My DON came to my house today

Specialties Geriatric

Published

  • Specializes in psych and geriatric.

I'm an RN who works at a small-town nursing home, owned by a large, multi-state company; I work nights--1745 to 0615 (or until the day is done--you know how it is). So here's the situation: geriatric pt with increasing edema. We attempt to contact the doctor but get his PA instead. The PA orders an increase in Lasix to 40mg po qDay x 3 days and a BMP with f/u with the doctor. The blood work gets drawn and sent to the lab the next morning and the first dose of Lasix 40mg is given. The BMP reveals a critical low potassium (2.9); results are faxed to the Dr. with a request for further instructions, which don't come that day. During the noc shift, I put the next dose of lasix on hold pending further instructions from the doctor and I fax him again and pass this on to the on-coming shift via verbal report. My DON comes in later, can't figure out why I would have held the lasix when it was a brand-new order, goes into a tizzy fit and COMES TO MY HOUSE!!! She pounds on my door, waking me up from a sound sleep, to demand to understand why I thought I could put a one-dose hold on that Lasix. She tells me that it was an inappropriate action on my part and orders the day shift LPN to give the Lasix anyway, apologizing to the doctor for my actions.

Here's my question: was I really out of line in holding one dose of lasix while waiting for further instructions on a critical low potassium? Did I overstep my legal authority as an RN? I did not d/c the order, only put it on hold pending further instructions. Is what I did so far from logical thought that it warranted her coming to my home and waking me up?

Specializes in LTC.

First, yes, I would have held the Lasix but I can't help but wonder why a crit lab was FAXED instead of being called on for orders? And why this lab went through a couple of shifts and no one followed up?

If my DON came to my house like that, I would 1.) Put in a time adjustment form. You can chew on me all you want, but you'll do it on YOUR time, not mine. And 2.) Look for another job. The practice there seems hinky to me.

mtjoanna

76 Posts

Specializes in psych and geriatric.

Our doctors have made it clear that they are not to be called unless it is an after-hours emergency--and critical labs don't count to them. It drives me nuts sometimes... We have to call them ahead of time for permission to send residents to the ER, even for serious bleeding and heart attack/stroke s/sx. We also have to get specific orders for use of an ambulance, even if it is after hours and we don't have anyone who can drive the facility van. I got my butt chewed by my DON for calling the doc "needlessly" when a (new) resident had a firm, distended abdomen with pain radiating from stomach to under her rib cage with no bowel sounds. Per my DON, I'd let the resident "manipulate" me into sending her to the ER. Good idea on the time sheet; I think I'll do that when I get to work tonight.

Specializes in Hospital medicine; NP precepting; staff education.

CM, this place sounds horrible and is a sentinel event waiting to happen. It is NOT ok that she came to your house for that purpose. That is crossing a line.

Permission (from the facility or doctor ) to send people to the hospital in an emergency doesn't make sense if the patient is able to consent or family. Am I missing something?

Nurse Leigh

1,149 Posts

Specializes in Telemetry.

I have no LTC experience but this whole thing seems ridiculous. My advice is to start putting out feelers for a new employer and I would consider calling for necessary orders regardless of MD preferences. Do you think if something bad goes down because they didn't intervene they'll accept their fate for their refusal to have you call as appropriate - OR - throw you under the bus?

And let them gripe if there is an emergency that requires a call to 911 before a call for permission.

Sorry you're dealing with inept people. Wish the families of residents understood what goes on behind the scenes and who creates the some of the problems instead of just blaming the nurses and aides caring for their loved ones.

canigraduate

2,107 Posts

I'd tell that DON if you catch her on your property again you'll press charges for trespassing and get a restraining order.

Going to your home and harassing you is NOT OK.

Anybody who comes pounding and yelling at my door will be escorted off the premises by someone in uniform.

You also need to write her up and report her for her conduct. What she did is so far beyond acceptable that she needs to be slapped back into reality before she does something even more criminal.

canigraduate

2,107 Posts

As far as holding the lasix, I guess you could have just given it and put your patient into an arrhythmia. *sarcasm*

Actually, that's not such a bad idea. Then they'd have to go to the hospital where there is no dumbass DON trying to kill them.

Jensmom7, BSN, RN

1,907 Posts

Specializes in Hospice.
As far as holding the lasix, I guess you could have just given it and put your patient into an arrhythmia. *sarcasm*

Actually, that's not such a bad idea. Then they'd have to go to the hospital where there is no dumbass DON trying to kill them.

Yes, but apparently they would still have to get permission from the doc to send the patient out, and the DON would still rant about her being "manipulated" by the patient.

Yikes.

Specializes in Hospital medicine; NP precepting; staff education.

I can't edit my post now, but I didn't mean CM. I hope the OP knew I was addressing her.

mtjoanna

76 Posts

Specializes in psych and geriatric.

You are only missing my DON. I chart just about everything, including when the docs are contacted and when they say yay or nay to the pt being seen. I've also been known to contact family/guardians and get their permission rather than the DON's, which means I'm not her favorite nurse sometimes.

mtjoanna

76 Posts

Specializes in psych and geriatric.

Part of the issue is that in our small community, our doctors are the hospital doctors who are on-call for the ER. It has gotten somewhat better since a couple of new PAs have shown up. We (the nurses as a group) have been known to wait for the clinic to close and the PAs to be on duty before calling in over a concern. Unfortunately, sometimes the docs still take call.

Karou

700 Posts

Specializes in Med-Surg.

What is your facilities policy on critical labs? We have a specific strict policy that we must call within 30 minutes to notify the physician and he/she must respond an hour after notification. It has to be documented. And it gets audited.

I don't think 2.9 is critical though, but very low. I would have held the Lasix as well. However, I would have woken that cranky doctor up to tell him of the K level and inform him why I was holding Lasix, and ask for K replacement along with the Lasix prior to administering. If he wanted to pitch a fit I would report he behavior to the administrator. You are the patients advocate, not the doctors.

I would be horrified if my supervisor came to my house for an issue like this. First of all, errors and mistakes happen. A phone call would be fine. Coming to your home is inappropriate and weird. It shows how little she cares about her staff when she supports this whole "wake the doctor only if the patient is basically coding" unofficial policy, yet wakes up your sleep at your home for a held Lasix.

+ Add a Comment