Sending People to the Hospital

[addylpn]

I work at a privately owned ALF, recently several nurses were reprimanded for sending residents to the hospital because of low census. Management has put the guilt trip on the nurses and have threatened to fire if it continues. All of the reasons were legitimate reasons or the family had insisted they go out. Isn't it our job to protect these people? If we try to treat the resident at the facility but no progress is made, wouldn't it be considered negligent not to send them out for the appropriate treatment?

[RNlove17]

it scares me that nurses are threatened with firing for providing safe nursing care...

[Been there,done that, ASN, RN]

Privately owned being the problem here.

Hopefully, you have a policy that covers this. It should include a doctor's order to do so.

Document, document, document ... and make yourself a copy.

If the residents are not medically stable in the ALF setting, it is your duty to seek appropriate level of care.

May also be your duty to report attempts to prevent it.

All of the nurses need to be on the same page with this and remember...

The best defense is a good offense.

[addylpn]

Yes, we are required to inform the Dr. Of all the info gathered and get an order to send out...

[Been there,done that, ASN, RN]

Yes, we are required to inform the Dr. Of all the info gathered and get an order to send out...

Then you are covered under the doctor's order.

Is the facility also attempting to bully the doctor?

I am thinking this is huge. Whatever way it works out, you need to protect yourself.

Start with seeking employment elsewhere.

[addylpn]

Yes, the administrater has complained to Dr. over her decision to have the residents evaluated. Has even started shopping for a new house Dr. to accomodate...pretty sad. Sometimes when the social workers at the hospitals suggest skilled nursing facilities to the family, the DON jumps in like a vulture, assuring them we are still capable to give the care even when we are not. All they care about is keeping census high so that the money keeps flowing in. I think you are right, need to start updating my resume!

[TheCommuter, BSN, RN]

Healthcare is big business (unfortunately). So when a nurse has a patient transported to a local hospital ER for evaluation, the administrator is griping about that bill for the $900 ambulance ride. The DON is griping about one or two less heads in the beds when census is tallied up at midnight.

It's not right, but it is what it is. The ALF doesn't get paid if heads are not in the corresponding beds when midnight strikes.

[SleeepyRN]

Then you are covered under the doctor's order.

Is the facility also attempting to bully the doctor?

I am thinking this is huge. Whatever way it works out, you need to protect yourself.

Start with seeking employment elsewhere.

EXACTLY. You got a doctor's order. Does your facility honestly expect you to disobey physician orders? This sounds ludicrous to me.

[jadelpn, LPN, EMT-B]

Hmmm...and I am willing to bet that the administrator is not a licensed nurse. Which of COURSE means that if a patient has a change in condition that warrants a trip to the ER and the licesned nurse chooses to ignore it on the say so of the administrator, then this is now on the licensed nurse. And the administrator can spin whatever story possible to the family--but one thing is certain, it will "never" be the adminstrator's fault.

Cover yourself always.

[NurseQT]

You are definitely in a lose:lose situation at this facility... You can either follow your nursing judgement, MD orders, and/or family/resident wishes to send the patient out and risk disciplinary action (a very unjust disciplinary action I might add) or go against your nursing judgement, MD orders, ect and risk the resident's health and well being and possibly an investigation from state.... I would get outta there fast!!!

[addylpn]

Yes, I want to protect both the patient and my own license. You are right, the administrater is not an LPN so is at no risk! All the responsibility will fall back on the nurses. I was taught in school to protect my license because a facility would have no problems throwing me under the bus if a potential lawsuit would occur. Time to move on!!!

[MedChica]

If someone needs to go out? They need to go out.

I'd just quit.