Big Question, Need Advice......

[OhbowhntrRN]

I have been placed on "Investigational Leave" from my job for being a patient and staff advocate. Please read and feel free to give advice/input.

While checking in on a pt., on the unit which I am one of the asst. mngr/pt. care coordinators, I hear the nurses talking about a pt. who is on Isoniazid(INH) for her recent (3months ago) (+)TB test, and CXR which was "questionable." This patient was admitted with Shortness of breath, and informed the nurse that she'd been on INH for TB, and that she'd also been having a productive cough, mostly yellow for 2wks, as well as night sweats and chills. After gathering this data, the nurse called the house officer, who initially ordered the patient to be placed on isolation, but when she asked him if he'd rather the patient go to the telemetry floor or critical care, because our unit does not have a negative pressure isolation room, he stated to her "Then she does not need isolation."

I was working on the other end of the unit, which expands when the hospital is overcapacity, and had previously assisted with two other patients on the unit, which I was coming to check up on when I heard this. After gathering some data, including that the patient has a questionable lung mass, has been "coughing her head off," has had chills and nightsweats with a productive cough for about 2wks." I called our Director of Infection Control, (unbeknownst to me, and my clinical educators, removed), who readily returned the call and was given the information I had at hand, and he quickly said absolutely this patient needs to be in isolation ASAP. So being a patient advocate, and staff advocate, I call the nursing supervisor, and house officer informing them of this decision, as no one in the hospital could seem to make an educated guess at whether the pt. did or did not need isolation. After my shift, my director of my department reams me, and tells me that this is going to get me in big trouble, because I consulted another doctor without an order. When I tell her that it was my understanding that Dr. X was our director of infection control, she informs me that he IS NOT, and hasn't been for about a year. She tells me I've overstepped my bounds, and she will have to do some investigating of this incident.

The BIG QUESTION???? Did I overstep my bounds, ensuring that this patient with some obvious possible signs of infectious TB was placed on isolation in efforts to protect the staff and other patients??? Note this patient was in a room with a roommate, and did cough numerous times during the 10-15 minutes I spent in the room with she and her daughter explaining everything to them, during which time she DID have a surgical mask(which I placed on her as I entered the room and verified who she was) on, in efforts to prevent any possible further exposure.

[cougarnurse]

I would like to answer with a question of my own. What would be their answer if this patient does end up being dx'd with TB? As is, there is enough evidence that points toward it. Why can't anyone come up with a definate dx, also?

Just a curious 'Cat'

[OhbowhntrRN]

Good question Cat, I really ticked them off when I said, "So if it was your mother in the same room with this patient would you still feel the same way?" and I got the "That's not what this is about response." Which means they support preferential treatment for their own family members over the "average" patient. Quite sad that we have two standards of care. Adding to the issue, None of the other asst. mngrs. were aware that our previous "Director of Infection Control" who ordered the pt. into isolation had been removed. So had any of them been in my situation, they'd have called him also.

On a positive note, I have had numerous staff support me, and complain about our director. And I re-updated my resume today, and have several good leads on jobs that will pay better, but will require me to drive 45-60minutes to work. Saddest thing about it is, I LOVE MY JOB, but hate administration, even though I am everso subtley a part of it.

[SoldierNurse]

Good luck on finding a better place with an Administration that cares about it's RN. We here care about you... keep us posted!

[Labor Witch]

At the end of the day you, as a caring and dedicated nurse did the absolutely right thing! (I think you already know that). If you do indeed end up leaving this job, or think you may have to, remember Things happen for a reason, and we can't always see it initially. When a door closes, another opens, etc. The director who suspended you has lost sight of nursing values and pt care priorities. Probably lost in all the paper pushing of admin duties. Good for you for intervening! I'm sure blessings and good things will come to you in direct relation to this incident.

Good Luck
God Bless

Labor Witch

[OhbowhntrRN]

Big meeting today in about an hour!!! I am just blown away that I am actually going through this all for doing the RIGHT THING!!!! I can't imagine how anyone with any knowledge of nursing/infection control/tb etc, could even rationalize punishing someone for ensuring staff and patient safety. This is really a case study for "NURSES EAT THEIR YOUNG!!!, except it's real life.

[OhbowhntrRN]

Meeting didn't go so well, mngmnt is still so focused on the policy and procedure side of this that they cannot see the true issue, which is patient and staff safety. Can they possibly be so blind as to not see the big picture???

Am I missing something, or is it reasonable to place a patient in TB Isolation when they present with a history of a (+) TB test, and productive cough and chills and night sweats for 2wks???? This is like a surreal fictional story, except it's REAL!!!

[Ricu]

Hi Ohbow,

Thinking through the information that you provided, it seems a "no-brainer." The patient you described should most certainly have been placed in negative pressure isolation until negative cultures were obtained or until adequate treatment had been underweigh. I'd even go so far as to say that a nurse NOT admitting such a patient to the negative pressure room should be counseled regarding nationally established infection control procedures regarding highly commuicable disease.

As I understand hospital politics after twenty-five years, the "alleged" infection control officer would likely have refused to get involved rather than give you instruction were he not the ID official or at least in a position of responsibility. I'm sure you stepped on someone's toes by escalating the matter. What likely happened was that your superiors clearly didn't know what to do, chose to do nothing effective and were humiliated when the ID physician started asking questions and the gravity of the situation came to light. They blew it, you fixed it making them look incompetent. They as you so rightly indicated, want to see you swing from the yard arm even if the best they can do is try to hang you with some stupid policy violation. Maybe there was a policy violated by not obtaining an ID consult from the PCP and perhaps the attending should have been called first. All of that is inconsequential especially when potentially active TB is uncontained in the institution and you are the only one involved who recognizes the urgency of the situation and is trying to contain it. You did the right thing by isolating that patient and I'm sorry you are taking heat for it. Those clipboard queens will keep trying to get their pound of flesh somehow or die in the process so, stay strong and get good support. You have an ally in the infection control officer so use him, and you have me too, for whatever that's worth... Keep us posted.

R

[cougarnurse]

Lordy! With the latest news of the strain of TB that is drug resistant, and this? Someone is trying to cover their heinies at someone else's expense/health. What else will it take?

'Cat'

[OhbowhntrRN]

For my legal protection I've been advised to share information with only those who PM me for further information, as this scenario could very likely expose my identity, and potentially hurt my case. If you desire more follow up information, PM me, and I can provide follow up.

Thanks for everyone's support, this may be looking better and better for me each day, as I am basically on a paid vacation, with a little extra stress. I can only hope that God will see me through this, and JUSTICE will be served.