I am an oversight nurse at a boarding home for chronically mentally ill residents who are able to do ADLS, take medications and do their own blood sugars etc. Part of my job is to go assess a resident that is in acute care for a physical illness to come back to our level of care.
That being said we had a geriatric age resident who has not rebounded since having pneumonia in January and was readmitted to acute care for possible sepsis due to a bursa draining done by a local ER . He was diverted to another local hospital and because at the end of his inpatient stay he could walk 200 feet he was not eligible for rehab in a LTC for a few weeks. Case manager at hospital stated this was due to Medicare regulations. I went and did a head to toe assessment walked with him and made sure he could do his ADLs for himself as he must to come back to us. i assessed him and seen that he was at his baseline that he was at before admission to acute care.
Well the next day the hospital discharged him . The administrator my boss called me saying he had SOB was sweating and was very weak after he was brought back to the facility. These s/s were not apparent when he was assessed by me a day prior or I would not have said he was strong enough to come home. He returned to the facility with these symptoms and I was asked to transport him via my own automobile back to the ER because a social worker at the hospital said they would take him back.. ( that is a minor miracle in itself). I stated to my boss I did not feel it was safe to transport a person with SOB and sweating and weakness in a privately owned vehicle and I felt an ambulance should be called in case he was having a stroke or pulmonary embolism or a myocardial infarction and I refused to do so because I felt it was not safe for him when this hospital is 20 miles away and I know if he had quit breathing on the way i could not have saved him and I would have been liable and my license in danger. After I stated this they were going to send him paratransit then got the activities director to take him in her car. She agreed to do so and the resident was able to return to the hospital with no problem and is now a resident at a LTC which i had been advocating for a while.Here is the kicker and the basis of my question and what I did in response. I wonder did I do the right thing as a nurse or did I fail my patient in some way. ? I of course have been getting the cold shoulder from staff but I feel it was Russian roulette what they pulled . I guess they felt because his condition changed from my prior assessment it was my responsiblity to take him back because I made a mistake well I know from years of working LTC the geriatric age patient can go downhill within hours just like children do. Also I have a license that if he died it would be on me as well as it not being the appropriate safe thing for this resident he deserved better care than that. Any thoughts or comments ?