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Help! Nurse contradicting doctor and changing care plan!!!

chemgirl

Ideal_Rock
Joined
Sep 16, 2009
Messages
2,345
I really don't know how to approach this without totally insulting the nurse.

Back story: DH had bursitis a few weeks ago and it was pretty severe. Our doctor drained it and gave him a steroid injection. Unfortunately, the injection site became infected and it didn't respond to antibiotics. At that point we were in my home town visiting my parents so we went to the ER. The ER doctor had to cut open his elbow and drain pus. Then we had to see an orthopedic surgeon for additional wound care. There was significant infection so the surgeon packed the wound with ribbon and left a wick for drainage. We were told to have the ribbon changed every 3 days and to follow-up with our GP to get it looked at and set up home care.

We did the follow-up and our GP said the wound was healing nicely, but she would like the ribbon changed every 2 days for the first week, then every 3 days if all looked good. We were referred to home care.

Small snag. There is a shortage of home care nurses in our region so they referred us to the hospital wound center.

A bit annoying since DH is in excruciating pain for the ribbon changes and needs to be on percocet. Our doctor tried to argue that he can't drive, but we live on a bus route so they wouldn't budge.

Anyway long story, but we hear from the hospital today (a day early) and they needed him in for a change immediately. He said no, he can't get there, so we are going first thing in the morning.

The head nurse says the doctors are all wrong and the ribbon needs to be changed daily.

Directions on the package say change every 3-5 days.

How do I deal with this nurse tomorrow? I am so bad at confrontation.

Eta: changed to omit identifying info.
 

distracts

Ideal_Rock
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Oct 11, 2011
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6,131
Re: Help! Nurse contradicting doctor and changing care plan

I would just repeat the doctor's instructions. Repeatedly. Tell her to take it up with the doctor and until you hear otherwise, FROM YOUR DOCTOR, you will be getting it changed on the doctor's schedule. If it helps, print out the study as backup and hand it to her.
 

chemgirl

Ideal_Rock
Joined
Sep 16, 2009
Messages
2,345
Re: Help! Nurse contradicting doctor and changing care plan

Thanks Distracts!

I know that's exactly what I should do.

I guess I'm just getting all geared up for a fight when it probably won't come to that. Just judging by the way she dismissed the doctors and acted like she knows all really rubbed me the wrong way and has me in knots.

I do know in the grand scheme of things this isn't that big of a deal. The treatment sucks, but it shall pass and we'll be OK.

Seeing my guy in pain really gets to me and the idea that she wants to subject him to more than necessary is very upsetting. I don't come across well when I am upset, socially awkward and all that, so there is a lot of anxiety surrounding tomorrow morning.
 

CJ2008

Ideal_Rock
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Dec 31, 2006
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4,750
Re: Help! Nurse contradicting doctor and changing care plan

I hate confrontations too and can totally understand your anxiety - same thing happens to me...along with the not coming across that great when I'm upset, and coming off awkward. The whole thing.

I think if maybe you start off with saying "with all due respect our Dr. has specifically asked us to not change the ribbon every day and I don't want to go against his instructions."

I know it's a little dramatic and not really 100% true since he didn't tell you that, but she doesn't need to know that.

Just remember that nobody will protect your DH like you will - so get into protect mode - and know you're coming from a good place.

Good luck - it will go just fine.
 

VapidLapid

Ideal_Rock
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Feb 18, 2010
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4,272
Re: Help! Nurse contradicting doctor and changing care plan

"I really appreciate your concern, and realize your perspective comes from years of first hand, clinical experience; which I, myself, do not have. I would be uncomfortable going against our doctor's specific instructions. Would it be ok for you to share your observations and concerns with the doctor so that he/she could take it under advisement? I, we, would really appreciate that."
 

PintoBean

Ideal_Rock
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Jul 27, 2011
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6,589
Re: Help! Nurse contradicting doctor and changing care plan

Is there a monetary motivation on the nurse's part? Like, billing per visit?

Nonetheless, I would emphasize following your docs directives to the "T"!
 

chemgirl

Ideal_Rock
Joined
Sep 16, 2009
Messages
2,345
Re: Help! Nurse contradicting doctor and changing care plan

Cj2008: Thanks! It's helpful to know that I'm not the only one who has trouble with these types of situations.

VL: I like your suggestion. I'm coming at this like it's going to be a battle. I need to take a different approach.

PintoBean: No idea about monetary gain. I think they are booked fairly solid, but who knows.

I texted a friend who is a doctor to get her take on it. She says the nurse sounds "old school" and new materials are designed to be changed every 3 days ish. Her words "it's never going to heal if they yank the ribbon out every day". Apparently we can basically double the healing time estimate from our doctor if we follow the nurse's plan. He also can't work on her plan and will be on percocet constantly rather than as needed.

It really does sound like her knowledge is very out of date.

So worked up about this that I can't sleep.
 

VRBeauty

Super_Ideal_Rock
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Apr 2, 2006
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11,210
Re: Help! Nurse contradicting doctor and changing care plan

Over the past 2 years my SIL has become an expert patient advocate for her husband, my brother. Her approach seems to be to keep the interactions polite and friendly (i.e. not overtly confrontational) while keeping things moving in the needed direction - and to cultivate allies. VL's response fits right in with that... stating that your preference is to follow the doctor's directive. In any event, since your hubby has not been hospitalized it would appear that you are, literally, in the driver's seat. Other than having to deal with an angry self-righteous nurse, would there be a down-side to bringing him in for care only every three days?
 

missy

Super_Ideal_Rock
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Jun 8, 2008
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53,978
Re: Help! Nurse contradicting doctor and changing care plan

VapidLapid|1436326028|3900203 said:
"I really appreciate your concern, and realize your perspective comes from years of first hand, clinical experience; which I, myself, do not have. I would be uncomfortable going against our doctor's specific instructions. Would it be ok for you to share your observations and concerns with the doctor so that he/she could take it under advisement? I, we, would really appreciate that."

Agree with VL. Ask the nurse to call the doctor so they can have a discussion and figure out the right/best course of action. Hope your dh is all better very soon!
 

chemgirl

Ideal_Rock
Joined
Sep 16, 2009
Messages
2,345
Re: Help! Nurse contradicting doctor and changing care plan

Thanks everyone.

Of course it all worked out.

I just asked if she could explain why the plan was different than what we had been told previously. The nurse explained and I wasn't totally sure if it made sense, so I asked if she would be OK with checking with the doctor. They talked and now we are to have the ribbon changed every day for the first 3 days and then every second day for a week. If that's all good then we go down to every 3 days until it's healed.

Much happier with this plan.

Was a little hairy getting it changed this morning because they were training someone new. She was perfectly nice and professional, but told us she has never packed a wound before so it didn't go as smoothly as we could have hoped for. Oh well.
 
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