Patients have right to be in control

I have a mother in a nursing facility. She recently had an emergency bowel resection and was returned to the nursing home two weeks postop. Due to her age, 80, and obesity, she is having trouble recovering. She has been lucid preop and postop. She has been weak and developed pneumonia, a wound infection and UTI. She had four blisters on her buttocks and back when she was readmitted to the nursing home from the hospital.

The problem is that she has refused to be turned and repositioned. The blisters have developed into stage 2 bedsores. I had a meeting with the assistant director of nursing at the nursing home because I was concerned that they weren't turning and repositioning my mother.

I am a nurse myself and have been disappointed with her care. The nurse told me that you cannot turn patients against their will, which I believe to be untrue. She also told me the rules at the nursing home are different than at the hospital.

I believe she developed pneumonia because of poor nursing judgment and her inactivity. I told the director I would have turned her even if she refused. That is a common nursing judgment from Nursing 101.

Please tell me if it is considered neglect when a patient in a nursing home isn't repositioned when she refuses to be repositioned.

~S.D.

The nursing facility should have a written "Patients' Bill of Rights" (or other similar language) posted in the facility. You should become familiar with the terms of this document. It usually states that the patient has the right to control his/her care and, specifically, to refuse care. Most states provide some form of a department of long-term care, which looks after persons confined to facilities.

A patient liaison usually is assigned to represent the interests of patients when the patient is at odds with the nursing facility. In your situation, the assistant director of nursing you spoke with is obviously aware of the importance of patients' rights.

Additionally, common law defines an "unwanted touching" as a civil battery, which is a valid, though difficult, claim for a lawsuit against the facility (hospital or nursing home). Your mother could conceivably initiate either of these processes from her nursing home bed. All health care facilities have rules about patients' rights. Patients confined to long-term care facilities, however, are generally presumed to be unable to protect their legal rights, thus the need for specific state legislation for their protection.

Having said that, we know that your mother needs to be turned. Use your best patient teaching skills to persuade your mother that some discomfort now will avoid bigger problems in the future. Confer with the nursing home about other types of beds or equipment to maximize her comfort during position changes.

Caring for family
Knowing that nurses are usually short-staffed, I volunteered to help watch after my sister's IVs. I would get bags of IV fluids as I noticed the present bag about to go empty and go ahead and hang it.

Also, the nurse brought an enema in to give while my sister was in the bathroom and left the enema on the table with "I'll be back." I am a critical care certified registered nurse. While taking time off from work to attend to my sister, was it OK to perform these duties as I saw that they were needed?

I hung IV fluids and received thanks from the nurses. After informing this RN that I went ahead and administered the enema, she said OK. Then she returned and said that she was uncertain if this was legally OK. Would you please enlighten me on this subject?

~C.F.

No, it is not OK to help out. The risk is really on the hospital, which should instruct its nurses that visitor participation in nursing duties is not permitted. Even if you are an employee of the hospital where this occurs, you are not insured because you are not performing your assigned job duties.

You should check your own insurance policy, but I doubt that it would cover you in this situation. If something had happened to your sister (e.g., a sudden fatal dysrhythmia from rectal stimulation or from the last medication given by the hospital nurse), the hospital would, of course, blame you and you could find yourself in the midst of a legal mess. When I am with a family member, I restrict myself to holding a glass of water, tightening sheets and fluffing pillows-nurses aide type duties. I don't even help myself to the linen cart until I have asked for and received permission.

Sometimes I have to sit on my hands to keep from messing with IV pumps. It is best to find your family member's nurse. Use your voice instead of your hands.

You also could check with the hospital to see if it permits private duty nursing. Then you would become an employee of your family member and your own insurance policy should cover you; check your policy to make sure. This means you go through the process of filling out some paperwork with the nursing office but you are then a nurse, not a visitor.

Flu shot administration
I am an RN working for a social service agency of aging and adult services. My title there is nurse consultant. During this flu season, I have been approached by many of my co-workers about the flu shot.

Am I, as an RN, entitled to order the flu shot vaccines and administer them to my co-workers? What is the limitation on an RN regarding the flu shot? Do you know of any resources in Washington state where I can check on those kinds of questions?

~H.L.

My understanding is that only MDs and advanced practice RNs can order vaccines. In the situation you describe, it would be highly risky to even administer the vaccine. Allergic reactions have been known to occur. It's best to leave vaccine administration to the clinics.

Your state nursing board is your best resource for the limits of your licensure. Your state pharmacy board also could have answered your question.