cyrnel

My family is in a difficult situation at a large hospital. Our mother has been on the slow road to recovery from heart surgery since Jan 27. A week ago things were fairly stable and we were handed off to the "floor". Care levels don't hold a candle to intensive care. Nurses aren't as well trained, egos take over for competence, mistakes are made, and people aren't reading the charts consistently. Our mother is back in afib, vent weaning isn't going well, and we're bouncing from one pulmonoligist and cardiologist to another as hospital shifts change. I know nothing about medicine (engineer by trade) but know something's wrong when one tells us the first cardioversion worked and she was in sinus rythm for a week then the next tells us several attempts were unsuccessful. (!?!) Similar incidents abound.

Hospital processes seem tuned to shift work between staff almost perfectly so nobody has accountability or a good understanding of the case. Now our alarms have brought in hospital internists ("Hospitalists") who suggest we should be ready for long term outside facilities, and their reasoning is based on conflicting intensivist interpretations. Surreal. Like multiple people telling you the weather by looking at the sky through straws.

Pardon the stream of consciousness. This is taxing. I feel strongly that it's time to shop outside the hospital for some type of professional advocate and I'm looking for ideas. Is anyone in the audience experienced with this type of situation such that you could point out ideas? Damn frustrating, and every day provides additional chances for mistakes and a longer rehab road, or worse.

bad jane

first, i'm very sorry to hear about your mother.

before you get hung up on the comparison between icu and floor health care...i just want to point out that they are two very different creatures! in a unit, a nurse generally has 1 or 2 patients. on a floor, it is often anywhere from 6 to 12 patients per nurse (varies a lot by location and hospital of course).

without knowing the full story, hard to say what is going on there. is it possible that the first cardioversion did work (as the first cardiologist said) but then she reverted despite their attempts to keep her in sinus (as stated by the next)?

i don't want to imply that you or your family are stupid--so please don't take it that way. but when a loved one is in the hospital, it's difficult to grasp everything that is being said, particularly if you don't really know what they are talking about to begin with.

i'm so sorry to hear you are having trouble getting the support and information you need!

dr.s are as stupid as the rest of us. they make mistakes and sometimes, they act like they know what they're talking about even though they don't have a clue. so your concerns over what's going on with your mother are very valid.

have you asked for support at the hospital? if they have pastoral care there, that is where i'd start. they should be able to help you figure out what's happening and serve as an advocate for your mother. if not, ask about speaking with a social worker or someone else who can help you and your family make sense of what is going on. do they have case managers you can speak with? if you feel it is appropriate, do they have an ethics committee you can meet with? your best bet is to just ask what services the hospital has because each one is a little different.

i'd start with hospital resources first. other than that, does your mother have a good family doctor who could help you out with this? even if her doctor can't help you, they may be able to offer some suggestions or point you in the right direction to other resources.

if you are concerned she's not receiving the attention she needs, look into hiring someone to stay with her. unless you live in a rural area, you most likely have access to agencies that allow you to hire nurses for private duty. or you could ask around, a lot of nurses will pick up this kind of work given the chance (though if you fear there is a hospital mistake, do not hire a nurse from that hospital). find someone with experience in this type of nursing (someone who's only worked at a nursing home isn't going to be as helpful). ask their opinion and have them help you come up with questions. this won't endear you to the hospital staff, but if you feel you need it, by all means do it. but i'll also warn you that these services are not cheap and her insurance prolly won't cover it.

if you really believe mistakes are happening with your mom, you need to educate yourself. ask questions, lots and lots of questions. if the person you ask doesn't explain it in a way you understand, ask them to explain it differently. ask for literature you can read so that you can ask more questions. learn everything you can. and if you still feel something is wrong--start talking to attorneys and see what they have to say.

i'm not an expert and i don't know you or your situation. but i know that i would not accept less than the best standard of care for my loved one. if i had suspicions that mistakes were being made that hurt their chances of recovery, i'd spring into action in a heartbeat.

all that said, people sometimes just don't respond the way we hope to treatments. despite the best efforts of the staff, people die and there really is nothing to be done about it. i have seen families sue hospitals when they had no case, but they just couldn't accept that it wasn't the fault of the staff.

and as ashamed as i am to admit it, i've seen hospitals make mistakes and the cover it up. your very best protection against that is knowledge--knowing everything you can about your mother's situation and what is being done for her, as well as what options are available.

i wish you and your family the absolute best. you have my sympathy.

