D.O.N. concerned more with census than NH residents care

  1. At the facility where i work the D.O.N. is denying nurses to send residents out to the hospital who need to go in order to keep the census up. Residents who are full codes have stayed in the facility while being in acute distress. Being a NH with very limited supplies there is very little we can do. She would rather the person died there it seems. I know when the lawsuits come she will be in the clear because she will say she was not aware of the serious nature of the situation. she has gotten unit managers to lie to family members telling them their loved one will sit in the ER for 8 hours without being seen and that it is better for them to stay in the facility. This particular resident was in resp distress! Everybody knows resp distress patients are priority in the ER, but the family believed them. This D.O.N even bosses around the nurse practicioner! I don't get it. This DON MSN claims to be a christian, and cares so much about people yet her bonus at the end of the quarter is more important than a human life!
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  2. 23 Comments

  3. by   unknown99
    If I were you,
    I would get out of there. Not sending a patient to the ER for emergency treatment when needed is considered negligence. If this happens, you can bet eventually a family will sue, and do you think the DON will bavk you up?? NO. She will cover herself; you will be fired; and named in a negligence lawsuit.
    I am sure you worked much too hard for your license to lose it like that!!
  4. by   Thunderwolf
    did i hear you say...you or someone else...made an anonymous complaint to the state bon or another governing body?....ooops, did i say that?

    please check out our ltc forum and our lpn corner forum which can be accessed via the forum link below.


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  5. by   Jessy_RN
    [color=olive][font=impact] welcome to the site, enjoy your stay and best wishes to you!
  6. by   Bird2
    Quote from burrt-lpn
    At the facility where i work the D.O.N. is denying nurses to send residents out to the hospital who need to go in order to keep the census up. Residents who are full codes have stayed in the facility while being in acute distress. Being a NH with very limited supplies there is very little we can do. She would rather the person died there it seems. I know when the lawsuits come she will be in the clear because she will say she was not aware of the serious nature of the situation. she has gotten unit managers to lie to family members telling them their loved one will sit in the ER for 8 hours without being seen and that it is better for them to stay in the facility. This particular resident was in resp distress! Everybody knows resp distress patients are priority in the ER, but the family believed them. This D.O.N even bosses around the nurse practicioner! I don't get it. This DON MSN claims to be a christian, and cares so much about people yet her bonus at the end of the quarter is more important than a human life!
    First off Welcome to Allnurses. Secondly, you are working off your license. So call the MD and notify them of any abnormal assessments and if the MD wants the resident sent to ER then they should go. I have worked LTC for a long time as an LPN, RN, and a nurse manager. You need to cover your own butt and protect your residents. Chart carefully your assessment and you conversations with the MD and family. Try to not take short cuts with this because you are busy.Sometimes families will chose to not allow an ER transfer and that is fine as long as the MD is on board and the nurse keeps all updated on condition and changes. This way you will be protected when DPH arrives for a complaint of improper nursing care. Good luck.
  7. by   SmilingBluEyes
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  8. by   txspadequeenRN
    Welcome to all nurses!!!! Now you need to run, not walk away from this job. When you are standing in court or defending yourself in front of the BON this DON will be no where to be found. DON or not if they need to go ....THEN THEY GO!!!! I would find another job if I were you. What does she think if they stay her census stays up until they all die ,then what. Then state comes busting through the door investigating these numerous deaths and look who's name is on the charting. You will never back your license by saying "Well the DON didnt want to send them out". It is a sad situation when money and census comes between doing the right thing.
  9. by   CoffeeRTC
    Maybe someone can move this out of the intro forum?

    This is total BS. Every year around the holidays they post a note about contacting the DON or ADM before sending a pt to the hospital. Um, no. Heck no. I am the nurse practicing on my license, not the ADM. I will assess the pts and call the doc for further orders. A lot of times a doc will try to just send the pt out even if it is something treatable in the NH. In those situations I will ask for treatment at the nursing home and they will most often agree, but if needed they are sent out. (A lot of nurses won't question a docs order and will just send them out for minor things....that is where the notes come from)

    Now the main reason I end up sending pts out is that over the weekends or holidays, labs don't come for pick ups, pharmacy is delayed or it is almost impossible to get an X ray done. If we would have better services at our nursing home, I would definatley make sure my pts stay in their home for treatments, but heck we all know the reality of the situation.

    You are the nurse, you are praticing on your license and under the doctors orders. Not the DONs or ADM.
  10. by   Thunderwolf
    Good suggestion. Thread is moved to the Long Term Care Nursing forum for additional viewing, feedback, and support. Good job, folks...who have responded thus far.
  11. by   CapeCodMermaid
    Can you spell "G" tag??? When in doubt ship 'em out...the DNS needs to get a grip! Where I work when the census goes down we take highly inappropriate (read psychotic) patients we are not equipped to deal with....
  12. by   leslie :-D
    i once had a don who gave me an order and i reluctantly carried it out.
    dph (dept of public health) ended up being involved; i told them i was carrying out an order from my don. the don outright denied ever giving me that order. inevitably she was charged, i was not. from that incident, i learned to trust my gut instincts and fiercely protect my license. sadly i've learned that there are many unscrupulous people in upper mgmt. and the bottom line is the $$, not the patients.

    leslie
  13. by   Marylou1102
    I am a DON in a LTC. Your DON is the kind of person that gives the rest of us a bad name. She probably wasn't a very good nurse either. You have two choices. You can leave and hope the residents don't die of neglect or you can stay. If you stay make sure that you document everything, and to be on the safe side make copies for yourself. Don't let people know that you are, just put them aside in case you need them later. You would be surprised at the records that come up missing. Always CYA.

    Always rely on your own judgement. You really do not need an order to send a resident into the hospital. If something like this would ultimately go to court, it would all come down to the nurse taking direct care of the resident at the time. Your nursing judgement is what would be on trial. I have sent residents to the ER without an order. Sometimes the doctor is mad at me, but I would rather it be him/her than a family with a lawyer.

    btw: when I said you could leave and hope the residents don't die of neglect, I wasn't really trying to put pressure on you to stay. It just sounds like they need a good resident advocate/nurse.
  14. by   dawnb70
    I have a similar problem where I work. We have to notify the DON and the Administrator before we send someone out. Plus they want us to use the facility van to transport instead of an ambulance whenever possible. At one point I had to have the DON do her assessment of the resident before I was allowed to send them to ER. It's disgusting. Now when someone needs to go to the ER I just make the calls and send them. If anyone gives me any flak I just say either we'll lose this resident temporarily or permanently (if they die), and if they have a three day hospital stay the facility will get the Med-A money (I think it's around $10,000 a month). That always shuts them up! I think the anonymous call to State was a wonderful idea. It sounds like your DON needs a huge wakeup call!!!

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