Sarah Koffler, a Float Pool RN, reported that after multiple attempts to advocate for her patient, she was having trouble convincing others caring for the patient to acknowledge her concerns.

The patient was an elderly gentleman on the 3rd floor in declining health who told Sarah he was not ready for hospice, as he was being told was the plan, but instead he wanted a chance to go to rehab and see if he could get stronger again and have more time. His family and his providers continued to say that he was not capable of making his own medical decisions, and his spouse believed that inpatient hospice was the right plan.

Sarah felt the patient’s cognitive ability to make his own medical decisions was being dismissed unfairly, and his wishes were being overridden. The doctors were listening to the patient's spouse rather than the patient about his goals of care. Sarah described the response from the care team to her attempts to speak up on the patient's behalf as dismissive and rude, and she even described a very berating and confrontational interaction with the patient’s wife when she tried to discuss these concerns with her.

Using CUS (HRO Term), Sarah did not give up. She continued raising her concerns with each doctor and the patient's spouse. She was not just ignored, but treated disrespectfully. Discouraged but determined, she went up the chain of command and ultimately to Compliance/Civil Rights and Risk Management for suggestions and support.

While planning to initiate a Clinical Ethics Consult, Sarah approached a 4th provider, new to the case. She listened to Sarah’s concerns, assessed the patient herself, and confirmed he was cognitively able to make his own decisions. This led to a change in the patient’s discharge plan. Instead of going to inpatient hospice, the patient was discharged to Good Samaritan Rehab, aligning fully with his wishes.

Sarah demonstrated the MultiCare Values of Respect, Kindness, and Integrity, and never veered from one of Nursing's key roles: Patient Advocacy.