I don't think I went too far. Your HONEST opinion would be gratefully received.

[Paul]

I genuinely want HONEST answers to this, please don't agree with me just to be polite - if you think I was an asshole, say so.

I have posted elsewhere about the problems I have if a needle touches the wall of the fistula ( http://ihatedialysis.com/forum/index.php?topic=34234.0 ). Because of this it states on my file that if this happens, the needle must be removed immediately (usual process involves a lot of preparation).

Today while putting me on the machine the needle ended up touching the wall. I told the nurse this and I said she needed to take it out immediately. She thought about it for a moment and started doing the slow preparation. I told her it had to be done quickly and told her to check on my file. She ignored me. I repeatedly asked her to check my file and do what it said in there, to be honest I was beginning to panic, it can get very nasty if they don't do it quickly (first time, it took the entire ward's medical staff to bring me back). As I got more frantic she stopped doing the slow preparation and she just stood staring at me doing nothing - nothing whatsoever. I got angry then and raised my voice (not shouting, but louder than polite). Eventually she went back to doing it the slow way, and after too long took the needle out.

The result was dangerously low blood pressure and feeling sick. Fortunately I did not pass out (got damn close) and no diarrhetic disasters. The lack of the more serious symptoms was due to another nurse slowing down pump speed and takeoff rate and extending the dialysis session to five and a half hours, to compensate.

Now my question is this: Because of her behavior I called the nurse who would not do as instructed in my file "stupid". When the emergency was over she complained to the manager about this, and the manager came over and told me off for using "abusive language to her staff". I don't think it was unreasonable for me to say this, if the other nurse had not fixed things the result would have been a lot worse. And it does say in my file that I should be taken off immediately.

What do you think? Did I go too far in calling her stupid?

[Simon Dog]

I think calling her "stupid" made it more difficult to get your point across.   Right or wrong is not relevant; what is relevant is getting what you want done when you want it done.

Rather than "name calling" just state what she did "This RN did not follow the instructions in my file, which I also reminded her about.   I wish to file a formal incident report.  How do I do that?".

Politeness rules.   Notice that even a prosecutor seeking the death penalty will address the target of his attempted killing as "Mr. Smith", not "Scumbag".

Since you have a particular requirement, it should be discussed with the RN or tech before the sticking starts.   Or, better yet, just learn how do self canulate.  While this is generally reserved for home patients, there is no reason an in-center patient cannot be taught this skill ... but you have to push for it.

[iolaire]

Now my question is this: Because of her behavior I called the nurse who would not do as instructed in my file "stupid". When the emergency was over she complained to the manager about this, and the manager came over and told me off for using "abusive language to her staff". I don't think it was unreasonable for me to say this, if the other nurse had not fixed things the result would have been a lot worse. And it does say in my file that I should be taken off immediately.

I'd say you have two courses.
1. apologize and move on
2. File a formal complaint with the center because the staff member ignored the medical orders in your file.  And then write an apology for the staff member to whom you used demining language in an attempt to get the staff member to follow the orders in your file.

If you are US based and don't have other convenient centers you do need to be a bit careful about the "abusive language" as they can use it as a reason to kick you from the center.  But I doubt that would happen after one or two instances.

You should stay away from personal attacks on people so it was stupid, but something you could learn from.  Maybe start to yell for the supervisor rather than continuing to try to make your point to the staff member?

[kickingandscreaming]

I think you had every right to be very angry.  Your health and well being were on the line and you had orders to back you up.  The issue is more about what works, and calling people names (however deserved they may be) is counterproductive for you.  In in-center hemo, there is such an air of passivity that is encouraged.  And I think that is very bad, and it's one of the reasons that I do home PD.  I don't want to sit there passively while people don't listen to me because I'm just a "stupid" patient.  But calling names doesn't increase your chance of being listened to.  It just gives them an excuse to dismiss you.

[Michael Murphy]

In my case I would call the Nurse That handles the visits to the clinic.  She would then rip the staff a new one.  I’ve seen it happened when she came in one day and found a nurse was exceeding my dry weight, the clinic nurse looked like she had been hit by a car.  At the minimum complain to your doctor if that doesn’t get through to them file a CMS complaint they are required to follow your doctors instruction.

[cassandra]

O Paul, how ever much I understand your frustration and anger, I have to agree with previous posts. Do what works and namecalling is not it.
Write to the MD. And learn to needle yourself.
I would start with 'studying' some youtube vids.


Love, luck and strength, Cas

[Michelle2016]

1. Quite a few new nurses or tech think they know everything. No matter what you tell them, they want to try it in their ways.
2. Quite few experienced nurses or tech think they know everything too. They will not listen to you.
3. As a patient, you know what’s going on. You have the right to make sure they do it right. You can refuse to do it with nurse if you don’t trust her or she doesn’t listen to you.
4. Please be polite and patient. Their jobs are to help you.  Their jobs are not easy too.

