Needing Advise - page 3

by Brianrn

3,226 Views | 29 Comments

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. 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.
  2. 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.
  3. 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.
  4. 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?
  5. 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.
  6. 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.
  7. 0
    Soooo I'm feeling a little confused. Why was a patient who had been there 20+ days discharged at that hour? Seems like an issue between the MD and management. I doubt it wasn't a surprise that the patient was ready to go home. I am trying to look at all the possible scenarios, and I am just not finding one where there is no option but to send a patient home, who has been in the hospital for 20+ days, in the middle of the night. NO ONE on dayshift was aware that the patient was ready to go home? After 20+days did those magical 4 or 5 hours make the patient stable to go home? Even if they were waiting on test results or something the MD could have written "DC patient if ____ results are ____" then dayshift could have just called and gotten a final verbal discharge order. After 20+ days the patient should be ready from a CM standpoint so that shouldn't be an issue. You were put in a bad position, and there is no excuse for your supervisor to make you come back to the hospital on no sleep after working all night to reprimand you face to face. That goes beyond bullying, driving that far on no sleep can be deadly. You didn't hurt someone, there were no missing narcs, she is just abusing her position. If I were you I would be looking for a new job, and I understand in this economy that can be difficult, so I would at least turn my ringer off during the day.
  8. 1
    Though this may seem like a simple matter it is actually a complicated one and one of the reasons there is QA, PRI, D/C Planning,Case Managers, whole teams ( Social Workers, OT`S, PT`S, RN`S) involved in a patient`s care. This one fell through the cracks and naturally the primary care RN is going to be hung out to dry. It is a reason there are care plans long and short term. It is why there are consultations and why they need to be read by RN`S as they affect outcome. References should be made to these consultations in the RN`S notes especially with a patient in hospital for such a long time. I`m an ED RN and in a hospital I worked in there was a section to tick in the triage area if D/C Planning was indicated. I did this routinely with with complex cases (be it medical and social) and made a referral to our Social Worker immediately even before they were evaluated and was thanked often for foresight. Otherwise the ED was left with a patient who could not be safely disposed. Remember admitting a patient is no longer a safe dispo as you expose them to a variety of potential dangers ie: infection, falls, loss of resources such as shelter.
    netglow likes this.
  9. 0
    I held my ground. The supervisor backed off.

    The way guide speaks sounds exactly what her point of view was. (I understand the information you are attempting to relay- Appreciate it)

    However, in the same situation. I would do it again.

    and Again
  10. 0
    In case someone is ever in my situation, what I did was I printed out the States Nursing practice information. I read to her that "A Registered Nurse is required to clarify any order- verbal or non-verbal with a physician.


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