Quote:
Originally Posted by lenora
I understand your frustration and I would suggest that the next time you accompany your client to the ER that you remember that you catch more flies with honey. It's a pain in the arse (especially for someone with my personality) but it has worked for me thus far. I remain calm but firm. Keep in mind, the more you b**** to the staff, the more likely they will avoid contact with you AND your client. Some will go so far as to delay checking for lab results (when there is no clear emergency). It sucks, but it is what it is.
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First of all why would you assume I was anything other than calm? Because I used CAPS? Andy why would you assume I don't know about hospitals? "Bitc#ing"? LOL OK.
This was a clusterf*, bottom line, and it can't be denied or blamed on the PATIENT/CUSTOMER. I didn't write an hour by hour dissertation, I'd be here for three page.
I spoke with the Floor Charge RN (not the weirdo) who was very nice several times because even SHE was concerned because my client was trying to remove her C collar and getting agitated and crying about her back pain because she couldn't move around wearing the C collar and having to go to the bathroom. SHe couldn't GET her to the catscan either. They couldn't sedate her again she had already had something at 5 PM. She was right outside our door, for goodness sakes.
I even WARNED her about last year that she tore the joint up (metaphorically) and had to be restrained so proceed delays with caution. SHE wanted her out of there, as much as me.
The fact that you say they'll retaliate against the patient says it all. AND EXACTLY why they have a quality process and advocates. AND encourage the patients/familes to ESCALATE.
I'm a dog walker, you cannot be excitable. And certainly you can't be excitable with a dementia patient and I'm the one known to keep HER calm.
Your admonition has nothing to do with the RN coming in to "CHAT" and overstepping his role, while ignoring giving me an update on the orders that the doctor left. He started off asking me if they have RNs at her ALF and then segued to bragging about knowing all about dementia meds. I'd say he was JOB HUNTING, not focused on his PATIENT'S needs. I didn't even know what he was doing for 20 minutes before finally saying "WHAT are you asking me?????"
Why does he care if RNs are at the ALF? To get a job, that's why. Which occurred to me later.
It also has NOTHING to do with the overnight hospital charge nurse FORGETTING to give the information to her replacement on the shift report.
It has NOTHING to do with the hospital jumping to restraints and ignoring her sedative that was right on the chart.
You seem to forget the quality process inserts the ADVOCATE in between the patient and the staff AND on the wall it lists every step of escalation and advises the CUSTOMER "If you have ANY concerns at all, contact the MANAGER on ext XXX". The MANAGER is the medical director that ties it all together among the medical staff. And the person you call if the ADVOCATE can't resolve the issues.
Why do you think they have that on the wall in every room?
The ADVOCATE facilitated everything I needed in the ER. I didn't KNOW she needed an advocate on the floor since the RN charge nurse was happy to have the downlow on the lady. WHO KNEW she'd forget it?
I think you're also forgetting that these facilities are RATED in the quality point system on these factors. TIMELY treatment, ACCURACY, and NOT passing on infection by not wearing GLOVES, for example. Which, ACTUALLY, I was so dumbfounded seeing I was speechless.
Perhaps you're happy to sit around not advocating for YOUR client (do you have any?) , but I won't do it, just like I didn't do it for my mother drowning in bureaucracy for two years.
And NO, I'm not going to sit around debating the meds my client takes with someone who has no business deciding they know more than her shrink, neuro and GP physicians.
No, you do NOT get more timely treatment by using HONEY (even though I was being nice), you just take longer to get answers, that are potentially not even CORRECT if you are not involved. Why are you assuming I went in with guns blazing and never ASKED NICELY where are THE TESTS after 3 HOURS????
Why do you think the ALF sent one of their STAFF over there the next day to make sure that she was treated correctly when I had to leave? Do y ou know that is UNHEARD OF you normally have to have the family pay a private agency but they called in an extra staff member who she knows...because they care about her.
My clients' family is quite happy to have someone navigate on their mother's behalf considering they couldn't even get a status from anyone on the
phone for 5 hours all morning after she was admitted. USING the HONEY technique, completely forgetting all they had to do was call the advocate and ASK because they were so frantic.
AND if they HAD called the ADVOCATE early, they would have gotten someone on the phone and been able to remind them about her anxiety issues and give the Ativan, which would have PRECLUDED the DRAMA of almost restraining her.
Perhaps you are unaware that restraints are considered a LAST resort and they're supposed to try everything ELSE first and need to write up a big report on why they had to use them.
ie Florida
Nursing Home Laws do not play around:
Quote:
Physical Restraints
Both Federal and Florida law restrict the use of physical restraints for nursing home residents. Under the Federal Nursing Home Reform Law, a physical restraint can be utilized only to treat a resident’s medical conditions or symptoms. Restraints never can be used for discipline or the nursing home’s convenience. (See Section 483.13(a) of Title 42 of the Code of Federal Regulations). Florida law (Section 400.022(1)(o) restricts the use of restraints allowing only those restrains authorized in writing by a physician for a specified and limited period of time or as are necessitated by an emergency.
In the case of an emergency, restraint may be only applied by a qualified licensed nurse who shall set forth in writing the circumstances requiring the use of restraint, and, in the case of use of a chemical restraint, a physician shall be consulted immediately thereafter. Restraints may not be used in lieu of staff supervision or merely for staff convenience, for punishment, or for reasons other than resident protection or safety.
The law restricts the use of restraints because there is a large body of research showing that the use of restraints is harmful, both psychologically and physically.
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http://www.burzynskilaw.com/Physical%20Restraints.htm
The same LAW prohibits withholding food/water for any reason, which was ANOTHER SUGGESTION someone HERE made to someone else on another thread.