Wish you the best.

[Michael Murphy]

The advise about being polite,  stand your ground firmly but politely, if they insist on not following doctors orders have them call the doctors office for confirmation, if they won’t do that and you have a cell phone call the doctors office to let the doctor know his orders are not being followed, if it’s out of hours leave a message with the service.  If they still pull this crap ask for the manager and politely ask about how to escalate your problem he or she should fully explain your rights and the process of escalating your complaint.  If this is not done ask for the number of CMS.  Remember if you loose your cool you loose the confrontation.

[Charlie B53]

Remember if you loose your cool you loose the confrontation.

Bolded to emphasize as this is most important.

[GA_DAWG]

I understand the frustration, but it is always more likely to go your way when you maintain your composure. Above that though, in the time I have been on dialysis, I have not seen the problem you have of a patients blood pressure bottoming out if the wall is touched. I have just seen the needle repositioned. There is a good chance the nurses and techs have not seen it either.

[Charlie B53]

Just because the Nurse and/or Tech have not seen the condition before does not mean that it cannot happen.  Especially if that particular patient has prior occurrences of that very condition AND it is spelled out in their record.

Paul clear stated in his original post this condition HAS previously occured, and this has been addressed in writing in his file.

Staff clearly are not bothering to READ their directions.

I am afraid if it were I there would have been some 'not so nice words' immediately following stupid.  Sorry?  Not necessarily, I'm an A-hole.  And they know it.  I managed to contain it during treatments.  So far.

[Xplantdad]

The advise about being polite,  stand your ground firmly but politely, if they insist on not following doctors orders have them call the doctors office for confirmation, if they won’t do that and you have a cell phone call the doctors office to let the doctor know his orders are not being followed, if it’s out of hours leave a message with the service.  If they still pull this crap ask for the manager and politely ask about how to escalate your problem he or she should fully explain your rights and the process of escalating your complaint.  If this is not done ask for the number of CMS.  Remember if you loose your cool you loose the confrontation.

We did exactly this when we had an issue with Fresenius...after the lady who ran the center told us to basically pound sand regarding our complaint. So, I made sure to call the cell number of Holly's nephrologist-and talked to him regarding everything that was going on-and what the lady who ran the center told me....all while standing in front of said lady.

Three things happened. 1) Said lady got a nasty call from the nephrologist right after I got off the phone with him. 2) The nephrologist finally agreed that we should do home hemo and not have the potential drama at the center 3)The lady was shown the door a week later-as the issue with us was the last straw. I honestly think she was burned out...and with the way they work people there, I can see why!

[Simon Dog]

[The nephrologist finally agreed that we should do home hemo

Were you actually have trouble convincing him/her to let you go with home hemo?

[Xplantdad]

Hi SimonDog...as weird as it seems, yes ! Apparently the location we were at, was a late adopter of the home Hemo program. We were the second family trained on it...

[kristina]

Question from Paul :
"I genuinely want HONEST answers to this, please don't agree with me just to be polite - if you think I was an asshole, say so.

I have posted elsewhere about the problems I have if a needle touches the wall of the fistula ( http://ihatedialysis.com/forum/index.php?topic=34234.0 ). Because of this it states on my file that if this happens, the needle must be removed immediately (usual process involves a lot of preparation).

Today while putting me on the machine the needle ended up touching the wall. I told the nurse this and I said she needed to take it out immediately. She thought about it for a moment and started doing the slow preparation. I told her it had to be done quickly and told her to check on my file. She ignored me. I repeatedly asked her to check my file and do what it said in there, to be honest I was beginning to panic, it can get very nasty if they don't do it quickly (first time, it took the entire ward's medical staff to bring me back). As I got more frantic she stopped doing the slow preparation and she just stood staring at me doing nothing - nothing whatsoever. I got angry then and raised my voice (not shouting, but louder than polite). Eventually she went back to doing it the slow way, and after too long took the needle out.

The result was dangerously low blood pressure and feeling sick. Fortunately I did not pass out (got damn close) and no diarrhetic disasters. The lack of the more serious symptoms was due to another nurse slowing down pump speed and takeoff rate and extending the dialysis session to five and a half hours, to compensate.

Now my question is this: Because of her behavior I called the nurse who would not do as instructed in my file "stupid". When the emergency was over she complained to the manager about this, and the manager came over and told me off for using "abusive language to her staff". I don't think it was unreasonable for me to say this, if the other nurse had not fixed things the result would have been a lot worse. And it does say in my file that I should be taken off immediately.

What do you think? Did I go too far in calling her stupid?"



