Why do nurses refuse to admit there is a pressure sore that developed in house? - AgingCare.com

Why do nurses refuse to admit there is a pressure sore that developed in house?

Follow
Share

Why don't they just call it how it is? How bad does it have to get. I float and watched a nurse take off a huge dressing on the patients bottom and saw a huge nasty sore with open areas and ooze. The discoloration was from the chemicals in the wipes we use and the open areas were skin tears. That is what she told another nurse doing an assessment, after they both got done refering to it as a pressure sore. She must have forgotten that CNAs don't change those dressings. So they decided to let it heal a week and documented how they hoped it will look. So we still boast no pressure sores. Would there be more documented pressure sores if CNAs just got blamed instead. We get blamed for everything, one more thing won't hurt. Then efforts can be made to treat them. Since that patients sore was not caused by pressure, even though it was, I heard them, they got defensive when I said I always find that patient flat on her back. She is not being repositioned. Wrong thing to say. The patient is on an air mattress, turning schedule and only up two hours. It is because she is not eating. And the way we are wiping the top of the bandage. Denying pressure as contributing to the worsening of her, I think they wrote abrasion, not sure, is preventing proper treatment. It will not get back to her not being turned, actually it has been denied. Maybe it is just where I work. I hope the big boss they are all hiding from does not deny it too.

This question has been closed for answers. Ask a New Question.
20

Answers

Show:
I would like to discuss the use of the term 'nurses' to describe the staff involved in this discussion of pressure sores too. Too many in our society do not understand the differences in kinds of 'nurses'. In Arizona, most skilled facilities, assisted living and memory care units have very few or NO registered nurses, who are the most highly skilled nurses....most of whom these days have a college education and are highly skilled in assessment skills and ability to think out of the box and realize that care needs are based on individual situations without a clear answer or routine that fits everyone. In AZ, if a facility does hire RNs, they are either the ones who keep all the paperwork in order, while supervising others, or they are the one in the front office, the 'director' of nursing, who is responsible for organizing all the direct care givers. Then there are LPNs, who many also call nurses...but they have had generally a year of school and are only slightly more educated than the aides....in that they can give medications, monitor IVs, give shots and do more things like dressing changes that require a bit more training. They do not have the critical assessment skills to be PLANNING care and changing plans based on individual's needs. In general, in Arizona, they are the ones supervising the aides and other caregivers, while giving meds to residents/patients. The general public typically does not understand this difference, and because I am a retired RN, I see red when I hear people referring to EVERYONE as 'the nurse'.....they think all the workers in the doctor's office are 'nurses' or are RNs. My mother, when referring to the caregivers in my Dad's facility, calls them all 'nurses'. His facility has ONE LPN on each shift that supervises staff in 5 different cottage...each can have up to 3 caregivers working and up to 14 residents each. There are NO RNs. Even the Program Director, who supervises all the direct care staff and handles staffing and hiring and training etc, is an LPN. The Executive Director of the entire facility is a RETIRED RN and the only RN in the entire place. So, there really are no direct caregivers, who really have the education and training to be making any clear assessment about someone's 'bed sore' at all. An LPN can say, "YES....it's not normal" and suggest that routine plans be made like turning every 2 hours. But they cannot recommend changing treatments or what medicine to apply nor will then generally be able to consider all else about that person's medical history and then be able to say....OH, she needs to be turned hourly, or she needs to get a whirlpool bath every day or we should add heat or this ointment or that or leave it exposed to air and not covered...and so much more. They will say, "We have to show this to the doctor the next time the doctor comes' for example. They just do not have the training to do much except observe and document or report what they see to someone else. These different types of nurses are licensed by the state to be able to do very specific things on their own. Typically, the aids work under the supervision of an LPN or an RN. LPNs can work alone in specific types of facilities. for example they can work alone in AL or Mem Care, but not in nursing homes. There has to be at least one RN on in a skilled nursing facility...but not necessarily at the bedside doing direct care. In a hospital, the LPN must work under supervision of an RN and both must be at the bedside. In a doctor's office, an LPN must work under supervision of a doctor if there are no RNs hired. And, just for the record, there are generally NO RNs or LPNs in doctor's offices anymore. They are all medical techs. And yes, the doctor can teach them to give a shot or medication....but not IV meds. Only an RN can start IVs or give IV meds, other than the physician. I so wish that more people would look at the person who is going to 'do something' to them, and ask directly 'What is your title and what is your education?' In the first big facility my Dad was in we were told the director of the Memory Care unit was a 'nurse'....and after we had problems communicating with her, discovered that she was not even an LPN! Then we had more issues and asked to talk to the nurse supervisor....that person came over, and said she was an LPN....but my daughter and I...both RNs...could not communicate with her at a basic level that an LPN should understand, so my daughter asked her the question about training and education. Turned out she HAD BEEN an LPN many years earlier; was in a job that required her to be an LPN but was no longer licensed as an LPN. She didn't understand a thing we were trying to discuss and get answers too....but would NOT admit she was not a licensed LPN. We reported that to the state. it was wrong. And everyone who gives meds in the memory care system in AZ, is only an aide who has gone through some training in how to give meds. They do not even have the ability to decide to give my Dad a Tylenol that is ordered if he has a headache, because they are not allowed to. So if Dad says his head hurts, they have to call the LPN to come and she has to talk to him and she has to tell the aide giving meds to give him a Tylenol. That means that typically nothing extra gets given unless family is there to push buttons about it because the aids/caregivers, do not like to call the LPN into the cottage when she is supervising so many and is in between 5 different cottages. So hope this helps everyone understand the differences in abilities of the types of caregivers you see in health care. And then explain why some of these strange things happen like 2 people talking about a bed sore and not wanting to call it what it is.....
Helpful Answer (0)
Report

