I work at a LTC facility in Ohio on the night shift, and I recently have had several run-ins with the DON about her new rules. I've been working there for over a year and a half, and had never been corrected before about my charting or my nursing decisions, but now this new DON is enacting some new policies I feel are not only neglegent, but also over-step her authority. I am looking for some insight before I inform her that I need to have a sit down discussion about her rules and the way I feel I am being treated.
The first incident happened the weekend before last, when a nurse who was supposed to have charge of a floor with 38 patients, called and QUIT 25 minutes into her shift. I called the DON (she was "on call") to ask what her plan was. She said I would need to take another set of keys and another floor as well as the floor I was already assigned to. She said she COULDN'T come in because she was 600 miles away in another state. Again, the next night, I had to do the SAME thing because she was still there and NO ONE was found for the other unit in 24 hours when she was already aware of the fact that the nurse was scheduled for Sat and Sun. On Mon morning she pulled me into her office, claimed that a patient heard me say, "don't come to me unless you're dead or dying" (something I would NEVER say), and that she SHOULD write me up, but that she didn't want to get off on an adversarial footing with me. I told her I would NEVER say anything like that, and I refuted the claim. She accepted that, but said that there may be times I have to take two units (I THOUGHT there was a ratio that was illegal and that I did NOT have to accept the responsibility of another unit I was not assigned to. It is also common practice that a unit manager be called in at those times. At least that was how it used to be BEFORE she became DON).
The second incident REALLY angered me on many levels, but I felt as if I were being bullied and could not do anything about it. She enacted this new rule that all nurses had to notify HER before calling the physician to have a patient sent out to the hospital. I had an elderly female patient who I already knew was positive for UTI, who had a DRAMATIC change in physical and mental status (she can usually ambulate to the toilet, but lacked the strength to take one step; she can usually speak intellgibly and with appropriate content, but I could not understand anything she tried to communicate). I called the DON, as she requested, and she said, "No. We don't send people out to the hospital for acting funny." and suggested I get lab work that would take days to get back, and even said, "I wouldn't call TONIGHT, though". So I called for the labwork and CXR anyway, and charted that I had notified her (including her name), wrote the incident report because the patient was lowered to the floor due to weakness, and reported to the dayshift nurse about her condition. The day shift nurse ALSO thought she needed to be sent out, but was also intimidated by the DON. The next day I worked, the DON stated, "Don't chart my name in the chart. You can chart 'oncall RN', or 'DON', but we don't use other people's names in our charting".
So my questions are: CAN I refuse to take on another unit if I don't feel I can safely manage them all? I know I can ignore her and call the physician and have a patient sent out anyway, but can she legally reprimand me for that? Can she really even tell me NOT to send her out? Can she make herself physically unavailable in the event that she is needed in the facility when she is oncall?
I feel like she is taking liberties with my license that I do not accept. I KNOW she doesn't want anyone sent out because she wants to keep the census up. And I definitely know she made up that stuff about a patient overhearing me say not to bother me to try to intimidate me into doing whatever she says, and that her patronizing tones and speech are a form of verbal/emotional abuse. But what are my options? Am I just going to make an already hostile situation worse?