a complaint with our insurance company which will also put that provider or system on notice. Too many complaints can make an insurance company think twice about renewing the contract with a provider or maybe lower the approved cost per procedure for that provider.
Not only did the night shift nurse completely lose her professionalism, but the supervisor in charge did nothing to rectify the situation. And there is the situation of you having to return to the hospital in the first place because of the bad care your dad received on his first visit. Quite frankly, you ought to have this same discussion with an attorney who deals with hospital malpractice.
Can you be sued for libel/defamation of character? This suit probably won't get any further than a call to an attorney. If you were making up a story about someone to damage his or her career, etc, then you could be successfully sued. Could you be stalked? Sounds possible. But if you're going to stand up for your dad and not allow this kind of horrific care to continue, you're going to have to do something that will help lead toward it never happening again to anyone.
Finally, to those who espouse the "live and let live" philosophy in this case, while it is true that everyone gets to the breaking point, has a bad day, has seen the victim(s) revictimized by criminal activity in retaliation, there comes a point in which someone has to stand up and say that this kind of behavior and care will not continue. There are those medical professionals out there who don't want your elderly loved one to continue to live simply because they're elderly...we've experienced them. We now start every conversation with a new provider explaining that our loved one is dear to us and we want the more aggressive approach. If we can't get that, we get a new provider. And there are those who's endurance for addressing medical neediness has been expended...we've experienced them, too. When possible, we've tried to encourage them and lift them up.
Sometimes, though, in an emergency, we don't get the option of choice. The night shift nurse in this situation had the choice of being reasonable for the sole purpose of patient safety. She chose the opposite. No one on this earth is perfect, but there are consequences when it is not longer an "honest mistake" and turns into the scene described in the original posting.
You say that you "refused to allow her to review the medication before the BP." Who are you to "refuse" to allow the nurse to do ANYTHING? Not all meds need a blood pressure taken before administration. Perhaps you should bone up on which meds require blood pressures & which don't before giving the nurse a hard time. You're not the one that determines what the parameters are for blood pressure readings---the doctor does. If your father was severely dehydrated, that would be the reason that his blood pressure did not go back to normal---it wasn't the clonidine. Clonidine peaks in 3 to 5 hours with a half life of 12 to 16 hours. The clonidine was far gone from your father's system in 24 hours. Don't be so obsessed with your father's blood pressure----the dehydration was the problem, not the B/P meds. Maybe you should go to nursing school so you can learn about this stuff.
The nurse blew a gasket because you were micromanaging your father's care & driving everybody crazy. Unless you have some sort of medical education or training, you have no right to micromanage anyone. I have an 85 year old mother who has been in the hospital 3 or 4 times in the last 5 years for serious medical issues, where she was admitted for at least a week each time. I am a master's/graduate level educated nurse anesthetist with 25+ years of experience & I would never consider telling a nurse or doctor what to do with her. Unless it is something blatantly dangerous, there is no reason to micromanage the care providers. And involving hospital administration for your father's readmission to the hospital is absurd. They have nothing to do with anything. In fact, I bet they were all rolling their eyes behind your back, not believing that they had to deal with the stupidity.
Be very careful about reporting the nurse to the board of nursing. I'm not saying that yelling was appropriate, but maybe she just couldn't take it anymore, being told what to do by you. Sometimes a person can only take so much, especially when they are being ordered around by a family member. You said that you "pitched a fit" on the phone----I take that as yelling at the person on the other end of the phone, as well as threatening them by saying "don't make me come back there". Why is that okay, yet a nurse yelling at you isn't? Your behavior toward the staff was uncalled for right from the beginning & you had no right to yell at them over the phone for not doing what YOU wanted them to do. Doctors & nurses don't take orders from the patient's family---that is lesson #1 that you need to learn. The nurse can come back & sue you for harassment if you report her to the board unnecessarily. And she's got witnesses to verify what happened at the scene. You don't.
Your father is 91 years old. You care about him. However, the doctors & nurses do not require your consent for every move they make----they're doing the best they can do to take care of him the best that they can. They are not required to call you every time his B/P is high or when it is low to get your permission to treat it. They had reasons for not adhering to his "medication regimen", like the fact that he was dehydrated from the diarrhea & his blood pressure was most likely already low from that. Taking him home against medical advice was an irresponsible thing to do---you do not have access to the emergency meds & machines to treat him in case something happens like the hospital does. Your demand that a "very precise treatment plan" be in place to consent to the admission is rather ridiculous. Treatment plans change all the time, based on the patient's response to the current treatment----and, here's a news flash: The doctor's don't need your consent to change the treatment plan for your father!! The human body is a dynamic machine, meaning that it is always changing & the treatment changes according to the body's responses.
Nurses have emotions too. They also have an EXTREMELY stressful & busy job to do. Plus, nurses are not stupid----they know their job. The last thing a nurse needs is a family member telling her what to do & micromanaging the care of your father. You have the freedom to hire a private duty nurse if you are not satisfied with the hospital staff nurses.
Say you have a parent, a child, spouse, whatever, who has complex co-morbidities. And say it is your experience, your actual as in it has already happened experience, that every single time your loved one is admitted to hospital there is a foul up. Every single time. Nothing catastrophic, just something that it takes a while to get straightened out again, because something comparatively minor has been overlooked. With me so far?
Okay, so given your long experience, which I respect, how *should* one act as that patient's advocate in a way that avoids pissing off a stressed, overworked nurse. How do you get people to give the devilish details that extra bit of attention without being unreasonable? What would you consider an acceptable approach?
It is a balancing act- many goof ups were made during my late Mothers care -
take care of yourself and choose your battles carefully