I think a lot of the problems lie with staff being asigned to different patients every day. they never get to know individual patients and there is no supervisor going round who knows everybody. As you say too many under trained staff.
Helpful Answer (0)
Report

They all deny it. The problem lies at under trained not caring staff. Very few cna,stna,hha, whatever they are being called nowdays, actually do their job and care, in my opinion LPNs should replace all cna, stna, hha direct care positons they have real training. I did hear some hospitals screen all prospective caregivers ( doctors, nurses, pt ,ot, ect.)for how empathic they are toward people and wont hire people they think arent caring enough. Thats why they are the top hospitals
Helpful Answer (0)
Report

I am so glad we (my dad and I) decided to keep my mom home and care for her there. We love her and do the best we can with help from hospice. Yes she has bed sores but we are taking care of her all day long. She is dying and there is nothing we can do about that she is almost 92, but we love her and bathe her and move her and talk to her and feed her. At least she is not being ignored at a facility that is only interested in the money.
Helpful Answer (2)
Report

Dear Veronica,

Thank you very much for responding to my post and thank you for the hug. Yes, this was my first death. I have experienced death in the past of friends and family members but I was not the caregiver and did not experience the transition to end of life. I will always remember this particular person. I actually learned so much from her during the time I took care of her even during the transition and I thanked her for allowing me to help her even when I knew she had no hearing left. You make sense in that I am grieving though I did not think I was grieving. I will let myself feel the way I feel and perhaps my new assignment will help me move forward. I start this Thursday. I feel so much better now having read your response and having answers to my questions from you as to what I am feeling. I think I was so used to going to my little lady's home each day and seeing her husband, her friends, her doggies and caring for her that it became such a huge part of my life and perhaps I was even in some denial about her life coming to an end. But yes, you are right in that professionally I must move forward and file the feelings away in my inventory of experience. The way you said this makes sense to me. File it away and move onward. Maybe I will talk to my husband one of these days about this experience but right now it just feels so intimate and personal and that is why I turned to this group as I knew I would be able to write down my feelings with other professionals and get the help I need. Thank you Veronica. Sending a big hug back to you:) I hope we can stay in touch. Sincerely, Elizabeth
Helpful Answer (0)
Report

