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Can you help me see where I demonstrated confrontation and non-professionalism by giving out pain meds before dressing a wound?

Wednesday November 27, 2013
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Question:

Dear Nancy,


I had a 73-year-old patient who was admitted for bowel obstruction, had a colectomy done almost three weeks earlier, ending up with an abdominal wound and a colostomy.

The weekend I worked with this patient, her son had told a nurse tech he wanted the mom's abdominal wound dressing and colostomy bag changed, shortly after I took report from the off-going nurse who claimed the dressing had been changed alongside her colostomy not too long ago. I went in the room, assessed the patient and told the son, I will get the supplies and be back to redress
the wound.

As I headed out the door, three other patients rang the call bell for pain medication. I decided to attend to those in pain before going back to dress the wound. By the time I went back to take care of the wound, a co-RN approached by the patient's son had started the dressing and I had joined her. In my progress notes on this patient, I had indicated the patient's son demonstrated impatience.

I was written up by my manager and HR for lack of professionalism, poor prioritization of care and confrontation because, in their judgment, the patient's wound should have been addressed first and under no circumstance should I have written about the son's impatience in my notes. Can you help me understand where I demonstrated confrontation and non-professionalism?


Dana



Dear Nancy replies:

Dear Dana,

Your question underscores the difficulty a staff nurse faces when trying to prioritize patient care needs. It also is unfortunate your manager felt your nursing judgment in the situation was poor. Although changing a dressing on a wound is important and in some instances may take priority over another patient's complaint of pain, it was your judgment, at the time, the pain relief was
most important.

You can grieve the write-up by your manager through your employer's grievance policy and procedure. It would be important to be factual, accurate and include your nursing assessments of each patient and how those assessments impacted your decision to deal with the other patients' complaints before you changed this patient's dressing.

Although you did not give much detail about the documentation you placed in the patient record concerning the son, it sounds as though you might have been trying to justify your actions in the patient's chart rather than factually documenting the dressing change and any objective comments about the son's presence and requests.

Concerns one has over impatient or demanding family members is best documented in an incident or occurrence report (and discussed with your nurse manager and in change of shift report).

It is important the patient record reflect objectively and factually the care provided to the patient and other significant issues concerning the patient's care (e.g., physician contacted, laboratory tests done). It is not a place to air disagreements or frustration with a patient or family members about the care you provided on a particular shift.

There are many reference texts on nursing documentation for you to review, including , “Mosby's Surefire Documentation: How, What and When to Document” 2nd Edition (2006) and Springhouse's “Complete Guide to Documentation.” 2nd Edition (2007).


Cordially,
Nancy




Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.