Needing Advise

Nurses General Nursing

Published

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 went to the room to D/C patient and the patient stated "I am not going home tonight, the doctor said in the morning." (Approximately 2135 hrs) I immediately called the MD who stated VIA telephone order "Cancel D/C till AM." This order was written. (He apologized- He also admitted to this conversation.)

My supervisor (Charge Nurse) came in and asked the patient and she stated "I am going home tomorrow."

The next morning my supervisor demanded me to come in for an "urgent matter." I drove 50 miles (Without sleep)

She kept stating that "this is a business" and there was "no need to call the doctor."

Do you guys know any Standards of Care or National Care that I could bring up in the meeting this afternoon. I live in Louisiana. Thank You in advance!

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?

Specializes in Gerontology, Med surg, Home Health.

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.

Specializes in Emergency & Trauma/Adult ICU.

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.

Specializes in Adult Internal Medicine.

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.

Specializes in Psychiatry.

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.

Specializes in Psychiatry.
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.

Specializes in Emergency & Trauma/Adult ICU.
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.

Specializes in Adult Internal Medicine.

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?

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.

Specializes in Adult Internal Medicine.

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.

Specializes in Emergency & Trauma/Adult ICU.
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.

Specializes in Adult Internal Medicine.

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?

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