NO autonomy!

I'm used to having the autonomy of using my own judgement in certain things, but at this LTCF, it seems like you have none.

The other nite, it was time to change this old gents foley. I could not get the new cath to pass, so I asked the other nurse who hadn't left yet to try - she couldn't get it either - by this time I figured that we had poked enough, and was ready to try a coude, which we had in the facility. Oh, no, can't do that, so the other nurse kept poking and poking - by this time I told her that we'd just leave it out for the night, and call the doc in the AM. She finally got it to pass. But I'm sure that after all that poking, if he didn't need a coude before, he'll need one now. At the hospital, I'd have gotten a coude, and at some point would have notified the doc of the difficulty passing the regular one.

The DON told me the next morning that we should never call docs at nite - after all, "this is a nursing home, and the rules are different". Fine, I understand that, but if I think a patient is having a problem - I'm calling, I don't care what time it is.

A couple of weeks ago I came in on a Saturday nite to find out another fella had suddenly had blood in his cath all day - not just a little either. He was A/O and didn't think he'd pulled on it. When I asked if they'd called the doc I was told they'd do it on Monday.

I just don't get it!! Does this sound right to you guys? I've seen them do this on multiple occasions.