Doctor vs Nurse - page 4

I work in a nsg skilled facility and rehab at the same time. Our medical director always orders continue to monitor when I report something to him. One time I reported an extremely high blood glucose... Read More

  1. Visit  BrandonLPN profile page
    6
    Quote from VICEDRN
    Will chime in as a emergency room nurse. Please do not send your hospice patient with s/s of flu to us. We won't treat flu but when we draw labs and find all manner of other things, we will treat those. This will hasten the patients deathand ultimately cause them to die in the hospital which they don't want. Please do not do this. Otoh, if you and every one else hears wheezing on a non hospice patient, call 911. That's not acceptable.
    Am I misunderstanding, or are you really saying we should call 911 on all full code residents who have audible wheezing? That's one way to clear out my hallway fast!
    Altra, Nascar nurse, wooh, and 3 others like this.
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  3. Visit  anne919 profile page
    0
    As much as I want to call 911, my hands are tied with sending the resident out cause we do have a policy that the md should give an order first before sending the patient out. hence the md ordered cxr. I know it is unethical and unlawful.

    As a novice nurse i carried out the md's order. hoping the resident will be fine. Until now I am monitoring the resident. Maybe the md will actually visit the resident when he goes to the facility for which he do not do.
  4. Visit  anne919 profile page
    0
    Quote from brittne

    When a patient usually is 'fighting for her life' or improving, doesn't that mean they usually go off hospice care? Honest question...no sarcasm attached.
    That is what I dont really get. I need to study more in depth about hospice for it is confusing for me.
  5. Visit  BrandonLPN profile page
    1
    Calling 911 in LTC is an extreme step. It's for emergencies. As in a code. I've coded a resident twice in my career so far and that's also the number of times I've told the CNA to call 911. How is your resident now? Did the wheeziness resolve? If the situation was such that you felt calling 911 was indicated, then why did the resident deny any distress. Is she demented? In my experience, if she was really in acute, dire distress she would have been pretty panicky. I still feel like I don't understand what was going on with this pt.
    SionainnRN likes this.
  6. Visit  anne919 profile page
    0
    As described by the resident's daughter, the resident does not complain or say anything. The resident tend to keep everything on her own.

    Last month I saw the resident grimacing appearing as if in agony of pain. I assessed the resident but the resident denies anything.

    Maybe if the resident was not wheezing audibly we would not treated her and she would have been discharge.
  7. Visit  CapeCodMermaid profile page
    2
    We can treat wheezes in long term care. A wheeze in and of itself is not a reason to send someone out 911.This discussion makes me appreciate MY medical director even more. He is polite, listens to the nurses, and is quite reasonable when ordering (or not ordering) interventions.
    wooh and Anna Flaxis like this.
  8. Visit  anne919 profile page
    0
    This is the first time I had seen a doctor who does not order labs or xray or other exams. All he ever order is continue to monitor the patient.
  9. Visit  BrandonLPN profile page
    3
    I thought he ordered a CXR and ABX....
    wooh, psu_213, and SionainnRN like this.
  10. Visit  anne919 profile page
    0
    He ordered that cxr and abt after I told him that I really think and the other nurse-happens to be the resident's daughter- thinks the resident should be sent out to the hospital.

    We have a low census and that doctor is running out of residents in the facility because the resident asks for another md to tend to them since he does not even visit them. He gives new medication to the resident without seeing them, no labs to confer it to. The residents asked for discharged because of his actions.

    Sorry if I did not fully describe the circumstances here for I am so tired from work thinking and trying to keep the residents alive and satisfied with their care since they do not like how the md works for them.
  11. Visit  SionainnRN profile page
    3
    Quote from anne919
    As much as I want to call 911, my hands are tied with sending the resident out cause we do have a policy that the md should give an order first before sending the patient out. hence the md ordered cxr. I know it is unethical and unlawful.

    As a novice nurse i carried out the md's order. hoping the resident will be fine. Until now I am monitoring the resident. Maybe the md will actually visit the resident when he goes to the facility for which he do not do.
    Why in the world would you call 911 for wheezes??? As another ED RN that is an extreme reaction. Your patient has wheezes and poss pneumonia on an CXR, and guess what? The MD started abx and breathing treatments and O2. What in the world do you think we could do that isn't being done? The only reason to call 911 in this case is if the pt couldn't maintain their O2 sats and was going into resp distress. Otherwise give the abx some time to start working, geez.
    And this is in NO WAY unethical or unlawful. It seems to me you have your panties in a bunch about the doctor and are trying to find anything you can to make them look bad.
    BrnEyedGirl, ♪♫ in my ♥, and wooh like this.
  12. Visit  anne919 profile page
    0
    Initially he did not order abt neither cxr. His only order was monitor the pt. He would not o rder anthing besides monitor.
  13. Visit  SionainnRN profile page
    2
    Quote from anne919
    Initially he did not order abt neither cxr. His only order was monitor the pt. He would not o rder anthing besides monitor.
    But he DID order a chest xray and antibiotics. I don't know about anyone else but not only am I having a hard time following your posts, but to me it's just coming off like you have it out for this doc. You work in tertiary care, the md is ordering appropriate care, you are trying to make him/her out to be unethical and not only that, you are not a doctor yet you continue to diagnose pts and LIE about your assessments. I get that it's hard not to be defensive, but you really need to look at your actions here.
    ♪♫ in my ♥ and wooh like this.
  14. Visit  anne919 profile page
    0
    Maybe it is just really hard to explain the scenarios. He only order to monitor the patient in most of the cases not just this one.

    To make the story short to fully describe this is that most of the old nurses in the facility are the ones who orders their lab without the md order. I know that is malpractice.

    I dont medically diagnose my patient. Nurses do have nursing diagnosis based on signs and symptoms.

    Maybe the thread had become so inconsistent with the time frame im so sorry.

    First off, the patient had audible wheeze. Auscultated the pt learned that the resident has inspiratory and expiratory wheezing. Use of acessory muscle but denies everything. States that wheezing is nothing. Patient daughter asked for re-assessment from md because the resident is to be discharged for the next day.

    I called the md. Described how the resident was. His order was just keep on monitoring the patient. He hanged up on the phone cause he is with another patient. Gave the md some time to call back for clarification. Told him again that the resident exhibits inspiratory and expiratory wheezing and the daughter thinks its best to send out the resident. Then now the md ordered cxr abt
    Last edit by anne919 on Dec 29, '12


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