This Patient is a VIP

…Or how to insult a nurse.

“This patient is a VIP.”

The shift starts out with with a “higher up” going over the staffing sheet with the charge nurse. They whisper but I know what it means. They’re trying to decide which nurse should take care of the VIP (very important patient). You should be flattered if asked – it means they think you’re the best nurse on the shift for the job. But I’m not flattered. I’m insulted.

Who is a VIP?

From movie stars to the CEO of the hospital, physicians to nurse managers of other units, sports figures to musicians, financial donors to the neighbor of a “higher up”, they are considered VIPs in various contexts. Their importance (social status, politics, occupation, fame, position, donor status, etc.) has the potential to influence clinical judgement or behavior.

What is VIP treatment?

It’s assumed that VIP treatment results in superior care and service. However, this can backfire and compromise patient safety and service.

We need to keep the VIP happy at all times, so rules are bent or broken. Clinical protocols are not followed. Steps are taken to please the VIP but this often results in sub-standard care and inferior service. Decisions are made to please the patient. Decisions should be made according to clinical guidelines.

One possible scenario:

To afford privacy, a VIP is given a room at the end of the wing. All other rooms and the hallway are blocked. Security checks IDs and if a person is not on the list, they can’t get access to the hallway. The patient has pain. Physicians associated with the VIP case prescribe narcotics. If the VIP still complains of pain additional medication is given, ignoring the rules of clinical response, dosing protocols, and setting reasonable pain management goals with the patient. The patient stops breathing due to an overdose of narcotics. The code blue team is called for respiratory arrest leading to cardiac arrest. Team members names are not on the approved access list and can’t enter the hallway. The VIP dies because life-saving personnel could not get to the patient in time.

A few more scenarios:

• A nurse is assigned to cater to the VIP. There are many other high acuity patients on the unit, but they have to wait for care while the rest of the staff divvies up the patient load and works short.
• The approved visitors list, made by administration to restrict access to the VIP patient, inadvertently omits close family members. The patient is unaware of the VIP status (designated so for the spouse or parent of a physician or administrator, a neighbor of a “higher up”, etc.) and family is unwittingly denied access.
• Clinical tests (x-ray, ultrasounds, etc.) are done at the bedside with portable machines so the VIP doesn’t have to travel to the radiology department where others may identify him/her. Other necessary tests (MRI, CAT scan) are not ordered because there is no bedside equivalent.
• Restricted diet orders (diabetic, cardiac, renal) aren’t strictly enforced when the family brings food. Everybody wants the VIP to be happy regardless of the consequences.

Why are we bending any rules to make the VIP happy?

Because we want to please them? Because we want the VIP to tell others about their great experience at our facility?  Is it really about excellence in healthcare, or is it about the expectations of the patient?

Did I mention HIPAA and privacy?

While caring for the VIP patient, a number of physicians and administratiors call for updates or visit the unit to ask the nurse. Wait – is this a trick? Because I’m certain HIPAA rules prevent me from discussing care, progress or anything else unless it is on a need-to-know basis. And they don’t need to know. They want to know.

I’m insulted.

I give excellent care and service to all of my patients. Calling ahead to warn of a VIP or even designating the person as such implies that I need to give better care to the VIP than my regular patients. Not possible. I give everybody the same quality of care (excellent) and therefore to imply otherwise is insulting to me as a nurse. I won’t tell you anything, either, because all patients deserve to have their privacy protected.

Please don’t assign the VIP to me.

*Note: No HIPPA laws were violated in writing this posting.