My day off...Im the MD for the day?

Where I work, if another nurse sees one of my patients, she would call the doctor and then call me with report. Altho I have felt like I don't get a day off, this week I was too sick to work, but still answered calls from doctors, and other nurses. It's just a part of the job. You are right about the doctor should be the one to know what to do, but it is our responsibility as nurses to question a bad order as you did. You didn't say if those 3 patients that weren't home were medicare or not, but if so, and they were not at the doctor, I would have to question homebound status. Are you saying you are going on your day off to see these 3 patients that didn't get seen? You deserve a day off, and if you are off, then you shouldn't go out to see patients, that is the job of the scheduler to make sure they are covered on your day off, at least at my agency it is. We all get burnt out at times, but I love the flexibility of the job. I have done home care on and off for over 20 years for the same company (different states tho) and I always come back to home care. It sounds as tho you are getting burnt out, maybe a break from home care would be beneficial.

I most likely would not have taken my day off to go see those patients. It is hard to really say, not knowing the circimstances of the patients and rules of the agency. If they couldn't have been seen the day the were suppose to be seen (again you didn't say if they were medicare or not, or if they had Doctor's appointments or not). I would question homebound status. We all have days off for a reason, and productivity or pars for a reason, so as not to get burnt out and all stressed out for example. I would guess by what you said, you were stressed all day, and upset because you had to work on your day off. Do you (or any of us, not picking on you personally) give the best care when you are stressed, or upset because you are working on your day off. We all deserve to have our days off just like the next nurse so why did you have to go on your day off to see those 3 patients? Is this common pratice for this agency? Is this common practice for you? Could it not have been done the next day you worked or by someone else? Why did you pick up a SOC and 2 other visits? Is getting paid really well worth the stress of that whole day (regardless of the economy at this time, health is much more important, because if you are not healthy physically and/or mentally what good are you to your patients)? Working from early morning to 9:30 pm then coming home and doing charting until midnight is not healthy for anyone to do especially already all stressed out. Are you the type of person that just can't say no? If so then you may want to find another field of nursing to work in. Home health will always take advantage of you if you can't say no. I know for a fact that they will let you see 10 patients a day, if you agree to it. Once you agree you are stuck doing the visits then. I love doing home health but I also have learned to say no.

Also back to the order for the Coumadin was this a PCP, coumadin clinic Cardiiologist? Maybe it is someone unfamiliar with coumadin and dosing? I would question if that came from the Doctor or the staff (some coumadin clinics have protocols they go by allowing the nurse to adjust dose looking at the protocol.I know depending on the patient, why they are taking the coumadin some doctors want INR between 2-3, some 2.5-3.5. I have not heard of increasing Coumadin with an INR of 4.6. Not knowing the circumstances I guess it is hard to know for sure what that Doctor was thinking. I would almost wonder if they heard you correctly the first time and if so, I think I would be very scared taking orders from this Doctor.

When enough was enough for me, I cut back with my agency. When enough got out of hand, and I should have been in the hospital, I stopped working altogether, and how surprising, I wasn't even missed. The trick is to figure out when enough is headed toward too much, and pull the plug before you do end up in the hospital. Chances are very high that there will be no visitors from your employer at the hospital or the morgue either.

Unfortunately very, very true. Like I said, if you say yes they will let you see 10 patients a day, which is not a normal patient load in home health. In Phoenix, when I ended up with sky high BP and another BP med, I told them I had to cut back on productivity, and I learned to say NO!! There will usually be someone to fill your spot when you quit, so usually you aren't missed. You have to know when enough is enough, and when to say hell no. It's not worth your life, your patients life, or your license.