LLL2

I work at a hospital.I agree with you that ICU nurses know more stuff then the other floors.They have to though,they deal with people fresh out of the OR,knows how the tricks of the trade.

Nurses are some of the dumbest people alive,some of the stuff will make you say wow ,how the heck did you get pass nursing school ?
I work in supplies at a hospital,some women was talking about something she needed,i was like ok do you have a REF number ? she said what's a REF number.However the worst nurse I ever experience is when a nurse that souned she fresh off the boat from asia called and ask for something,couldn't understand her one bit,and she got piss at me,but then i notice that there like 10 nurses at the hospital the sameway.How can the hospital hire those people ? Because there is a nurse shortage.
I notice though cancer floors and ICU floors know alot more then floors that just there to keep people clean and for them to take their medicine.Would i blame the nurses though? No,blame the doctor,there's only one thing a nurse is scared of,that's a doctor.That's the only way they can get fired.

bad jane

llc, they don't teach you abour ref numbers in nursing school. could you read a tele strip for me? no? is it because you are dumb or because it's something you've never learned? big difference there and if your hospital is anything like mine, nurses rarely have a need for that type of knowledge (ref numbers) anyway. secretaries order supplies and typically if a secretary isn't around, the manager or supervisor does it.

nurses who work in a unit (icu, cvicu, sicu, nicu, micu--whatever) are more specialized but that doesn't mean they automatically know more. if i had to select the specialization that had the largest knowledge base, i'd go with er nurses--they have to be capable of dealing with anything that walks through the door.

nurses that work on a floor aren't more likely to make mistakes because they are stupid--they are more likely to make mistakes because they have 3-12 times as many patients to take care of. and sometimes they have patients who really shouldn't be on the floor anyway--but nurses don't make that choice. they have to prioritize what needs to be done and crappy as it may be, someone's loved one is always a low priority. patient 1 wants their pain medicine, patient 2 has their call light on even though someone was just in the room so who knows what she'll want, patient 3 needs a new iv, patient 4's admission still needs to be completed, patient 5 is confused and since the family wouldn't stay with him he's now out wandering the hall with no clothes on, and patient 6 just had his surgical wound open and his guts are being held in while the or is preparing for his emergency surgery--a nurse can only be with one of them at any one time!

being short staffed and overloaded with patients doesn't make mistakes acceptable--but it does make it more likely they will happen. nurses are human and humans make mistakes.

and all that said--doctor's don't get to fire nurses unless the nurse works for them. in a hospital setting, nurses do not typically work for the dr. i know plenty of dr's who've complained about various nurses but they've not lost their jobs for it. but even then, nurses aren't afraid of losing their jobs because they can walk into damn near any establishment in the country and be hired by someone else. when you know you won't be out of a job for more than the time it takes you to fill out an application, job security is not a fear. loosing their license is another matter--but dr.s (or hospitals) are not the ones who determine that.

mr sticky

cyrnel-

It's time to have a sit down with your mom's medical staff, and have what I call a "come-to-Jesus-meeting!" You are obviously underinformed. Whatever is going on with your mother should be easily explainable to a person of your educational level. It's damn near criminal for you not to be absolutely on top of your mom's condition and her plan of care.
The problem is that none of your mom's physicians are taking any time to explain anything but the most immediate medical care. I assure you that if you could get even fifteen minutes of dialog, then you would be able to lose that helpless, lost, and supremely irritated feeling that you are carrying around with you.
Health care makes sense. There is nothing magical about it. As an engineer, they should be able to explain the whole of it in no time.

Don't stop until you are informed and included. Don't take no for an answer.
Good Luck to you and your mom.

