Vent thread... when to send a pt out - page 2

by pppp87

6,935 Views | 29 Comments

I've been at an LTC facility for 3 months now. One thing is clear at my facility: take caution before sending residents out to the hospital. I was always taught as far as LTC goes, especially as a newer nurse, "when in doubt,... Read More


  1. 6
    A breathing treatment? With those s/s? Really?! To echo the sentiments of all who have posted, you did a great job!!!

    And tell the DON to go ahead and put a bandaid on an arterial bleed while she's at it...
    LTCNS, michelle126, al586, and 3 others like this.
  2. 3
    I say, pat yourself on the back for providing a proper nursing assessment and taking action in advocacy for your patient.

    Consider your DONs comments as "educational" but having little relevance to the situation you described.
    Readmits are a huge problem, but not all can be prevented.
    LTCNS, IowaKaren, and Nascar nurse like this.
  3. 3
    Sounds like your DON is going to find herself in some pretty hot water eventually. With an attitude like that, something's going to come back and bite her in the butt.
    LTCNS, Kooky Korky, and cp1024 like this.
  4. 0
    Quote from ktwlpn
    DNH does not mean do not treat.
    The nurse acted appropriatly IMHO-she reported her findings to the physician and he gave the order to send her out.
    This was in reference to the 101 lady who was kept comfortable at the facility not the OP (as indicated by my quotes of the previous post.) DNH means do not hospitalize and palliative patients will often, but not always, have this order.
  5. 2
    You did a fantanstic Job! I've worked LTC and ICU and I would have done the same thing. Any change in mental status that is not baseline and has a new onset audits a trip to the ED IMO.

    PCU will be great for you!
    LTCNS and T-Bird78 like this.
  6. 0
    My old DON used to blame me for sending residents out for "no reason" I'd always send them out when in doubt. Sometimes they would come back right away and sometimes they'll be admitted to ICU or the floor. However, can never be too cautious.
  7. 0
    Just want to say that you rocked that one! I wouldn't administer neb tx without an order, especially if there was no reason to.
  8. 3
    I get sass from our ED all the time. They see an old person at the jumping off point who's having old-person problems and think it's a waste of their time and skills. Not saying it's all EDs, just the one we use. I think they're super burned out on drug seekers and people using the ED for primary care, that unless you're spurting blood from some hole in your body, they'll roll their eyes and point to the waiting room. I've had nurse-friends who worked in the ED say as much.

    Anyway, you did fine. Pay lip service to your DON. Her job is to watch the bottom line. "Yes, DON, I'll remember that for next time. But this is the reason why blah blah blah. I didn't want their family to call the state on us!" Mention "The State" and your DON will be quiet. Same with giving meds without orders. Mention that it's illegal. What's she going to say? "So, I know it's illegal, do it anyway?" Probably not. If she does, RUN.
    al586, IowaKaren, and WhereIsMyCallBell like this.
  9. 0
    Quote from pppp87
    my don actually encourages us to give meds without an md order. she criticized a new nurse, asking her what she would do in an emergency if she wasn't able to get an md. her expectations are that we act first and get an md order later.
    Huh?? On AN there are all sorts of things for which nurses think they can lose their license. Well, practicing medicine without a medical license is something for which you can actually lose your license. Chart your attempts to try to contact the doctor--be specific: when you called, how you tried to reach him/her (answering service, cell phone, etc.). But don't just give a med and look for an order later. If it is a bad outcome, there is a good chance the doctor and your DON will hang you out in the wind.
  10. 0
    Another OH SO FAMILIAR vent. You did YOUR best, you went to another "more experienced nurse" for an opinion, then advocated for your patient. You did exactly what was right for the situation. I have been a LTC RN for going on 7 years now. We nurses who see these patients and interact with them WAY MORE than any hospital nurse; sometimes we must stand our ground!! You will learn as you go. You will develope a keen instinct. Before you know it you will know without a shadow of doubt. Just when to use your nursing "judgement", assessment and clinical skills in order to be able to stablize your patient and when HOLY CRAP Ms. Debbie D. Patient is a code status CPR, call the ambulance stat! For the most part, I am sure the DON does not mean anything personaly towards you. She is just doing her job. Heads in the beds = job security. Also the longer you work there the more Admin. will trust you. There are ALOT of nurses who seem to loose their head and want to send, send, SEND 'em out before trying other options first (in appropeiate situations). I have been in your shoes, seems like yesterday. You are gonna be just fine. Just don't take it personal! Of course your DON wants what is best for your patient, but is also heavily involved with the business end of the facility too. Best of luck to you always


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