Published On January 15, 2007
A Tale of Two Families
We recently had a patient in the ICU for more than three months. It was clear that she would never leave the hospital.
Yet the family was adamant that everything be done for her. That family was there every day to watch her deteriorate. At least they were taking responsibility for their decisions. Yet a few rooms down, another patient is in a similar situation. He has written notes saying he’s ready to die. The family won’t accept it.
The difference? The family very rarely comes to see this patient. They’ve put him in hell, and now they won’t watch it. They aren’t present for the times he coughs and needs suctioning. They aren’t there to step out of the room so that we can clean up his incontinent bowel movements. They just aren’t there.
Staying Out of Court
I cannot get my head around the concept of providing care based on protecting myself from litigation and/or losing my license. This week, I had to deal with this defensive nursing attitude. It involved “wasting” a narcotic. If we use less than the dispensed amount, another RN has to waste the leftover med with us; this involves his or her witnessing your dispensing of the remainder.
This nurse took a TB syringe, withdrew the waste, and said that I wasn’t wasting 5mg, but really only 4mg. I showed her a small drop or two in the vial that must have made the difference. “Lighten up, will you?” I said. She responded: “I worked too hard for my license…No one will take it away from me!” Gee. I wasn’t trying to, okay?
“Do you mean to say that even if my patient needs a walker to get up out of his wheelchair he doesn’t qualify?” I asked incredulously of the Medicare representative. The answer was affirmative.
“Do you also mean,” I continued, “that a patient who becomes more ambulatory should remain confined to a wheelchair because Medicare feels the paltry cost of a walker is just too much to provide?” I was informed, that yes, in Medicare’s view, he should stay in the wheelchair. I hung up the phone and put my face in my hands.
What bureaucratic nightmare will I encounter tomorrow? And what is a lowly nurse, a mere cog in the health care wheel, to do? Let’s hope that no faceless bureaucrat at Medicare is scheming even more insidious ways to diminish the quality of life of its recipients.
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