Doctor vs Nurse

Nurses Safety

Published

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 level of our hospice pt.he just told me what should he do since she's hospice! As much as I want to talk back on him that we should still treat the resident even if they are hospice I only suggested to increase her insulin. And as soon as I got the order I hung up on him.

Yesterday, I learned from my co-workers that he was infuriated that I logged a pt condition and stating the pt med that might have had a side effect.

I also wrote down that a couple of pt was having early s/sx of flu.

Oh yeah, one of our resident also has an incredibly audible wheezing inspiratory and expiratory but he doesnt want the resident be on a hospital so he ordered a stat cxr. The patient has an atelectasis. He ordered an antibiotic med. My gut feeling is telling me to send that resident into the hospital but I cannot make him give me an approval to send her out.

How can I speak with my DON about this matter?

Yes for the flu. What I documented was runny nose, febrile and muscle aches.

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Specializes in ER.

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 death and 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.

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Yes for the flu. What I documented was runny nose, febrile and muscle aches.
Ok, fair enough. I think many of us were under the impression you simply charted "pt presents with flu symptoms" or something. Even if you do list the actual symptoms, you should still never chart a phrase stating "pt has the flu" or "pt has a bowel obstruction". Just don't do it. That's diagnosing, never looks good in a nurses note....
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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!
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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.

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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.

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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.

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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.

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Specializes in Gerontology, Med surg, Home Health.

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.

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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.

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I thought he ordered a CXR and ABX....

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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.

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