__________________
The sad thing is... as you get older you come to realize that you don't so much pilot your life, as you just try to hold on, in a screaming, defiant ball of white-knuckle anxious fury

tres

I used to work in the Cath Lab as a Cardiology Tech and I used to do cardioversions on a daily basis. I'm gonna agree with bad jane and say that they probably converted her to sinus. The thing with cronic a-fib is that people , you me, or anyone can be going in and out of a-fib and never know if we have that disease. It's quite possible that they had to cardiovert her again and this time it might not have worked so well. Ask them about a drug called Cardizem. It is a medication that can put a heart back in to Sinus, however it's not for everyone, and doesent always work on everyone.

As far as the differences, your soo right.. mistakes happen, if they contradict themselves, then definetly ask them to check the chart and clarify.

Usually the doctors you see are all apart the the same medical group. In other words, your seeing his colleage, not just some other cardiologist. From my experience, they conference with eachother in the daytime to make sure they are on the same page. If you are unhappy, don't be afraid to switch to another group (different set of doctors)

good luck

cyrnel

Everybody, thanks. Your info has helped. I'm busy as heck right now. Quick summary:

-To provide in-bed weighing they switched my mother to a model with one rail each side. (I've helped several nurses with functions and setup since it's really one of their ICU beds.) A slightly scatterbrained nurse left one side open and my mother (who can't talk or use the small call buttons) tried to get out to the bathroom. She fell badly, hurt her head, chest, and one leg. Head CT & chest xray show nothing serious but it got plenty of attention. I'm not sure how it'll play into things but have a feeling it might. At least for mindshare. (I want progress, not payback.)

-I have a better understanding of staff functions and influence.

-My research into vent weaning paid off. I was hitting everyone up for alternative methods/protocols and eventually found the senior ICU pulmonologist. He was good enough to take charge of my mother's case until his vacation in 3weeks. (continuity is a wonderful thing)

-I'm interviewing RN's & CNA's as sitters to help cover when I'm sleeping. Some hospital staff appear nervous, others think it's great.

-This week we're back with the slightly better hospitalist. Between her and the pulmonologist I'm getting better information. I'm coming to understand who to pay attention to, who to remind about customer service, and who represents insurance interests.

-I have fairly good access to the chart, depending on who's on duty. Some staff are completely taken aback by it. It amazes me how much is recorded incorrectly and what isn't recorded at all. Definitely helps fill in the blanks.

-I'm logging things daily. Just having the notebook with me and writing in it seems to encourage activity from the better nurses, and avoidance from the ones I've learned to watch.

Heading back across the street now. I'll try to put more energy into this later tonight.

Thanks again!

bad jane

sounds like you are making some progress! glad to hear it!

sorry to hear about your mom's fall--were you there when it happened? if so, write down everything you recall about it and keep that info. in most states, you have years to sue if you decide to go that route. you'd be amazed at how differently people remember things as time goes by. i was recently involved in a lawsuit at my hospital and the pt was so mixed up about what happened that the family didn't realize they had no case till their lawyer did my deposition. she fell while i was in the room with her. i felt horrible, but her leg gave out and there wasn't anything i could actually do about it. her family sued on the basis i shouldn't have had her up alone--but i had charted that she'd been getting up on her own throughout my shift. they also described me as being too small to offer her any assistance--the pt had confused me with a girl who worked the shift before (who is about a foot shorter and 100 lbs lighter). making notes now will save you headaches later!

as for her chart, you should be able to get every bit of info in it. the hospital most likely has procedures for you to go through (rather than letting you flip through the one they use) but it is worth the time to do it. a lot of hospitals don't do straight paper charting any more--it is either all on the computer, or part on the computer and part by hand. if they use a computer for any charting, you want access to that info as well--they'll have to print it out for you. you can ask the nurses how to go about this--most likely you'll just need to fill out some paperwork for medical records.

also, be sure to ask that dr who is going on vacation to refer you to someone before he leaves! and if you trust him but aren't happy with your mom's current cardiologist, ask for a recommendation on that as well!

once you find one or two people that you like and trust on staff--they will be your greatest resources! some people won't say a bad thing about another staff member, others will give you an honest opinion if that is what you want. while some nurses may not be very nice, they may be the best at what they do--an honest person will tell you she's a crabby bitch, but she's a crabby bitch who knows what she's talking about!

wish you all the best and speedy recovery for your mother!