Needing Advise - page 2

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... Read More

  1. Visit  CapeCodMermaid} profile page
    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.
  2. Get the hottest topics every week!

    Subscribe to our free Nursing Insights newsletter.

  3. Visit  Altra} profile page
    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.
  4. Visit  BostonFNP} profile page
    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.
  5. Visit  Vishwamitr} profile page
    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.
  6. Visit  Vishwamitr} profile page
    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.
  7. Visit  Altra} profile page
    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.
  8. Visit  BostonFNP} profile page
    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?
  9. Visit  netglow} profile page
    0
    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.
    Nope, not anymore. Got to have an excellent reason to keep them if the patient data for dx/LOS says times up.
  10. Visit  BostonFNP} profile page
    1
    Quote from netglow

    Nope, not anymore. Got to have an excellent reason to keep them if the patient data for dx/LOS says times up.
    Not (in entierty) the RNs job to decide.
    tokmom likes this.
  11. Visit  Altra} profile page
    0
    Quote from BostonFNP
    Not (in entierty) the RNs job to decide.
    I agree with this. However, when a discharge order is received (as it originally was in the OP's scenario), I would consider it the nurse's responsibility to see that the patient is indeed discharged unless there is a change in condition or some other ongoing diagnosis that really warrants another day's stay.
  12. Visit  BostonFNP} profile page
    0
    Quote from Altra

    I agree with this. However, when a discharge order is received (as it originally was in the OP's scenario), I would consider it the nurse's responsibility to see that the patient is indeed discharged unless there is a change in condition or some other ongoing diagnosis that really warrants another day's stay.
    So if you had the order, went to the patient's room to d/c them and they said to you that the provider told them not until the morning you would go ahead and d/c them without verifying the order? You would instead judge if you felt like they warranted another nights stay and move on?
  13. Visit  thecool1Nscrubs2no} profile page
    2
    I feel that you did the right thing based on what I'm reading. Even if it was after 9pm. It was a good idea to call and get clarification on the order. Reason being we have had patients d/c late at night for beds or whatever. Also this gives case management an idea of who's leaving the unit and also when payment stops to the hospital,helps to prevent double billing to assure proper discharge takes place. I would have done the same thing as you did. This also holds the MD accountability for writing specific orders that include the date. You were just being cautions and assuring safety. Sounds like more people need to adapt that concept. Because what if that patient condition had changed and someone called the MD he or she could have said humm I thought that pt was d/c already.......
    Last edit by thecool1Nscrubs2no on Jan 6, '13
    netglow and tokmom like this.
  14. Visit  Anna Flaxis} profile page
    2
    There could be many compelling reasons to delay discharge until the morning that are not related to a change in condition. Maybe the patient is frail and debilitated from their 20 day hospital stay, lives on a fixed income and can't afford the taxi fare to their rural home in a remote location with an empty refrigerator, and their grand daughter who checks on them when she can works night shift at a convenience store and can't afford to take the night off and can only come to get Granny and settle her in at home and buy her some groceries and make sure the house is heated in the morning after her shift. This is why I couldn't do case management. I would be too sympathetic to the old woman's plight to just kick her out without making sure all of her resources are in place first.
    LTCNS and netglow like this.


Nursing Jobs in every specialty and state. Visit today and Create Job Alerts, Manage Your Resume, and Apply for Jobs.

Top