Dear Paul,
I can assure you, that - sooner or later -  we all go through those little moments of feeling "Baseball-batitis" coming along (I have just created that expression "Baseball-batitis" and hopefully you understand...) ... Our realistic situation is one of being totally dependent on the goodwill of nurses... and when one of them hurts us, that is when that little moment of "Baseball-batitis" "creeps" in... and it is very understandable... The only advise I could possibly give you, is to try and keep as calm as you can possibly be in whatever dialysis-situation.
I have noticed that most dialysis-nurses are constantly totally overworked and because of so many patients waiting, they hardly have the time to look up our (often very thick) file.
Please observe and please assist them as much as is possible by knowing your own medical details and communicate about them...
I always assist as much as I can by knowing the speed of the machine, how much fluid to take off, my weight right now, my dry weight etc. and all other medical details which are currently important...
Best wishes and good luck from Kristina.

[iolaire]

Please observe and please assist them as much as is possible by knowing your own medical details and communicate about them...
I always assist as much as I can by knowing the speed of the machine, how much fluid to take off, my weight right now, my dry weight etc. and all other medical details which are currently important...
Best wishes and good luck from Kristina.

This advice is spot on, plus go ahead and give a every treatment reminder that you react significantly if it hits the walls and need the needle removed immediately.  You should be able to stop the reminder after a few weeks, but make sure to remember it when a new team member shows up.

[GA_DAWG]

Agree with Iolaire. There is a small segment of my graft that is narower than the rest. I make it a point every time to remind whoever is going to be sticking me that day, regardless of how many times they have done so in the past. They have so many patients I do not expect them to remember. After reminding them, I have enver had a problem getting them to leave that spot alone. I also tell them how much fluid to remove each session and whether or not I think my dry weight needs adjusting. Now if we have a fill-in for a few days, the others will tell them just to listen to me as I know what I am doing. When a needle touches the wall, even on a graft, it hurts and we all understand that. But it is entirely possible to be firm without being profane.

[Riki]

OK, this is my take on it.

You know the consequences of leaving the needle touching the wall.  You explained this.  you told her to check the file.  Those kind of things are generally kept in the front of the chart so they can be found, we have a cardex that shows those kinds of things.  I'm not sure how they do charing where you are.

You were panicking.  You are going to raise your voice, and probably be angry that you weren't listened to.  Calling the nurse names is a natural reaction, and one I've had myself.  Although it's natural, an apology after you've calmed down should have been given.

A complaint should also be made.  They are supposed to do things your way, not theirs.  There are reasons you do things a certain way, and they should follow it, expecially if it's spelled out on your chart.  She didn't do that, and she took her time, which put your life in jeopardy.  She may not have understood that.  She needs to.

The suggestion to remind the nurses of the issue is a good one.  Make sure they all know.  After  a while, you won't need to remind them anymore, and when you say "take it out" they will without delay.

[Charlie B53]

................................. They are supposed to do things your way, not theirs..................................................

This really makes me laugh.

I REALLY LOVE my Cath.    NO Needles!

Wednesday Nurse told me she is going to stick my fistula Friday.  She has received the Prescription from the Dr OK'ing it and that I will need to take the prescribed Zanax plus put the Lidocaine cream on at least an hour before hand.

This sucks.  I rather stay with my cath.

I'm such a wuss.

[kickingandscreaming]

Wish you luck, Charlie.  If you're a wuss, I'm a wuss squared.  I'll stick to PD as long as I can get away with it

[Simon Dog]

BTDT on both.    Actually prefer fistula, now that I know how to puncture it and because of the very real risks a cath presents.

But K&S is right - PD is less hassle if it works for you.

[Michael Murphy]

The first 6 months I started Dialysys I too would have preferred a cath.  However as the fistula grew and formed the bumps the problems ceased.  I am rarely infiltrated now when I started it was several times a month. 

[GA_DAWG]

When I want to be unhooked, get up, and leave, the catheter seems a good choice. But I feel so much better without it. Fresenius had the Right Start program when I first started. The nurse who called told me it would be much easier once I was not using the catheter. She was right. Still have the problems with clotting about once a year, but other than that and the time to stop bleeding, life without the catheter is much better. Showers are great too.

[Michael Murphy]

Last year I spent 2 full weeks in the hospital after suffering a massive MI. That’s when I discovered you can’t shower in a hospital any more.  They are too afraid of falls.  The first shower when I got home was heavenly

[Riki]

................................. They are supposed to do things your way, not theirs..................................................

This really makes me laugh.

It is true, though, since I am well informed on how things work, and will tell the nurses when they're not doing things the right way, I am the problem child.  I'm also the "senior patient" which means I've been there longer than anyone else.  Too bad it doesn't get me any perks.. *L*