elle3000, hugs to you for caring so much for your patient. You made a great deal of difference in her final time on this earth.
What you are now experiencing is probably simply grief.
Was this your first death?
Everyone experiences grief differently but look up stages of grief and you will find it takes a particular course and every stage has to be experienced. It is different for everyone and each stage does not have a predetermined length.
Once you begin your next assignment it will be easier to move forward. Every caregiver feels a sense of loss when they loose a patient but professionally you have to move ahead and file these feelings away in your inventory of experience. Some patients you will remember for ever others not so much. Now you have written about your feelings it will be easier to talk to your husband.
Helpful Answer (2)
Report

Hello. I wonder if anyone can help me to understand the feelings I am experiencing as a CPC who just lost a patient after taking care of her for two months. I adored this sweet lady and did my best to maintain her dignity and integrity right to the end of life. I went through the transition period with her. I sat by her for 24 hours straight when she was nearing the end. I left to go home and take care of a few things and then returned for a few hours until a family friend came over to sit with her. I advised my agency that I was going home. Within four hours of my leaving my little lady passed away. During the 24 hours of sitting with her my mind was constantly working with deep thoughts about life, God, death, suffering and so forth. It was like a "spiritual marathon" and though I was exhausted I could not stop my mind from questioning life and death. I could not bring myself to attend the services. My issue is that I am not depressed, I am not sad as she is now at peace but I feel very strange and cannot fully express my feelings to anyone. I don't feel any guilt as I provided her with the best care possible. I have had one bad dream since her death that shook me up a bit. I don't feel self pity or anger that I was not there with her when she passed away. When she was coherent we would talk quietly and there were times we shared some tears but I made sure she knew that I was honored to have been part of her life and she told me that we were friends. It meant a lot to me. I feel like I have been in a war zone but I don't have PTSD. I can't explain these feelings as I cannot pinpoint exactly what I feel. I continue with my daily activities but not with as much enthusiasm. My husband is a kind man but I cannot discuss my feelings with him as I would not know where to start. I don't feel like talking about all of this to friends or family or to my Agency. I am already lined up for another assignment which may be a blessing in disguise. Can anyone here help me to understand why my world seems so "blank" right now and why I can hardly muster the energy to smile. Thank you in advance for any suggestions or shared experiences.
Helpful Answer (0)
Report

Lots of things can cause skin irritations, but when one is in a long term care facility pressure sores come to mind. Many facilities do not want to document a decubitus, it looks better to have a record of none. If a facility has a pattern of skin breakdown they can receive a fine. Some people need to be turned and repositioned every hour instead of every 2 hrs. No matter how you look at it, a pressure sore is a pressure sore and many times it caused from lack of care. I agree that often the aids are blamed for things that happen, but it is also staff that cares about their residents make the residents life worthwhile. Don't stop caring.
Helpful Answer (0)
Report

Why do nurses (and others) refuse to admit there is a pressure sore (or other, similar problem)? Blame.

When you live - as we all do - in a culture where people focus far too much on who is to blame for a problem, rather than on dealing with the problem, everyone spends too much time dodging the blame. Thereby they also dodge the issue. It is bad news for everyone.

It also makes it very hard to ask questions or make observations without causing an automatic, defensive reaction: this leads to poor communication, which leads to poor care.

In a neutral world, you would be able to state calmly "this patient has developed a pressure sore" and all attention would be focused on getting it healed and attempting to prevent further ones developing - always bearing in mind, of course, that in very frail, ill patients it isn't even necessarily possible to achieve that. In our sad world, as you have so clearly described, half of the nurses' time and expertise is wasted on polishing the patient record. It is infuriating, it is wrong, it is detrimental to patient welfare.

Much cleverer people than me are doing their best to sort it out, with some success in some hospitals for example, and that is the most hopeful aspect I can see of the whole sorry mess.
Helpful Answer (1)
Report

Love of Money is root of all Evil.
Helpful Answer (0)
Report

This question has been closed for answers. Ask a New Question.
Related
Questions