Needing Advise - page 2

by Brianrn

I am needing help with a problem at work. I had a patient that was in the hosspital for 20+ days. The MD usually comes at night (which he did) We were expecting a discharge. After he came in he had wrote "D/C Home." I... Read More


  1. 1
    Wait you're talking about this happening at 2130 but then you say you worked til 1830? I'm so confused.

    And then driving 70 miles, or 50 miles?? Please add more info, this story is inconsistent and apparently lacking in some key details. Why are you in trouble?
    RockinChick66 likes this.
  2. 0
    Basically, the DR told me to hold the Discharge. I wrote an order saying that. Unit director got angry because of LOS.(Length of Stay). I got called in at noon the next day and was told by my unit director that I needed to come in ASAP. So I drove 70 miles to the hospial to have a meeting with her. She stated that I should have never clarified with the doctor and that there was not a reason to.
  3. 0
    still a weird story- you needed to clarify an order- you did the right thing- dr said d/c home- but actually patient needed to leave next day- you clarified that...
    you work at topsy turvy general?
    Last edit by Esme12 on Jan 5, '13 : Reason: TOS/txt speak removed.
  4. 0
    I work in long term care. We routinely have patients admitted to us from the hospital after 6 or 7 or 8pm. It's not out of the ordinary any more for someone to be discharged at night even if they are going straight home.
  5. 1
    I imagine the supervisor in this situation thinking something along the lines of, "the MD can write whatever order s/he wants ... it doesn't mean we're getting paid for the extra day."

    And the supervisor is exactly right about that.
    itsmejuli likes this.
  6. 2
    I recently saw this same scenario from the other side of the equation. A family member had driven herself to the local ED with dyspnea, was found to have a significant effusion, it was drained an she was kept over night. The next day she was still weak but they wanted her out, so at 9pm they discharged her (it had been 24 hours exactly). They took her by wheelchair to the lobby and left her to walk to her car. To make matters worse, it had snowed 5 inches and she had to try and dig out with no gloves or shovel.

    She had asked her nurse if she could say till morning. The nurse told her no it was out of her hands. Needless to say I was livid.

    It made me think about how I have pushed patients discharges in the past. Medicine is changing, and it's hard to watch.
    tokmom and itsmejuli like this.
  7. 1
    Dear BrianRN,
    You did absolutely what a prudent or a compassionate nurse would've done in a comparable situation, bro. It's not like that you instigated the patient to stay overnight. She was the one who requested/ demanded to stay (I am also surprised that the inconsiderate MD would discharge someone at that unearthly hour without knowing if there was food in the house, electricity, running water, any family member, how far she lived, etc.) This patient was already in the hospital for 20 days so what is one more day (or night)? You couldn't keep the patient overnight once the D/C order was written so you had to relay the patient's request to MD and he did give you an order to withhold D/C. So who should have problem with that?
    And that Shylock charge nurse......I better not comment.
    This may be a business but we are not talking about a NYSE listing; we are talking about a human being.
    I would have first asked her to elaborate upon the "urgent matter", and I would not have driven back 50 miles without sleep. You could've had an accident. Do you think workmen's compensation would cover you? Technically, you were not on duty or on a business-related assignment although you were returning to your facility.
    As a bystander, I believe, you are well within your rights and do not much to worry about except having to standup to the Shylock nurse.
    thecool1Nscrubs2no likes this.
  8. 0
    Quote from Altra
    I imagine the supervisor in this situation thinking something along the lines of, "the MD can write whatever order s/he wants ... it doesn't mean we're getting paid for the extra day."

    And the supervisor is exactly right about that.
    Pardon my ignorance Altra, but the supervisor is exactly right about what?

    When a discharge is withheld as per MD's orders, yes, the hospital does get paid.
  9. 1
    Quote from Vishwamitr
    Pardon my ignorance Altra, but the supervisor is exactly right about what?

    When a discharge is withheld as per MD's orders, yes, the hospital does get paid.
    Not necessarily, and not just because discharge at 8pm or whatever time we're talking about is inconvenient or even unsafe. Is there still a medical condition that requires admission - then yes. If not -- the hospital will probably eat the cost of the extra day.

    Though I feel the supervisor's approach to the whole situation was poor ... the time that the nurse spent calling the MD might have been better spent using available resources to get the patient home.
    netglow likes this.
  10. 0
    Quote from Altra

    Not necessarily, and not just because discharge at 8pm or whatever time we're talking about is inconvenient or even unsafe. Is there still a medical condition that requires admission - then yes. If not -- the hospital will probably eat the cost of the extra day.

    Though I feel the supervisor's approach to the whole situation was poor ... the time that the nurse spent calling the MD might have been better spent using available resources to get the patient home.
    So if the provider had agreed to keep the patient till the morning, you would have still utilized your time to secure resources to get them home?


Top